Burden of Impaired Oral health in people with severe mental illness: results from UK Biobank and NHANES population based studies

Problem

Oral health outcomes are worse in people experiencing severe mental illness (SMI). However, few studies have explored outcomes in large, nationally representative data. A better understanding of shared risk factors for impaired oral health in SMI would enable targeted prevention.Aims: To investigate the extent to which people with SMI have decayed, missing and filled teeth and periodontal disease and whether this is associated with demographic, life-style, and co-morbid medical conditions.

Approach

Cross-sectional analyses of baseline data from the UK Biobank study (2007 -2010) and from the NHANES (1999-2016). Information was available on self-rated oral health: ache in mouth, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. SMI was identified using clinical diagnosis, antipsychotic medication, and self-report. Demographic (age, gender, ethnicity, socio-economic status), lifestyle (BMI, blood pressure, smoking and alcohol intake, physical activity) and physical co-morbidities (cancer, cardiovascular, respiratory, inflammatory disease and metabolic conditions) were included as potential risk factors for periodontal disease in logistic regression, ordinal logistic regression and zero-inflated negative binomial models.

Findings

Both analyses revealed similar predictors and patterns for impaired oral health. In the UK Biobank cohort, risk of periodontal disease was higher in people with psychosis, regardless of how cases were identified. Patients with a clinical diagnosis had the highest proportion of periodontal disease compared to the general population (21.3% vs 14.8%). Older and female cases were more likely to experience periodontal disease. Lifestyle factors (e.g. smoking) and comorbidities (e.g. cardiovascular, cancer, or respiratory disease) were also associated with periodontal disease in people with SMI. Similarly in the NHANES population in the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.40, 95% CI: 1.12-1.75). In people with SMI, risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes.

Consequences

People with SMI experience higher rates of periodontal disease and tooth loss than the general population, and certain subgroups are particularly at risk. Prevention and early diagnosis of poor oral health including periodontal disease should be a priority for oral health promotion programmes and should also address modifiable risk factors like smoking, which increase the risk of poor oral health and co-morbid systemic disease. Performing regular physical exercise and flossing may lower the risk of poor oral health. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes in people with SMI. Impact: These findings were used to inform an oral health consensus statement that sets out 5-year targets to improve oral health in people with SMI. (www.lancaster.ac.uk/right-to-smile-project).