Dental care and associated factors among older adults with schizophrenia

The Relationship between Oral Health and Schizophrenia in Advanced Age-A Narrative Review in the Context of the Current Literature

Schizophrenia is a psychiatric disorder that makes patients incompetent to perform day-to-day activities due to their progressing mental illness. In addition to disturbances with thoughts, behavioral changes, and impaired cognitive functions, oro-systemic health also becomes compromised. Even though the population with schizophrenia is primarily made up of older people, little is known about this group's oral health treatment. The present review explores the relationship between oral healthcare and elderly patients with schizophrenia. Our literature search included databases, like PubMed, Embase, and Google Scholar, for appropriate and evidence-based information. Preventive and management strategies outlined in the included articles and future research perspectives in this field are discussed. To the best of our knowledge, this is the first review that looked at dental care and related characteristics in older schizophrenia patients. The findings highlight the necessity for targeted dental interventions to address the dental health challenges faced by this vulnerable population. Integrating dental health into the overall medical management of elderly individuals with schizophrenia is crucial. Although specific therapies remain limited, the emphasis is on preventive dentistry to reduce the occurrence and progression of oral diseases in this group.

Oral hygiene status and factors related to oral health in hospitalized patients with schizophrenia

OBJECTIVE

This study aimed to elucidate the oral hygiene status and the factors associated with poor oral hygiene among patients with schizophrenia.

METHODS

The relationships of oral hygiene status (calculus index [CI], debris index [DI]), the mean number of decayed-missing-filled teeth (mean DMFT), and Revised Oral Assessment Guide (ROAG) with related factors (hospitalization, chlorpromazine equivalents [CPZE], age, Barthel Index [BI], frequency of cleaning teeth, and self-oral hygiene ability) among 249 hospitalized schizophrenic patients were investigated.

RESULTS

The results for oral hygiene status were as follows: median (range); CI 0.5 (0-6.0), DI 1.7 (0-6.0), ROAG 10.0 (7.0-15.0); and mean DMFT 21.7±7.3. The average CPZE was 524.4±353.6 mg (mean ± SD), and the BI was 76.4±30.7. There was a negative correlation between BI and DI (r = -0.34) and a positive correlation between age and mean DMFT (r=0.57). Male patients tended to have worse oral conditions (ROAG) than females. The least-squares multiple regression analysis revealed that BI for DI, age for mean DMFT, sex for ROAG, and self-oral hygiene ability for CI, DI, and mean DMFT were factors related to oral health status.

CONCLUSION

Patients with schizophrenia tended to have poor oral hygiene. BI, being male, and low activities of daily living were associated with poor oral hygiene. Furthermore, advanced age was associated with an increased risk of dental caries.

An examination of predisposing and enabling factors that predict dental utilization among individuals with serious mental illness in Detroit, Michigan

OBJECTIVES

This study evaluated which predisposing and enabling factors prospectively predicted dental utilization over 6 months among people with serious mental illness.

METHODS

A sample of individuals with serious mental illness (86.3% African American; 97.4% with public health insurance) was recruited from community mental health centres in Detroit, Michigan, and responded to questionnaires at baseline and at least one follow-up visit at 3 or 6 months (N = 190). Baseline assessments included demographic and clinical information, established measures of health literacy, health insurance literacy, stigma related to mental illness, experiences of racial discrimination and medical mistrust. Insurance coverage for dental care and the availability of dental services at the participants' mental health centres was recorded. At follow-up visits, participants reported healthcare utilization, including dental and primary care, since baseline.

RESULTS

Three factors emerged as meaningful predictors of having a dental visit in bivariate and multivariate analyses: more medical comorbidities and dental care co-located with mental health care predicted increased likelihood of a dental visit, whereas having experienced racial discrimination in a medical setting predicted lower odds of having a dental visit in the follow-up period. Co-location of dental care with mental health care was the strongest predictor of having a dental visit.

CONCLUSIONS

Co-locating dental care with mental health care may increase dental utilization among people with serious mental illness, possibly by mitigating known barriers to dental care for this population. Among African Americans, the co-location of dental care with mental health care may also attenuate the negative effect of prior racial discrimination in a medical setting on dental utilization.

