title: A systematic review and meta-analysis of the association between poor oral health and severe mental illness.
abstract: BACKGROUND
  Psychiatric patients have increased comorbid physical illness. There is less information, however, on dental disease, especially tooth decay, despite life-style risk factors or psychotropic-induced dry mouth in this population. Importantly, poor oral health can predispose people to chronic physical disease leading to avoidable admissions to hospital for medical causes.
  
  
  METHODS
  Using MEDLINE, PsycInfo, EMBASE, and article bibliographies, we undertook a systematic search for studies from the last 25 years regarding the oral health of people with severe mental illness (SMI). Results were compared with the general population. The two outcomes were total tooth loss (edentulism) and dental decay measured through the following standardized measures: the mean number of decayed, missing, and filled teeth or surfaces.
  
  
  RESULTS
  We identified 25 studies that had sufficient data for a random-effects meta-analysis. These covered 5076 psychiatric patients and 39,545 controls, the latter from either the same study or community surveys. People with SMI had 2.8 the odds of having lost all their teeth compared with the general community (95% confidence interval [CI] = 1.7-4.6). They also had significantly higher decayed, missing, and filled teeth (mean difference = 5.0, 95% CI = 2.5-7.4) and surfaces scores (mean difference = 14.6, 95% CI = 4.1-25.1).
  
  
  CONCLUSIONS
  The increased focus on the physical health of people with SMI should encompass oral health. Possible interventions could include oral health assessment conducted using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral.
authors.affiliation: From the School of Medicine (S.K., D.S.), The University of Queensland, Woolloongabba, Australia; Griffith Health Institute (S.K., N.W.J.), Gold Coast, Queensland, Australia; Schools of Population Health and Dentistry (H.B.), University of Queensland, Herston, Queensland, Australia; and Australian Centre for Population Oral Health (R.L.), School of Dentistry, The University of Adelaide, South Australia, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Kisely
authors.forename: Hooman
authors.initials: H
authors.lastname: Baghaie
authors.forename: Ratilal
authors.initials: R
authors.lastname: Lalloo
authors.forename: Dan
authors.initials: D
authors.lastname: Siskind
authors.forename: Newell W
authors.initials: NW
authors.lastname: Johnson
mesh_terms: D016022:Case-Control Studies; D015897:Comorbidity; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D006801:Humans; D007575:Jaw, Edentulous / Q000453:epidemiology*; D001523:Mental Disorders / Q000453:epidemiology*; D009909:Oral Health; D012720:Severity of Illness Index