Exploring oral health indicators, oral health-related quality of life and nutritional aspects in 23 medicated patients from a short-term psychiatric ward

Background Patients suffering from psychiatric disorders face many difficulties due to their condition, medications and lifestyle. Oral health and nutrition may be affected, further complicating their lives. Our aim was to provide in-depth information on oral health and nutritional factors in a small group of patients in short-term psychiatric ward. Methods Twenty-three patients (mean age 36, average medications five) were recruited during short-term hospitalization in a psychiatric ward. Inclusion criteria: anxiety, psychosis and/or depression, and use of at least one antidepressant or anxiolytic/antipsychotic drug with xerostomia as a known side effect. Subjective oral dryness was evaluated using the Shortened Xerostomia Inventory (SXI). Oral examination included Clinical Oral Dryness Score (CODS), secretion of unstimulated (UWS) and stimulated whole saliva (SWS), and evaluation of dental, gingival, and periodontal status. Self-reported complaints of oral disorders were recorded. The Oral Health Impact Profile-14 (OHIP-14) was used to explore oral health-related quality of life. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and diet quality was assessed using the Mediterranean diet score (KIDMED). Results Compared to healthy controls, the patients had significantly higher SXI scores and CODS, and SWS secretion was lower. Complaints of dysgeusia and halitosis were significantly more frequent among patients. Gingivitis was more common in patients. OHIP-14 scores were much higher in the patients, and they reported significantly poorer oral and general health. Most patients lacked a regular meal pattern. Very low diet quality was observed in five patients, while improvements were needed in twelve. “Dry mouth” and “No appetite, just did not feel like eating” were the most common symptoms preventing patients from eating enough. The PG-SGA-SF symptoms component score showed a strong negative correlation with self-reported oral health, and a strong positive correlation with OHIP-14. Conclusion This relatively small group of patients in short-term psychiatric ward had both reduced oral health and poor oral health-related quality of life. Furthermore, their nutritional intake was affected by their oral health problems. Although larger groups need to be studied, these findings indicate that oral health and nutrition should be evaluated and adjusted in these patients to improve their overall care.

[1]  B. Gillain,et al.  Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients' and Healthcare Professionals' Perspectives , 2022, Frontiers in Psychiatry.

[2]  S. Teasdale,et al.  The Development of a Nutrition Screening Tool for Mental Health Settings Prone to Obesity and Cardiometabolic Complications: Study Protocol for the NutriMental Screener , 2021, International journal of environmental research and public health.

[3]  G. Navis,et al.  Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment Short Form and their predictive validity in hospitalized patients. , 2021, Clinical nutrition ESPEN.

[4]  G. Tsakos,et al.  Adult oral health-related quality of life instruments: A systematic review. , 2021, Community dentistry and oral epidemiology.

[5]  I. Shatwan,et al.  Snacking patterns throughout the life span: potential implications on health. , 2021, Nutrition research.

[6]  V. Anand,et al.  Barriers to and Facilitators of Oral Health Among Persons Living With Mental Illness: A Qualitative Study. , 2020, Psychiatric services.

[7]  N. D. de Vries,et al.  Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review , 2020, Nutrition reviews.

[8]  E. Fotiadou,et al.  MEDITERRANEAN DIET AND ADOLESCENTS WITH INTELLECTUAL DISABILITIES , 2020 .

[9]  P. Kris-Etherton,et al.  Nutrition and behavioral health disorders: depression and anxiety. , 2020, Nutrition reviews.

[10]  Hwanseok Choi The Relationship Between Obesity and Depression Among Federally Qualified Health Center Patients , 2019, Journal of Public Health in the Deep South.

[11]  A. Bye,et al.  Patient interpretation of the Patient-Generated Subjective Global Assessment (PG-SGA) Short Form , 2019, Patient preference and adherence.

[12]  B. Baune,et al.  A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED) , 2017, Nutritional neuroscience.

[13]  D. Jager,et al.  Clinical oral dryness score: evaluation of a new screening method for oral dryness , 2018, Odontology.