Oral health status of hospitalised patients with mental disorders: Systematic review of the literature

According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. The aim was to carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD). A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017. According to the different filters that were applied, 14 articles describing the oral health status were obtained-through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)-of hospitalised patients with MD. The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis

AIM

To understand the relationship between serious mental illness and oral health self-care behaviours using meta-analytic methods and a narrative synthesis of available literature.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines [PROSPERO reference: CRD42020176779]. Search terms pertaining to serious mental illness and oral health were entered into EMBASE, PsycINFO, Medline and CINAHL. Eligible studies included a sample of people with a serious mental illness and a quantitative measure of an oral health self-care behaviour (eg dental visits, toothbrushing). The Effective Public Health Practice Project tool was utilised to appraise the quality of the literature. Studies in the meta-analysis contained a non-clinical or general population comparator sample.

RESULTS

People with a serious mental illness were significantly less likely to visit the dentist (OR 0.46, 95% CI 0.32-0.065, p > 0.001) or brush their teeth (OR 0.19, 95% CI 0.08-0.42, p < 0.001) when compared to non-clinical comparator samples. Few studies explored other oral health self-care behaviours (eg flossing and mouth washing), but uptake was generally low in people with a serious mental illness. The study quality of included studies was variable.

CONCLUSIONS

The research showed a reduced uptake of oral health self-care behaviours in people with a serious mental illness. Suboptimal oral health can negatively impact on physical, social and psychological functioning. Further research is needed to understand the reasons for low rates of oral health self-care behaviours in this population.

The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study

People with a diagnosis of serious mental illness (SMI) have a greater incidence of poorer oral health as compared to the general population. The aim of this quasi-experimental study was to determine the effect that a combination of the use of a battery-operated toothbrush and a related educational intervention may have on the oral health of individuals with serious mental illness. Key findings include that the battery-operated toothbrush resulted in a significant improvement in the mean change in gingival index, a common indicator of oral health. The study also found that oral home care instructions, smoking and level of negative symptoms did not have an effect on the mean change in plaque or gingival indices. This project suggests that the implementation of a relatively simple, cost effective measures such as a battery-operated toothbrush may have a positive impact on the oral health in this population.

Oral Health Status of Hospitalised Patients with Mental Disorders: Systematic Review of the Literature

BACKGROUND

According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care.

AIM

To carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD).

MATERIALS AND METHODS

A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017 RESULTS: According to the different filters that were applied, 14 articles describing the oral health status were obtained - through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)- of hospitalised patients with MD.

CONCLUSIONS

The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Dental Implants: A Remote Option in Case of Somatic Delusion Disorder

A 29-year-old female was referred by a psychiatrist for dental implantation and prosthodontic rehabilitation, as she had all her healthy permanent teeth extracted within a span of 2–6 months, due to somatic delusional disorder. She presently refuses artificial dentures and implants with the fear of having worms in her teeth and the fear not yet allayed. The patient cannot be treated for her edentulous state until her psychiatric symptoms are treated. This is the limitation for the implant surgeon where service rendered is impaired in spite of advanced professional skills, ideal patient ridge, and other factors, just where the patient is not mentally prepared for the dental rehabilitation procedures.

Effects of an educational intervention on oral hygiene and self-care among people with mental illness in Japan: a longitudinal study

Background

The oral hygiene of patients with a mental illness is an important concern in psychiatric care, and it is necessary to increase the level of self-care among these patients. In this study, we administered an oral care questionnaire to people with mental illness in Japan and compared their answers before (baseline) and at 1 week and 1, 3 and 6 months after they participated in an educational program.

Methods

The questionnaire was distributed to 390 patients. It included questions about age, education, income, between-meal snacks, number of teeth, frequency of tooth brushing, and other items. The educational program was developed for the purposes of improving self-care.

Results

Before the program, the proportion of male patients who had had a mental illness for ≥ 10 years was significantly higher among those patients who did not brush their teeth before bed. In addition, such patients did not have primary care dentists, and a significantly higher proportion of male patients, compared with female patients, did not undergo routine dental checkups more than once per year. The educational program resulted in an improvement in the use of fluoride toothpaste from baseline to 6 months after the intervention (p = 0.001). The daily use of interdental brushes or floss was significantly different 6 months after the intervention.

Conclusions

Male and long-term inpatients need oral hygiene instructions. Our educational program showed the effects of using oral hygiene tools. Future studies should include a control group to measure the impact of the educational program.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0372-7) contains supplementary material, which is available to authorized users.

Severity of illness and extra pyramidal symptoms as predictors for oral diseases among patients with schizophrenia

OBJECTIVE

The study explores the association between severity of illness (positive, negative, depressive and cognitive symptoms) and extra pyramidal symptoms (EPS) with dental caries, periodontal disease and prosthetic needs among patients with schizophrenia.

