Improving oral health in people with severe mental illness (SMI): A systematic review

Background Those with severe mental illness (SMI) are at greater risk of having poor oral health, which can have an impact on daily activities such as eating, socialising and working. There is currently a lack of evidence to suggest which oral health interventions are effective for improving oral health outcomes for people with SMI. Aims This systematic review aims to examine the effectiveness of oral health interventions in improving oral health outcomes for those with SMI. Methods The review protocol was registered with PROSPERO (ID CRD42020187663). Medline, EMBASE, PsycINFO, AMED, HMIC, CINAHL, Scopus and the Cochrane Library were searched for studies, along with conference proceedings and grey literature sources. Titles and abstracts were dual screened by two reviewers. Two reviewers also independently performed full text screening, data extraction and risk of bias assessments. Due to heterogeneity between studies, a narrative synthesis was undertaken. Results In total, 1462 abstracts from the database search and three abstracts from grey literature sources were identified. Following screening, 12 studies were included in the review. Five broad categories of intervention were identified: dental education, motivational interviewing, dental checklist, dietary change and incentives. Despite statistically significant changes in plaque indices and oral health behaviours as a result of interventions using dental education, motivational interviewing and incentives, it is unclear if these changes are clinically significant. Conclusion Although some positive results in this review demonstrate that dental education shows promise as an intervention for those with SMI, the quality of evidence was graded as very low to moderate quality. Further research is in this area is required to provide more conclusive evidence.

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Oral health inequality in people with severe mental illness: a cross-sectional study using National Health and Nutrition Examination Survey 1999-2016

10.1101/2021.03.17.21253840 ◽

2021 ◽

Author(s):

Jing Kang ◽

Jianhua Wu ◽

Vishal Aggarwal ◽

David Shiers ◽

Tim Doran ◽

...

Keyword(s):

Risk Factors ◽

Mental Illness ◽

Oral Health ◽

General Population ◽

Health Outcomes ◽

Severe Mental Illness ◽

Tooth Loss ◽

List Type ◽

Cross Sectional ◽

Oral Health Outcomes

AbstractOBJECTIVETo explore whether people with severe mental illness (SMI) experience worse oral health compared to the general population, and the risk factors for poor oral health in people with SMI.METHODThis study used cross-sectional data from the National Health and Nutrition Examination Survey (1999-2016) including on self-rated oral health, ache in mouth, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. The authors used ordinal logistic regression and zero-inflated negative binomial models to explore predictors of oral health outcomes.RESULTS53,348 cases were included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.40, 95% CI: 1.12-1.75). In people with SMI, the risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes.CONCLUSIONSPeople with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Having a healthy lifestyle such as performing regular physical exercise and flossing may lower the risk of poor oral health. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes.Significant outcomes (x3)People with severe mental illness were at 40% higher risk of tooth loss when compared to the general population.Older adults, smokers and people with diabetes were at particularly high risk of poor oral health.Physical exercise and daily use of dental floss were associated with better oral health outcomes.Limitations (x3)The number of cases with data on periodontal disease was limited.The study was cross-sectional so causation could not be inferred.The analysis used prescriptions of antipsychotic and mood stabilising medication as a proxy measure of severe mental illness, as clinical diagnoses were not available in the dataset.Data availability statementThe NHANES 1999-2016 data is available at CDC website: https://www.cdc.gov/nchs/nhanes/index.htm, and is accessible and free to download for everyone.

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A systematic review of oral health outcomes produced by dental teams incorporating midlevel providers

The Journal of the American Dental Association ◽

10.14219/jada.archive.2013.0017 ◽

2013 ◽

Vol 144 (1) ◽

pp. 75-91 ◽

Cited By ~ 13

Author(s):

J. Timothy Wright ◽

Frank Graham ◽

Catherine Hayes ◽

Amid I. Ismail ◽

Kirk W. Noraian ◽

...

Keyword(s):

Systematic Review ◽

Oral Health ◽

Health Outcomes ◽

Midlevel Providers ◽

Oral Health Outcomes

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A Systematic Review and Meta-Analysis of the Association Between Poor Oral Health and Severe Mental Illness

Psychosomatic Medicine ◽

10.1097/psy.0000000000000135 ◽

2015 ◽

Vol 77 (1) ◽

pp. 83-92 ◽

Cited By ~ 58

Author(s):

Steve Kisely ◽

Hooman Baghaie ◽

Ratilal Lalloo ◽

Dan Siskind ◽

Newell W. Johnson

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Oral Health ◽

Severe Mental Illness ◽

Meta Analysis

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Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis

Clinical Oral Investigations ◽

10.1007/s00784-018-2611-y ◽

2018 ◽

Vol 22 (8) ◽

pp. 2685-2702 ◽

Cited By ~ 14

Author(s):

Mariana Gonzalez Cademartori ◽

Márcia Torres Gastal ◽

Gustavo Giacommelli Nascimento ◽

Flavio Fernando Demarco ◽

Marcos Britto Corrêa

Keyword(s):

Systematic Review ◽

Oral Health ◽

Health Outcomes ◽

Meta Analysis ◽

Oral Health Outcomes

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Beverages Consumption and Oral Health in the Aging Population: A Systematic Review

Frontiers in Nutrition ◽

10.3389/fnut.2021.762383 ◽

2021 ◽

Vol 8 ◽

Author(s):

Roberta Zupo ◽

Fabio Castellana ◽

Sara De Nucci ◽

Vittorio Dibello ◽

Madia Lozupone ◽

...

