Community Mental Health Journal

, Volume 46, Issue 6, pp 553–562 | Cite as

Oral Health of Adults with Serious Mental Illnesses: A Review

  • Naira Roland Matevosyan
Original Paper


(A) To assess the prevalence of suboptimal oral health in adults with SMI in studies published in 1971–2009; (B) To describe approaches that promote oral health among adults with SMI. A total of 57 randomized, quasi-randomized, cross-section, and cohort studies from samples of 38–4,769 mental health consumers are identified through database, journal, and Internet searches (Cochrane, FASTSTATS, PUBMED, Selected studies are inclusive for the sample, reported statistical power, and external validity. Oral health adverse outcomes (xerostomia, sialorrhoea, dental caries, extracted teeth, malocclusion, periodontal disease, edentulous, oral cancer) are considered as measurable outcomes. This review suggests a substantial prevalence of suboptimal oral health (61%) among individuals with serious mental illnesses. The following outcomes are mostly met: xerostomia, gross caries, decayed teeth, and periodontal disease. Poor oral hygiene, higher intake of carbonates, poor perception of oral health self-needs, length of psychotropic treatment, and less access to dental care determine suboptimal oral health among this population. Further replication of this research should generate gender-wise ethnic cohorts, including detailed observations of environmental factors, and medical problems that contribute to suboptimal oral health. This review highlights the importance of bridging dental health education to psychiatric rehabilitation programs.


Serious mental illness Oral health self-assessment 



Competing Interest

None declared.

Consent of the Research Subject

This is a literature review with synthesis. No human subjects are involved in this study.

Copyright Permission

This study does not include items that are subjects for copyright permission.