MATERIAL AND METHODS

A total of 71 schizophrenic patients diagnosed based on ICD-10 criteria participated in the study. Clinical Global Impression - Schizophrenia (CGI-SCH) scale was used to evaluate positive, negative, depressive, cognitive symptoms and overall severity of schizophrenia. Simpson-Angus Scale (SAS) was used for assessment of EPS. Dental examinations were conducted as per WHO (1997) criterion.

RESULTS

Mean DMFT and CPI scores with periodontal pockets were 5.57 ± 2.12 and 2.37 ± 0.74; significant differences being noted among those with and without EPS (p < 0.001). Positive and EPS associated with dental caries with odds ratio of 5.26 (1.05, 26.2) and 8.52 (2.31, 31.4) (p < 0.001). Depressive and EPS were associated with periodontal disease with odds ratio of 4.19 (1.53, 32.5) and 5.27 (1.29, 21.5), respectively (p < 0.001). Cognitive and EPS were associated with dental prosthetic needs with odds ratio of 4.33 (1.47, 31.2) (p < 0.001) and 7.78 (1.43, 42.2), respectively (p < 0.001).

CONCLUSIONS

Patients with schizophrenia had high dental caries, periodontal disease and unmet dental prosthetic needs. Severity of the schizophrenic and EPS was associated with poor oral health. Efforts need to be focused on strengthening the evidence of its association with oral health indicators through further studies including cohort investigations.

Barriers and enablers for oral health care for people affected by mental health disorders

BACKGROUND

People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies.

RESULTS

The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions.

CONCLUSIONS

Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Dental caries status of patients with schizophrenia in Seville, Spain: a case-control study

BACKGROUND

The aim of this study was to assess the dental status (DMFT) in patients with schizophrenia compared with a control group.

MATERIAL

In this case-control study, 50 patients with schizophrenia attended in the Psychiatric Unit at the Virgen Macarena University Hospital of Seville were compared with 50 people (without systemic diseases and not taking psychotropic drugs) in a control group attended in the School of Dentistry of Seville. Decayed, missing and filled teeth (DMFT) were assessed according to the World Health Organization WHO criteria.

RESULTS

Patients with schizophrenia showed a decayed teeth (DT) score of 7.26 ± 5.69 compared with 6.50 ± 4.37 for patients the control group. These differences were significant and suggest that dental caries are most prevalent in patients with schizophrenia. People who smoked showed significantly higher DT scores in both groups. Among patients with schizophrenia, smokers scored 9.34 ± 5.42 compared with 4.38 ± 4.82 for non-smokers. Among the healthy controls, smokers scored 6.88 ± 4.85 compared with 6.12 ± 3.85 for non-smokers (p < 0.05). Patients with schizophrenia showed a missing teeth (MT) score of 9.10 ± 8.56 compared with 5.38 ± 5.14 in control patients. MT scores increased significantly with age and with smoking in both groups of patients (p < 0.05). Patients with schizophrenia showed a filled teeth (FT) score of 1.38 ± 2.70 compared with 2.34 ± 3.48 in control patients. FT differences in gender and smoking habits between patients with schizophrenia and healthy control subjects were statistically significant (p < 0.05). This data, along with the DT scores, suggests that patients with schizophrenia have extensive untreated dental disease.

CONCLUSIONS

Patients with schizophrenia constitute a high risk population for dental health. This group showed a greater prevalence of decayed and missing teeth and more extensive treatment needs.

Utilization of dental care among patients with severe mental illness: a study of a National Health Insurance database

Background

The oral health of patients with severe mental illness is poor, in general, and this may be attributed, in part, to inadequate dental care. This study investigated dental care utilization among patients with severe mental illness using a national representative sample.

Methods

This study used Taiwan’s National Health Insurance Research Dataset for 2009. Patients with the diagnosis of severe mental illness (ICD-9-CM: 290–298) were recruited as the study sample, and others comprised the control. Any visit to a dentist was defined as positive in terms of dental care utilization. Regression analyses were applied to determine the odds of dental care utilization for each diagnostic entity of severe mental illness, compared with the general population and controlling for potential covariates.

Results

Only 40 % of 19,609 patients with severe mental illness visited the dentist within 12 months. This was significantly lower than the dental visit rate of 48.3 % for the control population (odds ratio [OR] = .72, 95 % confidence interval [CI] = .69–.74; P <0.0001). The odds of dental care utilization differed among the severe mental illness diagnostic categories; e.g., the odds were lowest among those with alcohol psychoses (OR = .54, CI = .43–.68), senile dementia (OR = .55, CI = .52–.59) and other organic psychoses (OR = .58, CI = .52–.65), and highest among those with mood disorder (OR = .89, CI = .85–.94), with schizophrenic patients occupying a mid-level position (OR = .63, CI = .59–.67).

