Dental conditions in inpatients with schizophrenia: A large-scale multi-site survey

Abstract

BackgroundClinical 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.MethodsInpatients 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.Results523 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.ConclusionsGiven 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.

Dental caries status of patients with schizophrenia in Seville, Spain: a case–control study

“…The mean DMFT score in the oldest age group (over 46 years) was approximately twice that of the youngest age group (up to 35 years). These findings are consistent with those seen in similar psychiatric groups demonstrating that age is an important determinant of poor oral health [12, 14, 15, 17, 24, 28]. Among the patients with schizophrenia, the carious disease process seems to progress over time, and teeth are lost rather than being restored.…”

“…Decayed and missing teeth were significantly more prevalent in patients with schizophrenia, suggesting a lack of restorative care with extensive unmet dental treatment needs [6, 16, 23, 24, 27, 28]. In the present study, the DMFT score of the group with schizophrenia was comparable to scores found by other studies concerning non-institutionalised patients with schizophrenia in Mediterranean countries with similar demographic variables [23, 24].…”

“…Schizophrenia should be considered a risk factor for poor oral health because patients with schizophrenia are likely to face a unique set of factors that lead to the development of advanced oral diseases—and to receive less oral health care [21–28]. …”

“…Another factor that contributes to increased incidence of dental caries in patients with schizophrenia is higher sugar intake. Snacking frequency is associated with a higher prevalence of dental caries and plaque index, and this frequency is higher in this kind of patients than in general population [6, 17, 28]. …”

“…Negative symptoms and personality disorders of mental illness may be responsible for poor tooth brushing habits [11, 23, 24, 28]. Almost all patients with schizophrenia have large amounts of plaque and calculus and high bleeding indices [6, 9, 10, 13, 17, 18].…”