  1. Almomani, F., Williams, K. B., Catley, D., et al. (2009). Effects of an oral health promotion program in people with mental illnesses. Journal of Dental Research, 88(7), 648–652.CrossRefPubMedGoogle Scholar
  2. Angelillo, I. F., Grasso, G. M., Sagliocco, G., et al. (1991). Dental health in a group of drug addicts in Italy. Community Dentistry and Oral Epidemiology, 19(1), 36–37.CrossRefPubMedGoogle Scholar
  3. Baker, S. R. (2009). Applying Andersen’s behavioral model to oral health: What are the contextual factors shaping perceived oral health outcomes? Community Dental Health Epidemiology, Epub Oct. 21.Google Scholar
  4. Balwant, R. (2008). Oral health in patients with mental illness. The Internet Journal of Dental Science, 6(1).
  5. Bohlmann, G., Karl, C., & Loebe, F. M. (1986). Stomatological studies in schizophrenic patients—Contributions to the problem of medical and social integration of psychiatric patients. Psychiatrie, Neurologie, und Medizinische Psychologie (Leipz), 38(4), 194–197.Google Scholar
  6. Boyd, L. D., Dwyer, J. T., & Papas, A. (1997). Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: A case study. Nutrition Reviews, 55(10), 362–368.CrossRefPubMedGoogle Scholar
  7. Brothwell, D. J., Jay, M., & Schönwetter, D. J. (2008). Dental service utilization by independently dwelling older adults in Manitoba, Canada. Journal of Canadian Dental Association, 74(2), 161a–161f.Google Scholar
  8. Brown, L. J., & Lazar, V. (1999). Dental care utilization: How saturated is the patient market? Journal of the American Dental Association, 130(4), 573–580.PubMedGoogle Scholar
  9. Brufau-Redondo, C., Martín-Brufau, R., Corbalán-Velez, R., et al. (2008). Burning mouth syndrome. Actas Dermo-sifiliograficas, 99(6), 431–440.CrossRefPubMedGoogle Scholar
  10. Clark, D. B. (2003). Dental care for the patients with bipolar disorder. Journal of Canadian Dental Association, 69(1), 20–24.Google Scholar
  11. Cohen, L. K., & Gift, H. (1996). Disease prevention and oral health promotion: Socio-dental sciences in action. NY: Hardcover.Google Scholar
  12. Cormac, I., & Jenkins, P. (1999). Understanding the importance of oral health in psychiatric patients. Advances in psychiatric treatment, 5, 53–60.CrossRefGoogle Scholar
  13. DeBate, R. D., Plichta, S. B., Tedesco, L. A., et al. (2006). Integration of oral health care and mental health services: Dental hygienists’ readiness and capacity for secondary prevention of eating disorders. The Journal of Behavioral Health Services and Research, 33(1), 113–125.CrossRefGoogle Scholar
  14. Dougall, A., & Fiske, J. (2008). Access to special care dentistry, part 6. Special care dentistry services for young people. British Dental Journal, 205(5), 235–249.CrossRefPubMedGoogle Scholar
  15. Dougall, A., & Fiske, J. (2009). Surviving child sexual abuse: The relevance to dental practice. Dental Update, 36(5), 294–296. (298-300, 303-4).PubMedGoogle Scholar
  16. Dumitrescu, A. L., Dogaru, C. B., & Dogaru, C. D. (2008). Instability of self-esteem and affective lability as determinants of self_reported oral health status and oral health-related behaviors. The Journal of Contemporary Dental Practice, 9(1), 38–45.PubMedGoogle Scholar
  17. Finch, H., Keegan, J., Ward, K., et al. (1988). Barriers to the receipt of dental care, a qualitative study. A Report. London: Social and community planning research.
  18. Flammer, E., Breier, A., & Steinert, T. (2009). Oral health and hygiene among persons with severe mental illness. Psychiatric Services, 60(10), 1402. (author reply 1402-3).CrossRefPubMedGoogle Scholar
  19. Friedlander, A. H., & Liberman, R. P. (1991). Oral health care for the patient with schizophrenia. Special Care in Dentistry, 11(5), 179–183.CrossRefPubMedGoogle Scholar
  20. Griffiths, J., Jones, V., Leeman, I., et al. (2000). Oral health care for people with mental health problems: Guidelines and recommendations. British Society for Disability and Oral Health, A Report.
  21. Harris, C. K., Warnakulasuriya, K. A. A. S., & Johnson, N. W. (1996). Oral and dental health in alcohol misusers. Community Dental Health, 13, 199–203.PubMedGoogle Scholar
  22. Hashimoto, Y., & Mogi, K. (2006). Mental health of community-dwelling patients with mental disorders. Kitakanto Medical Journal, 56(1), 33–38.CrossRefGoogle Scholar
  23. Herrero, R., et al. (2003). Human papillomavirus and oral cancer: The international agency for research on cancer multi center study. Journal of the National Cancer Institute, 95(23), 1772–1783.PubMedGoogle Scholar
  24. Islam, S., Ahmed, M., & Walton, G. M. (2009). The association between depression and anxiety disorders following facial trauma. A comparative study. Injury, Epub Aug. 17.Google Scholar
  25. Kenealy, P. M., Kingdon, A., Richmond, S., et al. (2007). The Cardiff dental study: A 20-year critical evaluation of the psychological health gain from orthodontic treatment. British Journal of Health Psychology, 12(Pt 1), 17–49.CrossRefPubMedGoogle Scholar
  26. Kilbourne, A. M., Horvitz-Lennon, M., & Post, P. E., et al. (2007). Oral health in Veterans affairs patients diagnosed with serious mental illness. Journal of Public Health Dentistry, 67(1), 42–48.CrossRefPubMedGoogle Scholar
  27. Kressin, N. R., Reisine, S., Spiro, A., 3rd, et al. (2001). Is negative affectivity associated with oral quality of life? Community Dentistry and Oral Epidemiology, 29(6), 412–423.CrossRefPubMedGoogle Scholar
  28. Kumar, M., Chandu, G. N., & Shafiulla, M. D. (2006). Oral health status and treatment needs in institutionalized psychiatric patients: One year descriptive cross sectional study. Indian Journal of Dental Research, 17(4), 171–177.CrossRefPubMedGoogle Scholar