Conclusions

Patients with severe mental illness received less dental care than the general population. Health care providers and caregivers of patients with severe mental illness should encourage them to visit the dentist regularly, in order to improve the oral health of these vulnerable patient groups.

Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study

OBJECTIVES

Individuals with mental illness face an increased risk of oral disease compared with those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filling psychotropic medication prescriptions and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so.

DESIGN

Pharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization.

SETTING

Six community pharmacy locations.

PARTICIPANTS

Adults (≥18 years of age) filling prescriptions for psychotropic medications.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Self-reported oral health, dental utilization, desire to discuss oral health with a pharmacist.

RESULTS

Participants (N = 178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (SD 14.3, range 19-82 years). One in 4 (24.9%) said their mouths "always" or "frequently" felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (P <0.01) and rated their oral health as significantly worse (P <0.001) than participants whose mouths "never" or "occasionally" feel dry. A small percentage (5.7%) requested to speak with pharmacists about oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (P <0.05).

CONCLUSION

One in 4 patients reported having dry mouth, and those with dry mouth reported significantly worse oral health than patients without dry mouth. Although dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into seeking information regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients.

Oral health in adults with serious mental illness: needs for and perspectives on care

This study used qualitative methods to investigate barriers to and facilitators of oral health care among 25 adult community mental health outpatients with serious mental illness (SMI). Participants completed 30- to 60-min, semi-structured interviews that were recorded and transcribed. Qualitative analysis was used to characterize common themes. Results showed that lack of awareness of dental problems, poverty, and dental care access were key barriers to oral health care. When oral health care was accessed, fear of stigma was associated with missed opportunities to educate about the intersection of mental and oral health. Community mental health providers were viewed as trusted and important sources of advocacy and support for obtaining oral health care when needed. Oral health may be improved for persons with SMI by implementing education in points of frequent service contact, such as community mental health.

Clinical preventive service use disparities among subgroups of people with disabilities: A scoping review

BACKGROUND

Recommended use of clinical preventive services (CPS) reduces morbidity and mortality from preventable conditions. Disparities in CPS utilization between individuals with and without disabilities have been shown, but a greater understanding of the disability subpopulations with lowest utilization is needed to better inform research, policy, and practice.

OBJECTIVE

The objective was to conduct a scoping review of the literature to identify relevant studies on disparities in receipt of CPS among subgroups of individuals with disabilities.

METHODS

In July 2010, electronic and manual literature searches were conducted for years 2000-2009. Review for inclusion/exclusion and data analysis occurred in 2010 and 2011. In 2012, the review was updated to cover abstracts published in 2010 and 2011. Identified abstracts, and then full-text articles of included abstracts, were reviewed according to inclusion/exclusion criteria by multiple reviewers. For articles meeting all criteria, two reviewers performed independent data extraction. A gap analysis was performed to identify areas of concentration and gaps in the literature.

RESULTS

Twenty-seven articles met inclusion criteria for this review. Studies varied substantially in sample composition and research methods. CPS examined most often were cervical cancer screening (14 studies) and mammography (13 studies). Potential disparity factors studied most often were disability factors (i.e., disabling condition in 12 studies, disability severity in 10 studies). Stratification of CPS by disparity factors revealed substantial gaps in the literature.

CONCLUSIONS

The literature gaps point to a need for high quality research on access disparities among subgroups of individuals with disabilities.

Impact of mental health problems on self-perceived oral health needs in a Medicaid population

The purpose of this study was to examine the prevalence of self-perceived oral health needs among Medicaid-enrolled adults with and without mental health problems and to identify factors predictive of enrollees' perceived oral health needs. The study involved a secondary analysis of 1,721 respondents to the Florida Health Services Survey. Contrary to the previous research, the findings from this study indicated that respondents with mental health problems (52.9%) did not differ significantly in their dental needs compared to those who did not have mental health problems (49.3%). The results from a logistic regression suggested that after controlling for demographic characteristics, substance abuse problems and functional needs increased the likelihood of self-reported oral health needs, whereas the receipt of Supplemental Security Income (SSI) was associated with decreased dental needs. The prevalence of unmet dental needs among these respondents (i.e., 23%) supported the conclusion that a significant gap exists in the accessibility of oral health services among this population.

