Utilization of dental care among patients with severe mental illness: a study of a National Health Insurance database

Abstract

BackgroundThe oral health of patients with severe mental illness is poor, in general, and this may be attributed, in part, to inadequate dental care. This study investigated dental care utilization among patients with severe mental illness using a national representative sample.MethodsThis study used Taiwan’s National Health Insurance Research Dataset for 2009. Patients with the diagnosis of severe mental illness (ICD-9-CM: 290–298) were recruited as the study sample, and others comprised the control. Any visit to a dentist was defined as positive in terms of dental care utilization. Regression analyses were applied to determine the odds of dental care utilization for each diagnostic entity of severe mental illness, compared with the general population and controlling for potential covariates.ResultsOnly 40 % of 19,609 patients with severe mental illness visited the dentist within 12 months. This was significantly lower than the dental visit rate of 48.3 % for the control population (odds ratio [OR] = .72, 95 % confidence interval [CI] = .69–.74; P <0.0001). The odds of dental care utilization differed among the severe mental illness diagnostic categories; e.g., the odds were lowest among those with alcohol psychoses (OR = .54, CI = .43–.68), senile dementia (OR = .55, CI = .52–.59) and other organic psychoses (OR = .58, CI = .52–.65), and highest among those with mood disorder (OR = .89, CI = .85–.94), with schizophrenic patients occupying a mid-level position (OR = .63, CI = .59–.67).ConclusionsPatients with severe mental illness received less dental care than the general population. Health care providers and caregivers of patients with severe mental illness should encourage them to visit the dentist regularly, in order to improve the oral health of these vulnerable patient groups.

Oral Health Promotion Program for Persons With Severe Mental Illness: A Cluster Randomized Controlled Study

“…To cope with the universally poor oral health conditions among patients with SMI, multiple levels of strategies have been proposed, consisting of reorganization of dental services [26], increased accessibility to dental care [13], regular dental check-ups [19,27], undertaking aggressive preventive education programs [28], and improving oral health hygiene by means of educational intervention [29]. However, psychiatric patients are known to suffer from a variety of so-called negative symptoms, such as apathy and loss of drive, which would impede self-care and lead to neglect of oral hygiene [13].…”

“…Nevertheless, oral health is often neglected by psychiatric personnel and the patients themselves [13]. Despite their worsening oral health, these patients receive less dental treatment than the general population [19,20]. To date, only a few studies have investigated the effects of oral health education or interventions on people with SMI.…”

Can oral health and oral‐derived biospecimens predict progression of dementia?

“…Oral health tends to deteriorate as cognitive function declines (Martande et al, 2014;Ribeiro, Costa, Ambrosano, & Garcia, 2012). Reasons for this observation are likely multifaceted; for example, individuals with dementia often are limited by resources, capabilities for oral hygiene, and receive less dental care than the general population (Teng, Lin, & Yeh, 2016). Nevertheless, dementia has been found to be a strong predictor of poor oral health including the severity of periodontitis (Rapp, Sourdet, Vellas, & Lacoste-Ferre, 2017;Syrjala et al, 2012;Zenthofer et al, 2017;Zimmerman et al, 2017).…”

Comparison of attitudes towards persons with dementia, knowledge of dementia and ageism amongst students in Taiwan and Japan: A cross‐sectional study

“…Furthermore, hospitals tend to provide substandard care for older adults with dementia . A study of the National Health Insurance database of Taiwan revealed that the rate of visit to a dental office was 27.2% in older adults with dementia, which is significantly lower as compared to the control population (48.3%) . Conversely, a recent systemic review suggested that an increased risk of cognitive impairment was observed amongst patients with suboptimal oral health .…”