UK study results show that individuals with severe mental illness who live in the community and receive community-based psychiatric care have poorer oral health than the national adult population.
Rates of smoking were high and regular dental visits and check-ups were low in this population, and importantly, more than half of participants reported that their quality of life was affected by their oral health, note the researchers in the British Dental Journal.
They suggest that "an upstream approach to the management of these issues could be developed whereby specific oral health promotion activities are implemented to improve oral care, diet, reduce smoking, and increase dental attendance."
Rakhee Patel (University Hospitals Bristol) and Ana Gamboa (Queen Mary's School of Medicine and Dentistry, London) surveyed 89 people with severe mental illness using the oral health impact profile (OHIP) questionnaire, examined their mouths, and compared data with findings from the 2009 Adult Dental Health Survey to assess differences between the study population and national characteristics.
Over half (64.0%) of the study cohort were aged 45-54 years, and the majority were current smokers, at 78.1%. Access to dental care was poor, with less than half (41.6%) of individuals reporting regular and repeated attendance at a dental practice.
Indeed, approximately a third (32.6%) of participants reported not visiting a dentist in more than 5 years.
Mean OHIP scores were 25.4 of a possible 56.0, with physical pain being the most frequently reported impact domain. In all, 79.8% of patients reported painful aching or discomfort when eating within the previous year. Over half (53.9%) of respondents considered that their quality of life was adversely affected by their oral health.
Patel and Gamboa found that 7.9% of the cohort was edentulous, which is higher than the national rate of 6.0%. Of those with teeth, more than two-thirds (79.3%) had some visible debris, with 89.6% of participants having calculus on at least one tooth.
The researchers also observed a high rate of decayed teeth (mean 1.88 per participant), and a widespread need for periodontal treatment, at 93.9%. None of the study participants fitted the 2009 Adult Dental Health Survey criteria for "excellent dental health."
"Links between community mental health trusts and dental services should be strengthened to provide support and immediate access to dental care for people with severe mental illness," remark the authors.
"Oral assessments could be undertaken at psychiatric sites to over come issues in attendance and anxiety," they suggest.
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