Prevalence of bucco-dental pathologies in patients with psychiatric disorders

Introduction: Oral diseases in psychiatric patients are usually a result of bad oral hygiene and psychopharmaceutical side-effects. Objective: The aim of this study was to detect the most prevalent oral lesions in patients hospitalized in a psychiatric institution in Caracas, Venezuela with the confirmed diagnosis of psychiatric illness. Material and Methods: A transversal study consisted of 65 hospitalized patients with psychiatric disorders out of whom 50 were males and 15 females. Patients were aged from 19 to 80 years, mean age 50.2 years. Data on oral lesions were obtained within history and clinical examination of the oral cavity. Other medical data were collected from medical documentation. Statistical analysis was performed by SPSS version 17.0. Results: 56.92% of patients had caries in at least one tooth, 29.23% presented gingivitis and 56.92% periodontal disease. In relation to Temporomandibular joint, 36.92% presented articular sounds and 10.76% muscular pain. Between the most prevalent parafunctional habits were found cigarette habit, bruxism, onychophagia and cheek bite. Conclusion: Results imply that psychiatric patients are more frequently involved with oral lesions than healthy persons. It is necessary to organize specific preventive and educational oral health programmes with these patients, in a multidisciplinary group.

Key words:Phychiatric patients, schizophrenia, medication, periodontal diseases.

Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis: results from the WHO World Health Survey

This study explored whether physical health problems are related to psychotic symptoms independently of a mental disorder diagnosis. A total of 224,254 subjects recruited for the World Health Organization World Health Survey were subdivided into those with both a lifetime diagnosis of psychosis and at least one psychotic symptom in the 12 months prior to the evaluation, those with at least one psychotic symptom in the past 12 months but no lifetime diagnosis of psychosis, and those without psychotic symptoms in the past 12 months and without a lifetime diagnosis of psychosis. The three groups were compared for the presence of medical conditions, health problems, and access to health care. Medical conditions and health problems (angina, asthma, arthritis, tuberculosis, vision or hearing problems, mouth/teeth problems, alcohol consumption, smoking, and accidents), medication consumption, and hospital admissions (but not regular health care visits) were more frequent in individuals with psychotic symptoms but no psychosis diagnosis, compared to those with no symptoms and no diagnosis. The number of medical conditions increased with the number of psychotic symptoms. Given the sample analyzed, this trend seems to be independent from the socio-economic development of the country or the specific health care system.

An oral health intervention for people with serious mental illness (Three Shires Early Intervention Dental Trial): study protocol for a randomised controlled trial

Background

Oral health is an important part of general physical health and is essential for self-esteem, self-confidence and overall quality of life. There is a well-established link between mental illness and poor oral health. Oral health problems are not generally well recognized by mental health professionals and many patients experience barriers to treatment.

Methods/Design

This is the protocol for a pragmatic cluster randomised trial that has been designed to fit within standard care. Dental awareness training for care co-ordinators plus a dental checklist for service users in addition to standard care will be compared with standard care alone for people with mental illness. The checklist consists of questions about service users’ current oral health routine and condition. Ten Early Intervention in Psychosis (EIP) teams in Nottinghamshire, Derbyshire and Lincolnshire will be cluster randomised (five to intervention and five to standard care) in blocks accounting for location and size of caseload. The oral health of the service users will be monitored for one year after randomisation.

Trial registration

Current Controlled Trials ISRCTN63382258.

Unmet dental need in community-dwelling adults with mental illness: results from the 2007 Medical Expenditure Panel Survey

BACKGROUND

Mental illness (MI) affects approximately one in five U.S. adults, and it is associated with oral disease and poor dental treatment outcomes. Little is known about dental care utilization or unmet dental need in this population.

METHODS

The authors examined data regarding presence or absence of dental visits and unmet dental need in community-dwelling adults with MI from the 2007 Medical Expenditure Panel Survey. They tested differences between adults with and without MI by using multivariate logistic regression.

RESULTS

Eighteen percent of adults (N = 19,368) had MI, and of these, 6.8 percent had unmet dental need. Although people with MI were not significantly more likely to have had a dental visit (46.3 percent) than were those without MI (42.2 percent; odds ratio [OR], 1.09; 95 percent confidence interval [CI], 0.97-1.23), they were significantly more likely to report unmet need (11.0 versus 5.3 percent; OR, 2.00; 95 percent CI, 1.67-2.41). Those with mood or anxiety disorders were most likely to report having an unmet dental need (P < .001 for all values).

CONCLUSIONS

Although people with MI did not visit the dentist significantly more often than did adults without MI, their higher level of unmet need suggests that current use of dental services is not addressing their needs adequately.

PRACTICAL IMPLICATIONS

Dentists should be familiar with MI conditions as patients with MI may have greater unmet dental need.