The Mental Health Minute

Articles and news about mental health issues

Oral Health and Hygiene Among Persons With Severe Mental Illness

Although I applaud the actual investigation and study of dental health in the population of mentally ill patients, the study below has a few weaknesses that I can see.  First, it was a “self-report” study and no actual evaluation was done by a dental professional.  In my experience, it is sometimes difficult to get correct information from a schizophrenic or schizoaffective patient.  I find, during assessments, that these patients are very adept at either giving you the answers you want to hear, or trying to shock you (depending on how others have related to them in the past).

The second weakness that I can see is that no where do they include the variable that periodontal disease  may be caused simply by the stress of having no money and being ignored by the majority of the population in any given community.  Studies have shown that salivary cortisol can impair WBC’s from doing the job of protecting from infection.  This, in turn, allows for plaque to form and leads to gum destruction. High stress is also associated with oral care neglect in surveys of patients, as well as increases in sugar intake and stress behaviors such as smoking.

Another issue with mental patients is the use of psychotropic medications with the ensuing “dry mouth” that is the standard side effect.  Dry mouth leads to increased plaque and cavities which then increase the rate of periodontal disease.  Such periodontal disease leads to lost teeth, infection, even coronary disease.

Please go to the link at the end and read the reply posted immediately afterward.  Again, I do applaud the actual investigation into oral health for this population, but am saddened that such research occurs in foreign countries and not in the United States.  I hope to see an increase in these types of studies for our mentally ill.

To read the original>>Please click here


In the June issue Ponizovsky and colleagues (1) reported changes in dental health and oral care needs of psychiatric inpatients after dental services were implemented in Israeli psychiatric hospitals. But
the authors did not address the question of whether psychiatric patients have poorer oral health than a comparable group from the general population.

There is evidence from several countries that the dental health of patients with severe mental disorders is poor (2,3). Because dental health has been found to be related to socioeconomic status (4) and most persons with severe mental illness live in poor conditions, we sought to determine whether mental illness has an independent influence. We compared the dental health of 120 patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder (62 males and 58 females; mean±SD age of 45.3±15.6) and 118 social welfare recipients from the same geographic area who did not have a mental illness (61 males and 57 females; mean±SD age of 41.0±11.3).

Patients were recruited in 2008 from consecutive admissions to a psychiatric hospital, an outpatient clinic of this hospital, and residential homes (40 patients from each setting). Control group participants were recruited from visitors to social welfare services in the same area. Because of concerns raised by the ethics committee, dental examinations were not conducted. Instead, a self-report questionnaire that elicited sociodemographic data and information about oral diseases and oral hygiene was administered in person. All participants provided informed consent.

No significant between-group differences were found with respect to gum bleeding, periodontitis, and the
mean frequency of toothache. The total number of missing teeth reported by the participants was significantly greater in the patient group. The proportion of persons who brushed their teeth at least twice a day was significantly lower in the patient group (54% compared with 76%), but no differences were found in the proportion who brushed their teeth for at least two minutes at a time (61% in the patient group and 59% in the comparison group).

Except for having more missing teeth, the oral health of persons who had a severe mental illness was similar to that of persons of the same socioeconomic status who did not have a mental illness. However, oral hygiene was poorer in the patient group than in the group of social welfare recipients.

These findings support those of Ponizovsky and colleagues and also demonstrate the need for further efforts to prevent oral diseases among patients with severe mental illness. A major limitation of this study was the use of a self-report questionnaire instead of a dental examination.

In addition, patients were recruited from diverse treatment settings; future studies should compare patient groups from each setting with each other as well as with a control group.

Erich Flammer, Dipl.-Psych.
Andrea Breier, M.D.Sc.
Tilman Steinert, Prof.
The authors are affiliated with the Center for Psychiatry Suedwuerttemberg, Ulm
University, Ravensburg-Weissenau, Germany.


October 2, 2009 - Posted by | Mental Health | , , , , ,


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