A new meta-analysis has revealed a 61% lifetime prevalence of suboptimal oral health among people with serious mental illness in the U.S. and elsewhere in the world (Community Mental Health Journal, December 29, 2009).
The findings lend further weight to the need for dental and mental healthcare providers to coordinate efforts to improve the quality of patient care and overall health.
Naira Roland Matevosyan, M.D., Ph.D., Sc.D., a postdoctoral fellow in the Center for Psychiatric Rehabilitation at Boston University, performed the meta-analysis. She based it on a literature search that uncovered three book chapters and 54 articles documenting rigorously performed studies on oral health among people with serious mental illness.
— Joseph Parks, M.D., chief clinical
officer, Missouri Department of
Mental Health
International scope
The studies were conducted in North America, the U.K., Europe, Japan, Hong Kong, India, Jordan, and Israel. Thirty-seven of the studies used self-reported data; 26 were observational, cross-sectional studies; and 11 were prospective, longitudinal, interventional trials. Only 12 adjusted dental outcomes for psychotropic medication use and dietary patterns.
By using pooled estimates, Dr. Matevosyan found a 32% one-year prevalence of suboptimal dental health and a 61% lifetime prevalence. In addition, by using logistic regression analyses she determined significant correlations among age, female gender, and gross caries, periodontal disease, and missing teeth. Dr. Matevosyan also detected significant associations between substance abuse and xerostomia.
"This review underlines the importance of bridging dental health education and psychiatric rehabilitation programs," she concluded.
A related study published last November supports these findings (Psychiatric Services, November 2009, Vol. 60:11, pp. 1552-1554). In it, Swedish researchers documented that poor oral health has significant negative impacts on overall health and quality of life in psychiatric outpatients.
Major problem in the U.S.
According to Joseph Parks, M.D., chief clinical officer for the Missouri Department of Mental Health, Dr. Matevosyan's study appears to be a useful and robust meta-analysis that highlights a problem he and his peers have been battling for decades.
"This is a major issue nationally for the mental health community," Dr. Parks said in an interview with DrBicuspid.com. "I was just at the annual meeting of the National Association of State Mental Health Program Directors. Several commissioners or directors of state mental health agencies identified dental health as a big problem for the people they serve. And this is significantly exacerbated by the fact that people with severe mental illness are almost always covered by Medicare or Medicaid, and these rarely include dental benefits."
People with acute, severe mental illness are usually in institutions or access oral healthcare through emergency rooms and hence are rarely treated by community dentists, added Cyril Meyerowitz, D.D.S., M.S., professor and director of the Eastman Institute for Oral Health at the University of Rochester Medical Center.
"This is really more a public policy and public health issue … surrounding the need for a recognition within mental health facilities that oral health issues are a significant problem in this population," said Dr. Meyerowitz. "But while dentists do receive education about this population, more work needs to be done in areas such as helping dentists to understand their own discomfort with treating people with severe mental illness, and to understand specific problems such as the side effects and interactions between oral health and particular medications -- and other issues in this population, such as reduced ability to maintain oral hygiene and poor dietary habits."
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