[14]  D. Jager,et al.  Clinical oral dryness score: evaluation of a new screening method for oral dryness , 2018, Odontology.

[15]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[16]  R. Weyant,et al.  A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. , 2017, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[17]  R. Lalloo,et al.  The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. , 2016, Journal of affective disorders.

[18]  T. Bjørnland,et al.  Mandibular third molar surgery in 396 patients at a Norwegian university clinic: Morbidity recorded after 1 week utilizing an e-infrastructure for clinical research , 2016, Acta odontologica Scandinavica.

[19]  S. Kisely No Mental Health without Oral Health , 2016, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[20]  G. Proctor,et al.  Clinical Scoring Scales for Assessment of Dry Mouth , 2015 .

[21]  R. Lalloo,et al.  Oral health of patients on psychotropic medications: a study of outpatients in Queensland , 2013, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[22]  P. Marik,et al.  Narrative Review , 2012, Journal of intensive care medicine.

[23]  A. Al-Mobeeriek Oral health status among psychiatric patients in Riyadh, Saudi Arabia. , 2012, The West Indian medical journal.

[24]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[25]  W. Thomson,et al.  Shortening the xerostomia inventory. , 2011, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[26]  J. Pais,et al.  Advanced dental disease in people with severe mental illness: systematic review and meta-analysis , 2011, British Journal of Psychiatry.

[27]  Tiril Willumsen,et al.  Rusavhengighet, psykiatri og oral helse. Rapport fra et sykehusprosjekt i Oslo , 2010, Den norske tannlegeforenings Tidende.

[28]  G. Campisi,et al.  Oral manifestations of eating disorders: a critical review. , 2008, Oral diseases.

[29]  M. Adamek,et al.  Depression and anxiety. , 2013, The Medical journal of Australia.

[30]  A. Mackay-Sim,et al.  Normative data for the “Sniffin’ Sticks” including tests of odor identification, odor discrimination, and olfactory thresholds: an upgrade based on a group of more than 3,000 subjects , 2007, European Archives of Oto-Rhino-Laryngology.

[31]  P. Major,et al.  Prevalence of xerostomia in population-based samples: a systematic review. , 2006, Journal of public health dentistry.

[32]  Abraham Weizman,et al.  Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel , 2003, European Psychiatry.

[33]  G Kobal,et al.  Quantitative assessment of gustatory function in a clinical context using impregnated "taste strips". , 2003, Rhinology.

[34]  M Ferguson,et al.  Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer , 2002, European Journal of Clinical Nutrition.

[35]  R. Jagger,et al.  The oral health of psychiatric in-patients in South Wales. , 2001, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[36]  P. Cardon,et al.  A qualitative study. , 2001 .

[37]  G. Nordström,et al.  Oral health status of psychiatric patients. , 2000, Journal of clinical nursing.

[38]  J. Meurman,et al.  Xerostomia and Hyposalivation , 1999, Drugs & aging.

[39]  C. Douglass,et al.  The impact of edentulousness on food and nutrient intake. , 1996, Journal of the American Dental Association.

[40]  S. Langmore,et al.  Geriatric Oral Health and Its Impact on Eating , 1996, Journal of the American Geriatrics Society.

[41]  M. Lennernäs,et al.  Food selection in anorectics and bulimics: food items, nutrient content and nutrient density. , 1995, Journal of the American College of Nutrition.

[42]  B. Hede Oral health in Danish hospitalized psychiatric patients. , 1995, Community dentistry and oral epidemiology.

[43]  B. Hede Dental health behavior and self-reported dental health problems among hospitalized psychiatric patients in Denmark. , 1995, Acta odontologica Scandinavica.

[44]  G. Slade,et al.  Development and evaluation of the Oral Health Impact Profile. , 1994, Community dental health.

[45]  E. Truelove,et al.  A comparison of the oral health of persons with and without chronic mental illness in community settings. , 1990, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[46]  Y. Ericsson,et al.  Individual diagnosis, prognosis and counselling for caries prevention. , 1978, Caries research.

[47]  C. Aring,et al.  A CRITICAL REVIEW , 1939, Journal of neurology and psychiatry.