The oral health of people with serious mental illness

Jones, Hannah F. (2016) The oral health of people with serious mental illness. PhD thesis, University of Nottingham.

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The physical health needs of people with serious mental illness have been neglected for a long time (1), this has initiated the development of guidelines and recommendations from the British Society for Disability and Oral Health (BSDH) for the oral health care for people with serious mental illness (2). Guidelines recommend monitoring and advice and although they are well meaning, randomised controlled trial evidence to support the recommendations is missing (3, 4). Cochrane systematic reviews found no randomised controlled trials of oral health advice or monitoring for people with serious mental illness (5). A Cochrane systematic review of general physical health advice interventions for people with serious mental illness (6) found evidence to suggest such interventions could lead to people accessing more health services. For oral health there is some survey evidence to suggest regular dental check-ups have been found to be associated with better oral health (7), so if a monitoring and advice intervention can influence someone with serious mental illness to visit a dentist this may in turn improve their oral health.

A systematic review of 55 studies examining the prevalence of poor oral health and hygiene practices, dental treatment needs, and dental attendance of people with serious mental illness, was conducted to assess the extent to which people with serious mental illness brush their teeth and attend dental appointments. The majority of participants did not practice good oral hygiene, and were more likely not to have seen a dentist for a longer period of time than the general population. Those with serious mental illness also had more decayed teeth, more missing teeth, but fewer filled teeth, than the general population. Most of those with mental illness required some form of dental treatment ranging from oral hygiene instruction to complex dental treatment for those with shallow pockets or deep pockets in their teeth.

A narrative review of the knowledge and attitudes regarding oral health in populations with serious mental illness from service users, and mental health and dental professionals’ perspectives found that individuals with serious mental illness were more likely to have poor oral health due to neglecting their oral hygiene and because they did not attend regular dental appointments. Previous negative experiences at dental appointments or general dental anxiety prevented individuals with a mental illness from seeking help until they experienced a dental emergency. The majority of service users reported that support from mental health nurses was helpful, even though nurses tended to report feeling unconfident and inadequately trained to provide this care.

A systematic review of randomised controlled trials of interventions for improving the oral health of people with serious mental illness identified four studies which all had such varied interventions and measured different outcomes that combining them in a meta-analysis was not possible. Providing toothbrushes appeared to improve the oral health of people with serious mental illness. Some of the interventions involved an education element which also significantly improved oral health.

A pragmatic cluster randomised controlled trial of an oral health intervention for people with serious mental illness involved 1074 service users from the Early Intervention in Psychosis teams in the East Midlands of England being randomised either to receive a dental intervention or standard care. The dental intervention involved completing a checklist with their Care Co-ordinator concerning their oral health and oral hygiene behaviour and the standard care simply involved continuing with standard care for 12 months before then completing the checklist. At baseline only 271/550 service users randomised to the dental intervention group completed dental checklists. Only 98/271 (36.1%) of service users returned a completed dental checklist at the 12 month follow up and for those allocated to standard care 91/524 (17%) returned a completed dental checklist at the 12 month follow up. The checklist did not improve oral health behaviour in people with serious mental illness.

The oral health of people with serious mental illness remains a vastly under researched area. Mental health professionals should receive training to improve their oral health care knowledge. Mental health professionals should also provide advice to their patients regarding their oral health, monitor oral health as part of standard care and support patients to attend regular dental check-ups. An effective intervention that can be used within standard care could significantly improve the quality of life for people with serious mental illness.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Buchanan, H.
das Nair, R.
Keywords: Oral health, Dental public health, Mental illness
Subjects: W Medicine and related subjects (NLM Classification) > WU Dentistry. Oral surgery
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 32720
Depositing User: Jones, Hannah
Date Deposited: 19 Jul 2016 06:40
Last Modified: 07 May 2020 18:45

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