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Effect of Implementing Dental Services in Israeli Psychiatric Hospitals on the Oral and Dental Health of Inpatients

Dr. Ponizovsky is affiliated with the Department of Mental Health Services; Dr. Zusman, Dr. Dekel, Dr. Masarwa, Dr. Ramon, and Dr. Natapov are with the Division of Dental Health; and Ms. Yoffe is with the Department of Information and Evaluation, all at the Ministry of Health, Jerusalem, Israel. Dr. Weizman is with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and with the Geha Mental Health Center, Petah Tikva, Israel. Dr. Grinshpoon is with the Bruce Rappoport Faculty of Medicine, Technion, Haifa, Israel, and with the Sha'ar Menashe Mental Health Center, Hadera, Israel. Send correspondence to Dr. Ponizovsky at the Department of Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem 93591 Israel (e-mail: alexander.ponizovsky{at}moh.health.gov.il).

OBJECTIVE: Psychiatric disorders (schizophrenia, mood disorders, and organic brain disorders) and their treatment may lead to oral diseases, but assessment of dental status and oral care needs among patients with these disorders is lacking. This study reports changes in dental health and oral care needs of psychiatric inpatients after 1998, when psychiatric hospitals in Israel were required to provide regular dental examinations and treatment for every inpatient hospitalized longer than a year. METHODS: Two epidemiological cohorts from 1997 and 2006 representing long-term psychiatric inpatients before (N=431) and after (N=254) the reform of dental services were compared on the standardized criteria of the Decayed, Missing, and Filled Teeth (DMFT) index scores and DMFT component scores, as well as on the use of and need for dentures. RESULTS: Compared with the prereform cohort, the postreform cohort had fewer decayed teeth and lower DMFT index scores. These differences were independent of gender and clinical diagnosis. No between-cohort differences were found in the use of and need for dentures. On-site dental services were more effective than outsourced services in improving dental health. CONCLUSIONS: The results suggest a substantial improvement in the dental health of this at-risk population after the dental reform in psychiatric hospitals. However, oral health needs are still not fully met, and therefore, additional organizational efforts for further prevention and treatment of dental diseases are required.

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