title: The oral health of people with chronic schizophrenia: A neglected public health burden.
abstract: OBJECTIVE
  People with chronic schizophrenia have high rates of physical ill-health such as heart disease. However, there has been less attention to the issue of poor oral health including dental caries (tooth decay) and periodontal (gum) disease, although both have consequences for quality of life and systemic physical health. We therefore measured tooth decay and gum disease in Malaysians with schizophrenia.
  
  
  METHODS
  We recruited long-stay inpatients with schizophrenia from June to October 2014. Four dental specialists assessed oral health using the decayed-missing-filled teeth index, the Community Periodontal Index of Treatment Needs and the Debris Index of the Simplified Oral Hygiene Index. Results were compared with the 2010 Oral Health survey of the general Malaysian population.
  
  
  RESULTS
  A total of 543 patients participated (66.7% males, 33.3% females; mean age = 54.8 years [standard deviation = 16.0]) with a mean illness duration of 18.4 years (standard deviation = 17.1). The mean decayed-missing-filled teeth was 20.5 (standard deviation = 9.9), almost double that of the general population (11.7). Higher decayed-missing-filled teeth scores were associated with both older age (p < 0.001) and longer illness duration (p = 0.048). Only 1% (n = 6) had healthy gums. Levels of decay and periodontal disease were greatest in those aged between 45 and 64 years, coinciding with the onset of tooth loss.
  
  
  CONCLUSIONS
  Dental disease in people with schizophrenia deserves the same attention as other comorbid physical illness. The disparity in oral health is most marked for dental decay. Possible interventions include oral health assessments using standard checklists designed for non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth and early dental referral.
authors.affiliation: Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Mang Chek
authors.initials: MC
authors.lastname: Wey
authors.affiliation: Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia syloh@um.edu.my siewyimloh@yahoo.com.
authors.forename: SiewYim
authors.initials: S
authors.lastname: Loh
authors.affiliation: Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Jennifer Geraldine
authors.initials: JG
authors.lastname: Doss
authors.affiliation: Permai Psychiatric Institution, Johor Bahru, Malaysia.
authors.forename: Abdul Kadir
authors.initials: AK
authors.lastname: Abu Bakar
authors.affiliation: School of Medicine, The University of Queensland, Australia, Woolloongabba, QLD, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Kisely
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017281:Cost of Illness; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D006293:Health Promotion; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D009911:Oral Hygiene Index; D010512:Periodontal Index; D011634:Public Health; D011788:Quality of Life; D012559:Schizophrenia / Q000150:complications*; D016388:Tooth Loss / Q000453:epidemiology*; D055815:Young Adult
keywords: Oral Hygiene Index; Schizophrenia; burden of care; decayed–missing–filled teeth; dental caries; health promotion; inequality; institutionalized; periodontal; public health