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Effects of Mental Illness on Oral Health: A Brief Review

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Objectives. This review documents published obsessive-compulsive disorder (OCD) cases with dental and oral conditions with potential impact on the dental procedure. The research question was, what are the psychiatric and behavioral features of people with OCD that might affect dental sessions? Methods. This review followed the PRISMA guidelines (PROSPERO registration No. CRD42020212371). Six databases (PubMed, Scopus, Web of Science, LILACS, Cochrane Library, and PsycINFO) were screened for published clinical studies that report dental patients with obsessions or compulsions behaviors as identified by National Institute of Mental Health (NIMH). Inclusion of the studies was performed according to the eligibility criteria. The quality evaluation was carried out using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist. The results were qualitatively assessed for synthesis. Results. After elimination of duplication, 530 articles were screened, and 35 articles were evaluated for eligibility. 17 studies met the inclusion criteria (8 case reports, 5 cross-sectional studies, 1 longitudinal cohort study, and 3 case-control studies) and were included in the review. All case reports demonstrated symptoms of obsessions or compulsions such as fear of germs and contamination, aggressive thoughts, having things symmetric in perfect order, excessive cleaning or handwashing, repeatedly checking things, and compulsive counting. OCD-related behavior was assessed in the included clinical investigations using standardized protocols such as Florida Obsessive-Compulsive Inventory, Symptom Checklist-90-Revised, 4-item Corah Dental Anxiety Scale, Diagnostic and Statistical Manual of Mental Disorders, and the Crown Crisp Experimental Index. Quality assessment of the 17 included articles revealed 14 articles with low risk of bias and 3 articles with moderate risk of bias. Conclusion. The reported OCD symptoms may implement psychological difficulties during dental procedures without affecting the outcome. Although there was no contraindication for planning or performing dental treatments for a patient with OCD, dental-related procedures and protocols might be modified for successful dental appointments. 1. Introduction Obsessive-compulsive disorder (OCD) is a severe psychological disorder, with global prevalence of 2-3% [1]. The major characteristics of OCD include obsessional debilitating inner thoughts associated with repetitive behaviors [1]. OCD can be presented in four types of obsessive symptoms as identified by the National Institute of Mental Health (NIMH) including (1) fear of infection, germs diseases, and contamination; (2) aggressive thoughts against self or others; (3) impious thoughts; and (4) worries about symmetry and perfectionism [2]. According to these intrusive thoughts, obsessive patients feel the urge toward some behaviors as frequent washing and cleaning, checking things repetitively, and compulsive counting. OCD always shows two modes of onset. By approaching 11 years of age, the first peak starts and then in the early adulthood the second peak begins. Almost by 10 years of age, symptoms appear in around 20% of the affected population [3]. Several psychological symptoms might hinder the success of dental procedures and can give the dentist hard time during treatment periods. Due to fear of infection, patients with OCD may be distrusted about the disinfection and cleanliness of the materials, tools, table, and dental chair, which may irritate the dentist. Therefore, taking a complete medical history, including psychiatric, along with consulting the patient’s psychiatric physician is a vital step to avoid dental problems or oral conditions. Moreover, dentists should be aware of OCD diagnostic criteria as they might be the first ones to suspect that their patients may be diagnosed with OCD by correlating patient’s behavior with OCD diagnostic criteria. In this context, this review aims to familiarize dentists with OCD behavioral characteristics that were reported in dental clinics, which could be helpful to complete dental treatment sessions of patients with OCD successfully. 2. Materials and Methods 2.1. Protocol and Registration The protocol of this review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [4]. Registration of the protocol was done in International Prospective Register of Systematic Reviews (PROSPERO) platform with the Centre for Reviews and Dissemination at the University of York under code CRD42020212371. 2.2. Review Question The focus question in this review was, “what are behavioral characteristics of individuals with OCD in dental clinics?” 