  29. Lamey, P. J. (1989). Oral medicine in practice: Burning mouth syndrome. British Dental Journal, 167, 197–200.CrossRefPubMedGoogle Scholar
  30. Lautch, H. A. (1971). Dental phobia. The British Journal of Psychiatry, 119, 151–158.CrossRefPubMedGoogle Scholar
  31. Lewis, S., Jagger, R. G., & Treasure, E. (2001). The oral health of psychiatric in-patients in South Wales. Special Care in Dentistry, 21(5), 182–186.CrossRefPubMedGoogle Scholar
  32. Little, J. W. (2003). Anxiety disorders: Dental implications. General Dentistry, 51(6), 562–568. (quiz 569).PubMedGoogle Scholar
  33. Longley, A. J., & Doyle, P. E. (2003). Mental illness and the dental patient. Journal of Dental Hygiene, 77(3), 190–208.PubMedGoogle Scholar
  34. Lucas, V. S. (1993). Associated of psychotropics drugs, prevalence of denture-related stomatitis and oral candidiasis. Community Dentistry and Oral Epidemiology, 21, 313–316.CrossRefPubMedGoogle Scholar
  35. Lynch, U., Lazenbatt, A., Freeman, R., et al. (2005). Making equity a reality: Oral health promotion in a psychiatric setting. The International Journal of Psychiatric Nursing Research, 10(2), 1078–1092.PubMedGoogle Scholar
  36. McCreadie, R. G., Stevens, H., Henderson, J., et al. (2004). The dental health of people with schizophrenia. Acta Psychiatrica Scandinavica, 110(4), 306–310.CrossRefPubMedGoogle Scholar
  37. Morio, K. A., Marshall, T. A., Qian, F., & Morgan, T. A. (2008). Comparing diet, oral hygiene and caries status of adult methamphetamine users and nonusers: A pilot study. The Journal of the American Dental Association, 139(2), 171–176.PubMedGoogle Scholar
  38. Morris, S., Benjamin, S., Gray, S., et al. (1995). Physical, psychiatric and social characteristics of the tempero-mandibular disorder pain dysfunction syndrome: The relationship of mental disorders to presentation. British Dental Journal, 182(7), 255–260.Google Scholar
  39. Muhvić-Urek, M., Uhac, I., Vuksić-Mihaljević, Z., et al. (2007). Oral health status in war veterans with post-traumatic stress disorder. Journal of Oral Rehabilitation, 34(1), 1–8.CrossRefPubMedGoogle Scholar
  40. Petrie, K. J., & Weinman, J. (1997). Perceptions of health and illness: Current research and applications. London: Harwood Academic Press (Hardcover).Google Scholar
  41. Prasher, V. P., & Janicki, M. P. (Eds.). (2002). Physical health of adults with intellectual disabilities. Oxford: Wiley-Blackwell (Paperback, 304 pp).
  42. Ramon, T., Grinshpoonb, A., & Zusmana, S. P. (2003). Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel. European Psychiatry, 18(3), 101–105.CrossRefPubMedGoogle Scholar
  43. Rekha, R., Hiremath, S. S., & Bharath, S. (2002). Oral health status and treatment requirements of hospitalized psychiatric patients in Bangalore city: A comparative study. Journal of Indian Society of Pedodontics and Preventive Dentistry, 20(2), 63–67.PubMedGoogle Scholar
  44. Robb, N. D., Smith, B. G. N., & Geidrys-Leeper, E. (1995). The distribution of erosion in dentitions of patients with eating disorders. British Dental Journal, 178, 171–175.CrossRefPubMedGoogle Scholar
  45. Rosmus, L., & Cobban, S. J. (2007). Bipolar affective disorder and the dental hygienist. Canadian Journal of Dental Hygiene, 41(2), 72–85.Google Scholar
  46. Scheutz, F. (1984a). Dental health in a group of addicts attending an addition clinic. Community Dentistry and Oral Epidemiology, 12, 23–28.CrossRefPubMedGoogle Scholar
  47. Scheutz, F. (1984b). Five-year evaluation of dental care delivery system for drug addicts in Denmark. Community Dentistry and Oral Epidemiology, 12, 29–34.CrossRefPubMedGoogle Scholar
  48. Scully, C., & Cawson, R. A. (1998). Medical problems in dentistry (4th ed.). Oxford: Butterwoth-Heinemann (Hardcover).
  49. Stevens, H. E. (2007). Oral candidiasis secondary to adverse anticholinergic effects of psychotropic medications. Journal of Adolescent and Child Psychopharmacology, 17(1), 145–146.CrossRefGoogle Scholar
  50. Stewart, R., & Hirani, V. (2007). Dental health and cognitive impairment in an English national survey population. Journal of the American Geriatrics Society, 55(9), 1410–1414.CrossRefPubMedGoogle Scholar
  51. Stiefel, D. J., Trauelove, E. L., & Menard, T. W. (1990). A comparison of the oral health of persons with and without chronic mental illness in community settings. Special Care Dentistry, 10, 6–12.CrossRefGoogle Scholar
  52. Tang, W. K., Sun, F. C., Ungvari, G. S., et al. (2004). Oral health of psychiatric in-patients in Hong Kong. International Journal of Social Psychiatry, 50(2), 186–191.CrossRefPubMedGoogle Scholar
  53. Thomas, A., Lavrentzou, E., Karouzos, C., et al. (1996). Factors which influence the oral condition of chronic schizophrenia patients. Special Care Dentistry, 16(2), 84–86.CrossRefGoogle Scholar
  54. Velasco, E., Machuca, G., Martinez-Sahuquillo, A., et al. (1997). Dental health among institutionalized psychiatric patients in Spain. Special Care Dentistry, 17(6), 203–206.CrossRefGoogle Scholar
  55. Whittle, J. G., Sarll, D. W., & Grant, A. A. (1987). The dental health of the elderly mentally ill: A preliminary report. British Dental Journal, 162, 381–383.CrossRefPubMedGoogle Scholar
  56. WHO Headquarters. (2007). Design of an oral health survey—Basic methods extracts of the 4th edition (pp. 5–9). Geneva: Oral Health program.Google Scholar
  57. Wright, E. F., Thompson, R. L., & Paunovich, E. D. (2004). Post-traumatic stress disorder: Considerations for dentistry. Quintessence International, 35(3), 206–210.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Boston UniversityBostonUSA

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