Advanced dental disease in people with severe mental illness: Systematic review and meta-analysis

Kisely, Steve, Quek, Lake-Hui, Pais, Joanne, Lalloo, Ratilal, Johnson, Newell W. and Lawrence, David (2011) Advanced dental disease in people with severe mental illness: Systematic review and meta-analysis. British Journal of Psychiatry, 199 3: 187-193. doi:10.1192/bjp.bp.110.081695


Author Kisely, Steve
Quek, Lake-Hui
Pais, Joanne
Lalloo, Ratilal
Johnson, Newell W.
Lawrence, David
Title Advanced dental disease in people with severe mental illness: Systematic review and meta-analysis
Journal name British Journal of Psychiatry   Check publisher's open access policy
ISSN 0007-1250
1472-1465
Publication date 2011-09
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1192/bjp.bp.110.081695
Volume 199
Issue 3
Start page 187
End page 193
Total pages 7
Place of publication London, U.K.
Publisher Royal College of Psychiatrists
Collection year 2012
Language eng
Formatted abstract
Background Psychiatric patients have increased comorbid physical illness. There is less information concerning dental disease in this population in spite of risk factors including diet and psychotropic side-effects (such as xerostomia).

Aims To compare the oral health of people with severe mental illness with that of the general population.

Method A systematic search for studies from the past 20 years was conducted using Medline, PsycINFO, Embase and article bibliographies. Papers were independently assessed. The primary outcome was total tooth loss (edentulousness), the end-stage of both untreated caries and periodontal disease. We also assessed dental decay through standardised measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS). For studies lacking a control group we used controls of similar ages from a community survey within 10 years of the study.

Results We identified 21 papers of which 14 had sufficient data (n = 2784 psychiatric patients) and suitable controls (n = 31 084) for a random effects meta-analysis. People with severe mental illness had 3.4 times the odds of having lost all their teeth than the general community (95% CI 1.6-7.2). They also had significantly higher scores for DMFT (mean difference 6.2, 95% CI 0.6-11.8) and DMFS (mean difference 14.6, 95% CI 4.1-25.1). Fluoridated water reduced the gap in oral health between psychiatric patients and the general population.

Conclusions Psychiatric patients have not shared in the improving oral health of the general population. Management should include oral health assessment using standard checklists that can be completed by non-dental personnel. Interventions include oral hygiene and management of xerostomia.
Keyword Australian psychiatric-patients
Oral-health
Periodontal-disease
Treatment needs
Heart-disease
Adults
Impact
Caries
Population
Services
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Public Health Publications
 
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