People with severe mental illnesses like
schizophrenia or bipolar disorder are over three times more likely
to lose their teeth because of poor oral health than the general
research, published in the September issue of the British
Journal of Psychiatry, shows that psychiatric patients have
not shared in recent improvements in dental health.
Researchers from the University of Queensland,
Australia, analysed 14 studies into the oral health of people with
severe mental illness published over the last 20 years. All the
psychiatric patients in the studies (2,784) had been diagnosed with
severe mental illness, such as schizophrenia, dementia, bipolar
disorder or other affective disorders.
The researchers found that the psychiatric
patients were 3.4 times more likely to have lost all their teeth.
They also had an average of 6 more decayed, filled or missing teeth
than people without a psychiatric illness.
The researchers believe a combination of
factors are to blame. People with severe mental illness may not be
able to prioritise their oral health, or be unable to clean their
teeth properly because of poor housing or homelessness. They may be
reluctant to see a dentist because of they are scared of treatment,
or worried about the cost. Some medications such as antidepressants
and mood stabilisers can also reduce the flow of saliva and cause
dry mouth (xerostomia), which increases plaque formation.
Lead researcher Professor Steve Kisely, of the
University of Queensland, said: “Our analysis shows that, although
the oral health of the general population has improved in much of
the world, psychiatric patients remain at a disadvantage. This
mirrors findings in other areas such as cardiovascular disease,
where the health of the general population has improved – but not
that of people with severe mental illness.”
Professor Kisely continued: “In a UK survey,
the vast majority of psychiatric patients reported that clinical
staff had never asked them about any dental problems. We believe
that oral health should be part of the standard assessment for all
patients with severe mental illness.
“When patients are admitted to hospital, their
care plans should include a basic assessment of oral hygiene –
including factors known to cause oral ill-health such as
medication, tobacco and drug use. Patients with mental illness who
are treated in the community should be given advice on diet,
smoking and brushing technique. We believe policy-makers should
also consider providing free, accessible dental care for people
with severe mental illness.”
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Kisely S, Quek L-H, Pais J, Lalloo R, Johnson NW and Lawrence D. Advanced dental disease in people with severe mental illness: systematic review and meta-analysis. British Journal of Psychiatry 2011; 199:187-193