Wednesday, 29 August 2012

How to improve dental care in psychiatry


Dental care is poor and a disregarded health issue among people with serious mental illness. They are on a higher risk than average for tooth decay,inflamed gums and denture problems. Medication combined with reduced self care is an important cause. 
Poor dental health can increase the risk for social stigmatization / isolation and serious physical health problems. 
There is a causal link between poor oral health and cardiovascular disease and even stroke.Considering that people with serious mental illness like schizophrenia die 15-20 years earlier on average than the general population we have have enough reasons to take dental health seriously.




According to Danish research only 31% of schizophrenia patients complied with a regular annual dental check-up visit , compared to 68% in the general adult Danish population.  http://www.ncbi.nlm.nih.gov/pubmed/20584518 
Huge risks for poor dental care are: substance abuse diagnosis ,living in an institution or admission to a psychiatric facility for a minimum of 30 days  and male sex.
However Clozapine treatment, at least monthly outpatient visits , and age 50+ were associated with a lower risk for inappropriate dental care.

 

 Psychotropic meds can cause shortage or too much saliva or a change in acidity. Combined with poor oral health  this can make tooth decay occur faster. 
Many patients smoke. This increases the risk for gum disease : one of the leading causes of tooth loss in adults.
Smoking also slows down healing after oral surgery. It can damage gum tissue and receding gums leaving the roots of the teeth exposed. This can increase the risk of tooth decay and cause hot/cold sensitivity.

To improve the level of dental health we can help patients to

- Use less sugar and acidic products like carbonated drinks
- brush 2x a day preferably with an electrical toothbrush , they are much more efficient than ordinary brushes
- use fluoride toothpaste
- use floss or interdental cleaning brushes twice a day
- visit a dentist and support the visit if needed. We may ask the dentist about screening for the rate of salivation to see if the amount and acidity of the saliva is within limits.
- decrease smoking 
- Use 4 - 7 xylitol chewing gums or lozenges devided over the day. It needs to be 100% xylitol, no other sugar substitutes.This reduces dental    plaque. It stimulates the production of anti-bacterial saliva and remineralization of the teeth. And it partially replaces sugars in the diet (satisfies the ‘sweet tooth’) Using Xylitol chewing gum or rinse can decrease tooth decay with 60 %. For those who cant use gum or lozenges xylitol mouth water may be an option.
 In high amounts xylitol can have a laxative effect and cause flatulence.
- Inform patients that they should avoid to consume acidic products one hour before brushing  teeth. The surface of teeth is softened by the acid and can be damaged.

Let's make dental care a priority in psychiatry. After all it is basic care, not luxury .










17 comments:

  1. So very true I have personally lost 8 teeth due to my lack of care and have begged my CPN to come with me as I am too afraid to go alone. I always have to cancel appointments as do not have a friend to come with me. I can not go alone.

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  2. I support a lot of people on dentist visits.Some need a lot of encouragement and support to go there. I am supposed to do everything to increase physical and mental health so this is just part of my job. Maybe ask your CPN to schedule the appointments with you so it fits into her daily routine. Thats what I often do : I call the dentist for an appointment and explain that I have to come along.Good luck and dont forget the xylitol gum ! :)

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  3. I also agree with your blog that dental health require check up on regular basis.my mom is near about 48 year old and she lost almost all the tooth just because of her laziness of going for a dental checkup. Now she is taking the dentist treatment from past 2 month but dentist said that now your gems are also in a very bad condition so tooth implants is also not possible.
    Emergancy Calgary dentist

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  4. Im so sorry to hear that :-| Hoping to make a difference with my blog so further damage can be prevented for as many people as possible.
    I have 3 new clients since last month and they are all using the xylitol chewing gum now ( and were interested in the other advices , no one mentioned it before they said)

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  5. I've been a Mental Health consumer (patient) for over 20+ years now in my 40's. There has NEVER been a discussion about dental health or the side effects from medications that can damage/degrade oral hygiene and cause so much damage. Here in the US most people do not have dental insurance when working, let alone when collecting benefits/Social Security Disability. My parents are the only people I know (and they are healthy and retired) who maintain regular dental visits. I have bad wisdom teeth that will cost more than $4,000.00 to remove and i suffer every day, but I don't know when I'll be able to save that much money to have the treatment. Also, from the meds, my enamel is eroding like crazy and existing fillings are falling out. I never had a cavity/cary until I was 21 years old - now my mouth is a mess.

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    1. Governments need to help those with dental problems who can't afford to go to dentist. Doesn't cuba provide free dental for it's citizens. We need to expose the dental issues people face everyday!

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  6. Sorry to hear that :( In Europe things are very different. Is it possible to get help here ? http://www.dentalguideusa.org/state_dental_assistance.htm

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  7. I'm a 'service user' of mental health care in the UK - no one has mentioned anything about teeth, and it's only reading this that's made me notice I haven't been to the dentist in years and I hardly ever clean my teeth. Will try and do better. (AnnaM from twitter)

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  8. Glad it made you think :) Hope it will make many mental health workers think too, it a forgotten subject in psychiatry.
    Remember the xylitol gum, very important.Has to be the 100% variety.Many have different sugar substitutes, but only xylitol does the trick.

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  9. Thank you . Dental health is still easily forgottten by mental health workers. No priority. I have informed all my clients about this, now spreading the word worldwide hoping to create many white smiles among people with mental illness. With a little effort much can be achieved.

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  10. However Clozapine treatment, at least monthly outpatient visits , and age 50+ were associated with a lower risk for inappropriate dental care.click

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  11. We've been doing some research on oral health of Early Intervention in Psychosis service users. See following for some references:
    http://www.clahrc-ndl.nihr.ac.uk/clahrc-ndl-nihr/research/mentalhealth/dental-and-physical-health-needs/index.aspx

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  12. Interesting ! Hopefully in the next decade dental health care for these patients will improve.I had to inform my dentist about the topic, he had no clue. In the MH hospital its stil the part of care thats often forgotten.

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  13. Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P<0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P<0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P<0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency.

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  14. Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P<0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P<0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P<0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency.

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  15. It has been my experience that they tend to not take patient's dental health seriously at all when caring for psych. inpts. particularly in state institutions. Even when a pt. supplies things such as dental floss, they limit the size of floss to under approx. on inch or so. No wonder that ,coupled with a cocktail of psychotropic medications , and usual substandard health facilities coupled with the rate/fear of theft or loss of removed partials when asleep are some other reasons this should be public.Oh yes,I have also witnessed some staff at a now closed facility to have acted as if they thought it was entertaining to subject the patients to this type of treatment. It is about time that these very serious health concerns be made public !

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