2.3. Search Strategy A structure online database search was conducted independently by the two reviewers the till the 24th of December 2020. Searches were performed on six different electronic databases: PubMed, Scopus, Web of science (WoS), Latin American & Caribbean Health Sciences Literature (LILACS), Cochrane Library, and PsycINFO. The organization and duplicated articles exclusion were carried out by EndNote online (Thomson Reuters, Philadelphia, USA). For each database, numerous words’ combinations were done including “Obsessive compulsive disorder” AND “Dental” OR “Dentistry” OR “Periodontal” OR “Periodontitis” OR “Gingiva” OR “Orthodontic” OR “Dental implant” OR “Maxillofacial” OR “Teeth” OR “Tooth” OR “Tooth Extraction” OR “Pediatric dentistry” OR “Dental prosthesis” OR “Denture” OR “Bleaching” OR “Caries” OR “Amalgam” OR “Composite” OR “Oral lesion” OR “Tongue” OR “Edentulous” OR “Endodontic” OR “Pulp.” 2.4. Eligibility Criteria Articles of this review were chosen based on the PICOS elements (Table 1), where population (P) = dental patients diagnosed with OCD, intervention (I) = different dental procedures, comparison (C) = dental patients free from OCD, outcome (O) = clinical difficulties during dental treatment sessions, and study design (S) = published case reports, case series, cohort, cross-sectional, case-control, or randomized clinical studies. Only articles that were published in English language were considered. PICOS Inclusion criteria Exclusion criteria Population Patients having dental or oral condition and diagnosed with OCD. Patients with or without psychological disorder other than OCD. Intervention All dental procedures including preventative, conservative, or maxillofacial surgeries. Medical interventions without dental contribution. Comparison Mental and psychologically normal dental patients. Dental patients with psychiatric disorder other than OCD. Outcome Practicing difficulties associated with patients with OCD in dental clinics. Clinical practicing complications related to people with OCD in nondental clinics. Study design Published case reports, case series, cohort, cross-sectional, case-control, or randomized clinical studies. Conference abstract, editorial correspondence, book chapters, studies not involving human subjects, or review articles
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Background-Oral Health-related Quality of Life (OHRQoL) has been defined as "the absence of negative impacts of oral conditions on social life and a positive sense of dentofacial self-confidence. Obsessive compulsive disorder (OCD) is a chronic, heterogeneous, neuropsychiatric anxiety disorder, characterized by the presence of either obsessions, compulsive rituals or more commonly both.
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Objectives:It can be said that approximately 60-70% of the general population would probably experience at least one symptom of temporomandibular disorder (TMD) in their lives, but only about 5% of these people seek treatment. On the other hand, depression and anxiety are now recognized as a serious public health problem among adults. Anxiety disorder is a chronic, high-risk disease that may lead to dysfunction and reduce quality of life. The aim of this study was to assess the association between depression and anxiety with TMD in dentistry students of Zanjan Dental School in 2020-2021. Methods:The population of this study consisted of students with TMD, and the control population was selected from students of the same faculty. To collect the data, volunteers first answered questions about the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Then the Depression, Anxiety and Stress Scale (DASS-21) questionnaire was completed by students in both groups. The collected data were then entered into stata software version 14. Results:According to the results of univariate analysis of logistic regression, gender, tuition, residential status, stress, anxiety and depression have a significant effect on TMD (P <0.2). After examining the gisimultaneous effect of variables and eliminating possible confounding variables with multiple logistic regression models, stress was identified as the most effective factor in TMD (significance level in this model is less than 0.05). Conclusion:Based on findings, while there was a significant relationship between stress, depression and anxiety with symptoms of TMD, stress alone was identified as the most effective factor in developing TMD.
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Individuals with eating disorders, including anorexia nervosa and bulimia nervosa, may present with a range of gastrointestinal manifestations. The oral cavity, salivary glands, gastrointestinal tract, pancreas and liver can be impacted by nutritional restrictive and binge/purging behaviors. Complications are often reversible with appropriate nutritional therapy. At times, however, the complications in these disorders may be severe, irreversible and even life threatening. Given the often covert nature of eating disorders, the practitioner must be attentive to subtle clues that may indicate their presence. Extensive diagnostic evaluations of the gastrointestinal manifestations of eating disorders should be employed only when nutritional rehabilitation does not remedy the problems.