Keyword(s):

Systematic Review ◽

Oral Health ◽

Periodontal Disease ◽

Health Outcomes ◽

Tooth Loss ◽

Alcohol Intake ◽

Aging Population ◽

Alcoholic Beverages ◽

Sugary Drinks ◽

Oral Health Outcomes

Little study has yet been made of the effect of different beverages on oral health outcomes in the aging population. The purpose of this systematic review is to evaluate the association between different beverages, including alcohol intake, coffee, milk, tea, and sugary drinks, and a cluster of oral health outcomes, including periodontal disease, oral dysbiosis, and tooth loss in older adults. The literature was screened from the inception up to May 2021 using six different electronic databases. Two independent researchers assessed the eligibility of 1308 retrieved articles regarding inclusion criteria; only 12 fitted the eligibility requirements, representing 16 beverage entries. A minimum age of 60 was the inclusion criterion. No exclusion criteria were applied to outcomes assessment tools, recruiting facilities (hospital or community), general health status, country, and study type (longitudinal or cross-sectional). The consumption of alcoholic beverages was expressed as alcohol intake in all eligible studies, thereby replacing alcoholic beverages in the analysis. The quality of evidence was judged as moderate for alcohol and low or very low for beverages. In regard to oral health in the elderly, the review identified information on alcohol (56.25%), followed by coffee (18.75%), milk (12.50%), tea (6.25%), and sugary drinks (6.25%). Alcohol, sugary drinks, and coffee were found to be related to tooth loss. Periodontal disease was inversely related to coffee and milk, but fostered by alcohol consumption. In one article, tea but not coffee seemed to improve oral microbiota. In summary, alcohol seems to be a driver for tooth loss and periodontal disease in the aging population. However, more research is needed to gain a more solid knowledge in this research area.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO, Identifier: CRD42021256386.

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The effectiveness of sexual health interventions for people with severe mental illness: a systematic review

Health Technology Assessment ◽

10.3310/hta18010 ◽

2014 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Eva Kaltenthaler ◽

Abdullah Pandor ◽

Ruth Wong

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Sexual Health ◽

Severe Mental Illness ◽

Health Interventions

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Sedentary behaviour associations with health outcomes in people with severe mental illness: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz016 ◽

2019 ◽

Author(s):

Judit Bort-Roig ◽

Laia Briones-Buixassa ◽

Mireia Felez-Nobrega ◽

Anna Guàrdia-Sancho ◽

Mercè Sitjà-Rabert ◽

...

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Health Outcomes ◽

Severe Mental Illness ◽

Sedentary Behaviour

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Effectiveness of motivational interviewing at improving oral health: a systematic review

Revista de Saúde Pública ◽

10.1590/s0034-8910.2014048004616 ◽

2014 ◽

Vol 48 (1) ◽

pp. 142-153 ◽

Cited By ~ 27

Author(s):

Andreia Morales Cascaes ◽

Renata Moraes Bielemann ◽

Valerie Lyn Clark ◽

Aluísio J D Barros

Keyword(s):

Oral Health ◽

Dental Caries ◽

Health Behaviors ◽

Health Outcomes ◽

Motivational Interviewing ◽

Clinical Outcomes ◽

Dental Plaque ◽

Oral Health Behaviors ◽

The Impact ◽

Oral Health Outcomes

OBJECTIVE : To analyze the effectiveness of motivational interviewing (MI) at improving oral health behaviors (oral hygiene habits, sugar consumption, dental services utilization or use of fluoride) and dental clinical outcomes (dental plaque, dental caries and periodontal status). METHODS : A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google Scholar bibliographic databases was conducted looking for intervention studies that investigated MI as the main approach to improving the oral health outcomes investigated. RESULTS : Of the 78 articles found, ten met the inclusion criteria, all based on randomized controlled trials. Most studies (n = 8) assessed multiple outcomes. Five interventions assessed the impact of MI on oral health behaviors and nine on clinical outcomes (three on dental caries, six on dental plaque, four on gingivitis and three on periodontal pockets). Better quality of evidence was provided by studies that investigated dental caries, which also had the largest population samples. The evidence of the effect of MI on improving oral health outcomes is conflicting. Four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. In two interventions, the actual difference between groups was not reported or able to be recalculated. CONCLUSIONS : We found inconclusive effectiveness for most oral health outcomes. We need more and better designed and reported interventions to fully assess the impact of MI on oral health and understand the appropriate dosage for the counseling interventions.

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