Oral health and treatment needs of institutionalized chronic psyhiatric patients in Instanbul, Turkey

Department of Dentistry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
Community dental health (Impact Factor: 0.6). 09/2010; 27(3):151-7. DOI: 10.1922/CDH_2443Gurbuz07
Source: PubMed


To assess the oral health status and treatment needs in a group of hospitalized chronic psychiatric patients.
The dental status was assessed using the DMFT index. Demographic and medical data were retrieved from the institutional clinical files.
491 patients were examined in the study. 258 (52.5%) of the patients were males. The mean age was 52.3 +/- 12.3 years and the average length of hospitalization was 17.5 years. The majority of the patients (69%) were diagnosed with schizophrenia. The mean DMFT was 19.25 +/- 7.85. Missing teeth (81.4%) comprised the largest proportion of the DMFT while filled teeth (0.5%) the smallest. 18.1% of the DMFT consisted of decayed teeth. Stepwise logistic regression analysis showed that the DMFT significantly increased with age (p < 0.001) and was significantly higher in schizophrenia patients than those with mental retardation (p < 0.01). Males had significantly higher decayed teeth (p < 0.01) and fewer missing teeth (p < 0.01) than females. 58 dentate subjects (14.4%) were caries free. Two hundred and thirty five patients (58.5%) required restorative care, the mean number of treatments required per patient was 1.42 +/- 1.82. Eighty-nine subjects (18.1%) were found to be completely edentulous with only 17 wearing complete dentures. 70.6% of dentate patients needed tooth extraction for caries and 36.1% for periodontal disease.
The findings of this study demonstrate poor oral health status with extensive unmet dental and prosthetic needs. These underline the urgent need for specific preventive oral health programme to improve the dental care of these chronic psychiatric inpatients.

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    • "[3] was allotted by the authors to the water fluoride concentration (1.5-2 ppm). Multivariate analyses, when carried out, showed that many factors might affect the oral health of these specific patients: DMFS (number of Decayed, Missing or Filled Surfaces) or DMFT was correlated with socio-demographic factors (age [3,12-14,16-18], male gender [12]), psychiatric factors (duration of the mental illness [3,19], psychiatric diagnosis [19], diagnostic of schizophrenia compared to mental retardation [16]), physical factor (high Body Mass Index [20]), care factors (type of ward: open, closed, chronic of special ward [18]; infrequent dental visit [17]) and behavioral factors (irregularity of hygiene habits [3], frequent snacking [17]). "
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    ABSTRACT: Severe mental disorders have a chronic course associated with a high risk for co-morbid somatic illnesses and premature mortality and oral health is critical for overall systemic health. But general health care needs in this population are often neglected. Some studies have aimed at determining the oral health status of psychiatric in-patients but to date, no emphasis has been placed on oral health of psychiatric patients in France. The goal of this study was to assess the oral health and treatment needs of institutionalized patients in a large psychiatric hospital, where a dental service was available and free, to compare it with the average population, with psychiatric in-patients in other countries and to provide recommendations for psychiatrists and care-giving staff. The dental status (DMFT), the oral hygiene (OHIS: Simplified Oral Hygiene Index), the saliva flow rate were recorded on a randomized patient sample. Demographic and medical data were retrieved from the institutional clinical files. Among the 161 examined patients, 95 (59.0%) were men and 66 (41.0%) were women. The mean age was 46.9 +/- 17.5 years. The majority was diagnosed schizophrenia (36.6%) or mood disorders (21.1%). The mean OHIS was 1.7 +/- 1.1. Among the 147 patients who agreed to carry out the salivary examination, the average saliva flow rate was 0.3 g +/- 0.3 g/min. Saliva flow under the average rest saliva flow (0.52 mg/min) was found for 80.3% of the patient. The mean DMFT was 15.8 +/- 8.8 (D = 3.7 +/- 4.4, M = 7.3 +/- 9.4, F = 4.7 +/- 4.9) and significantly increased with age (p < 0.001) and degree of disability (p = 0.003) (stepwise linear regression). Eighteen patients (11.2%) were edentulous. The DMFT was similar to low income French population but psychiatric patients had almost 4 times more decayed teeth, slightly less missing teeth and 1.5 times less filled teeth. Oral health appeared to be better than in most other countries. But compared to general population, the still unmet dental and prosthetic needs indicated the major need of enhanced access to dental care and specific preventive programs.
    Full-text · Article · Sep 2013 · BMC Psychiatry
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    • "Suboptimal oral health has been self-reported among patients with SMI (3). Several reports detailing the oral health status of psychiatric patients in Denmark (4), The Netherlands (5), Italy (6), Spain (7), India (8), South Wales (9), Israel (10), United Kingdom (11) and Turkey (12) have revealed that mental illness and the medications used to treat the disorder can cause and magnify the severity of dental diseases with particular emphasis on caries experience (13). "
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    ABSTRACT: Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student’s t-test or analysis of variance. Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p < 0.01). Mean number of decayed teeth was higher in SG (3.1) compared to CG (1.8) (p=0.047). Mean number of missing teeth were 25.2 and 16.4 in SG and CG respectively (p<0.05). DMFT scores were higher in SG in all the age groups (p < 0.01). Mean number of teeth per person needing treatment was 3.4 in SG and 1.9 in CG (p= 0.037). The need for restorative dental care was significantly lower in the SG (0.8 teeth per person) than in the CG (1.7 teeth per person) (p = 0.043). Conclusions: Institutionalized psychiatric patients have significantly worse dental status and more dental treatment needs than non-psychiatric patients. Key words:Gerodontology, oral health, older adult, psychiatric patients, schizophrenia.
    Full-text · Article · Dec 2012 · Medicina oral, patologia oral y cirugia bucal
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    • "Previous surveys have demonstrated that patients with schizophrenia visit dentists less frequently, compared to healthy people, because of their difficult financial conditions and a lack of motivation in the maintenance of dental hygiene due to the illness [10-12]. However, while several previous surveys have examined demographic and clinical characteristics that are related with worse dental hygiene in schizophrenia [13-17], such data are still limited in the literature. Moreover, dental hygiene is expected to be subject to direct and indirect influences of current and local standards of care, which indicates a necessity of further information from various clinical settings in order to provide a robust agreement on this issue. "
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    ABSTRACT: Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia. Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score. 523 patients were included in this study (mean ± SD age = 55.6 ± 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p's < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score. Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients' dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.
    Full-text · Article · Aug 2012 · BMC Oral Health
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