title: Advanced dental disease in people with severe mental illness: systematic review and meta-analysis.
abstract: BACKGROUND
  Psychiatric patients have increased comorbid physical illness. There is less information concerning dental disease in this population in spite of risk factors including diet and psychotropic side-effects (such as xerostomia). Aims To compare the oral health of people with severe mental illness with that of the general population.
  
  
  METHODS
  A systematic search for studies from the past 20 years was conducted using Medline, PsycINFO, Embase and article bibliographies. Papers were independently assessed. The primary outcome was total tooth loss (edentulousness), the end-stage of both untreated caries and periodontal disease. We also assessed dental decay through standardised measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS). For studies lacking a control group we used controls of similar ages from a community survey within 10 years of the study.
  
  
  RESULTS
  We identified 21 papers of which 14 had sufficient data (n = 2784 psychiatric patients) and suitable controls (n = 31 084) for a random effects meta-analysis. People with severe mental illness had 3.4 times the odds of having lost all their teeth than the general community (95% CI 1.6-7.2). They also had significantly higher scores for DMFT (mean difference 6.2, 95% CI 0.6-11.8) and DMFS (mean difference 14.6, 95% CI 4.1-25.1). Fluoridated water reduced the gap in oral health between psychiatric patients and the general population.
  
  
  CONCLUSIONS
  Psychiatric patients have not shared in the improving oral health of the general population. Management should include oral health assessment using standard checklists that can be completed by non-dental personnel. Interventions include oral hygiene and management of xerostomia.
authors: Health LinQ, Room 518(A), MacGregor Building (No. 64), University of Queensland, St Lucia, Brisbane, Qld 4072, Australia. s.kisely@uq.edu.au
authors: Steve
authors: S
authors: Kisely
authors: Lake-Hui
authors: LH
authors: Quek
authors: Joanne
authors: J
authors: Pais
authors: Ratilal
authors: R
authors: Lalloo
authors: Newell W
authors: NW
authors: Johnson
authors: David
authors: D
authors: Lawrence
mesh_terms: D015897:Comorbidity; D005457:Fluoridation; D054624:Health Status Disparities; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D009909:Oral Health / Q000592:standards; D009910:Oral Hygiene / Q000592:standards; D009057:Stomatognathic Diseases / Q000453:epidemiology* / Q000209:etiology