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The poor physical health faced by people with mental illness has been the subject of growing attention, but there has been less focus on the issue of oral health even though it is an important part of physical health. This article discusses the two-way association between oral and mental health. In one direction, the prospect of dental treatment can lead to anxiety and phobia. In the other, many psychiatric disorders, such as severe mental illness, affective disorders, and eating disorders, are associated with dental disease: These include erosion, caries, and periodontitis. Left untreated, dental diseases can lead to teeth loss such that people with severe mental illness have 2.7 times the likelihood of losing all their teeth, compared with the general population. Possible interventions include oral health assessments using standard checklists that can be completed by nondental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral.
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Dental disease and psychiatric illness are among the most prevalent health problems in the Western world. While the dental needs of mentally ill people are similar in type to those in the general population (Markette et al , 1975) there is some evidence that patients suffering from mental illness are more vulnerable to dental neglect and poor oral health (Stiefel et al , 1990; Armstrong, 1994). Sims (1987) reports that physical health problems are more common in psychiatric patients. They seem to be poorly recognised by psychiatrists, and oral health is no exception (Hede, 1995). Oral health is an important aspect of quality of life which affects eating, comfort, speech, appearance and social acceptance (Nordenram et al , 1994).
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Eating disorders (EDs) are primary psychological conditions, often associated with severing medical complications. EDs are characterized by perturbed eating behavior patterns. Their increasing incidence and prevalence is causing concerns to healthcare professionals. Because eating disorders are a complex issue, a multidisciplinary approach to treatment is required and this team includes Psychiatrists, Psychologists and Nutritionists. The purpose of this paper is to review the role of the dentists especially the pediatric dentist and orthodontist in identifying oral manifestations of EDs, which may be utilized for oral diagnosis, referral and management of underlying psychiatric condition and also secondary oral conditions.
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Temporomandibular disorders is a collective term used to describe a number of related disorders involving the temporomandibular joints, masticatory muscles and occlusion with common symptoms such as pain, restricted movement, muscle tenderness and intermittent joint sounds. The multifactorial TMD etiology is related to emotional tension, occlusal interferences, tooth loss, postural deviation, masticatory muscular dysfunction, internal and external changes in TMJ structure and the various associations of these factors. The aim of this study was to evaluate the prevalence of the relationship between signs of psychological distress and temporomandibular disorder in university students. A total 150 volunteers participated in this study. They attended different courses in the field of human science at one public university and four private universities. TMD was assessed by the Research Diagnostic Criteria (RDC) questionnaire. Anxiety was measured by means of a self-evaluative questionnaire, Spielberger's Trait-State anxiety inventory, to evaluate students'state and trait anxiety. The results of the two questionnaires were compared to determine the relationship between anxiety levels and severity degrees of chronic TMD pain by means of the chi-square test. The significance level was set at 5%. The statistical analysis showed that the TMD degree has a positive association with state-anxiety (p = 0.008; p < 0.05) and negative with trait-anxiety (p = 0.619; p < 0.05). Moreover a high TMD rate was observed among the students (40%). This study concluded that there is a positive association between TMD and anxiety.
Oral cavity and eating disorders: An insight to holistic health
  • S Hasan
  • S Ahmed
  • R Panigrahi
  • P Chaudhary
  • V Vyas
  • S Saeed
Hasan S, Ahmed S, Panigrahi R, Chaudhary P, Vyas V, Saeed S. Oral cavity and eating disorders: An insight to holistic health. J Family Med Prim Care.2020 Aug 25; 9 (8): 3890 -3897
Necrotizing Sialo metaplasia and Bulimia: A Case Report. Medicina (Kaunas)
  • F Salvado
  • M A Nobre
  • J Gomes
  • P Maia
Salvado F, Nobre MA, Gomes J, Maia P. Necrotizing Sialo metaplasia and Bulimia: A Case Report. Medicina (Kaunas).2020 Apr 19; 56 (4): 188.
Licensed Under Creative Commons Attribution CC BY disease risk
Licensed Under Creative Commons Attribution CC BY disease risk. Proc Natl Acad Sci U S A.2012 Apr 17; 109 (16): 5995 -9.