To the Editor: In the June issue Ponizovsky and colleagues (1) reported changes in dental health and oral care needs of psychiatric inpatients after dental services were implemented in Israeli psychiatric hospitals. But the authors did not address the question of whether psychiatric patients have poorer oral health than a comparable group from the general population. There is evidence from several countries that the dental health of patients with severe mental disorders is poor (2,3). Because dental health has been found to be related to socioeconomic status (4) and most persons with severe mental illness live in poor conditions, we sought to determine whether mental illness has an independent influence.
We compared the dental health of 120 patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder (62 males and 58 females; mean±SD age of 45.3±15.6) and 118 social welfare recipients from the same geographic area who did not have a mental illness (61 males and 57 females; mean±SD age of 41.0±11.3). Patients were recruited in 2008 from consecutive admissions to a psychiatric hospital, an outpatient clinic of this hospital, and residential homes (40 patients from each setting). Control group participants were recruited from visitors to social welfare services in the same area. Because of concerns raised by the ethics committee, dental examinations were not conducted. Instead, a self-report questionnaire that elicited sociodemographic data and information about oral diseases and oral hygiene was administered in person. All participants provided informed consent.
No significant between-group differences were found with respect to gum bleeding, periodontitis, and the mean frequency of toothache. The total number of missing teeth reported by the participants was significantly greater in the patient group. The proportion of persons who brushed their teeth at least twice a day was significantly lower in the patient group (54% compared with 76%), but no differences were found in the proportion who brushed their teeth for at least two minutes at a time (61% in the patient group and 59% in the comparison group).
Except for having more missing teeth, the oral health of persons who had a severe mental illness was similar to that of persons of the same socioeconomic status who did not have a mental illness. However, oral hygiene was poorer in the patient group than in the group of social welfare recipients. These findings support those of Ponizovsky and colleagues and also demonstrate the need for further efforts to prevent oral diseases among patients with severe mental illness. A major limitation of this study was the use of a self-report questionnaire instead of a dental examination. In addition, patients were recruited from diverse treatment settings; future studies should compare patient groups from each setting with each other as well as with a control group.
The authors are affiliated with the Center for Psychiatry Suedwuerttemberg, Ulm University, Ravensburg-Weissenau, Germany.
Ponizovsky AM, Zusman SP, Dekel D, et al: Effect of implementing dental services in Israeli psychiatric hospitals on the oral and dental health of inpatients. Psychiatric Services 60:799–803, 2009
Angelillo IF, Nobile CG, Pavia M, et al: Dental health and treatment needs in institutionalized psychiatric patients in Italy. Community Dentistry and Oral Epidemiology 23:360–364, 1995
Hede B: Dental health behavior and self-reported dental health problems among hospitalized psychiatric patients in Denmark. Acta Odontologica Scandinavica 53:35–40, 1995
Sheiham A, Nicolau B: Evaluation of social and psychological factors in periodontal disease. Periodontology 2000 39:118–131, 2005