Abstract
Background
Young people experiencing a first episode of psychosis represent a vulnerable group of individuals with severe mental illness (SMI) who face poorer physical health than the general population across a range of conditions, with oral health no exception to that. The reason for this disparity is likely multifactorial, being a combination of medical, social, economic and lifestyle factors. Oral health is an important part of general health and well-being. Poor oral health can negatively impact an individual’s self-esteem, social interactions and their ability to eat, talk, smile, and laugh. Despite an improvement in overall population oral health, people with SMI appear to remain disadvantaged, experiencing poorer oral health and oral-health-related quality of life (OHRQoL) than the wider population.
This study investigated the oral health and OHRQoL of a group of young people with SMI in Christchurch, New Zealand. These individuals were being supported by Totara House, an early intervention, specialist, multidisciplinary service for young people experiencing their first episode of psychosis.
There is limited research in this field worldwide, with very few studies to have investigated oral health and OHRQoL in people with SMI. Only one such study exists in New Zealand (Broughton et al. 2020). That study observed longitudinal changes in the OHRQoL of these individuals and demonstrated that providing a comprehensive course of dental treatment greatly improved their OHRQoL. The current study adopted a similar methodological approach to that study by Broughton et al. (2020), with the aim to build on those findings.
Objectives
The objectives of this study were to:
(1) Describe the oral health status and dental treatment needs of mental health service
users in Christchurch and compare this to a similar age group in the general
population;
(2) Examine and quantify the impact of providing a course of dental treatment and
preventive care on the OHRQoL of this group of mental health service users; and
(3) Add context to these quantitative findings through qualitative interviews that explored the views of staff involved in the provision of services at Totara House and the Christchurch Hospital Dental Service.
Methods
A mixed-methods approach to an interventional study was undertaken, using a pre-post- treatment design complemented by qualitative interviews. A total of 35 participants (aged 18-30 years) were recruited from Totara House. They completed baseline questionnaires investigating sociodemographic, dental and self-care characteristics, dry mouth experience, dental fear, personality traits and OHRQoL (the latter measured using the OHIP-14). Baseline oral health status was recorded clinically and summarised as DMFT/DMFS scores and periodontal disease extent and severity. A comprehensive course of dental treatment and preventive care was then completed, with questionnaires repeated two months following treatment completion. A total of 11 participants completed the study in its entirety. Semi-structured qualitative interviews were also conducted to explore the views of six staff members on barriers to care as well as the sustainability and satisfaction of the integration of oral health care into the existing care at Totara House.
Results
The mean baseline OHIP-14 score was 20.6 (SD=10.2), and the majority of participants (77.1%) reported one or more OHIP-14 impact “fairly often” or “very often”. Psychological discomfort was the domain with the highest impact prevalence as well as the most severely- affected domain. A statistically significant improvement in OHRQoL was observed after dental treatment: the mean OHIP-14 score decreased from 19.9 (SD=9.9) before treatment to 14.7 (SD=10.0) after treatment; this represented a moderate improvement (ES=0.5) in OHRQoL after dental treatment. Likewise, OHIP-14 impact prevalence showed a statistically significant decrease, from 90.9% before treatment, to 36.4% after treatment.
The participants showed higher caries and periodontal disease experience than that of their age group in the wider population, with higher mean DT and DMFT and a higher prevalence of periodontal disease than 18-30-year-olds in the wider New Zealand population.
The key qualitative findings were that the integration of oral health services into the existing services at Totara House reduced barriers to oral health care and improved engagement with mental health services.
Conclusion
This study demonstrated that oral problems had a substantial impact on the well-being of these individuals at baseline, but that providing a comprehensive course of dental treatment significantly reduced the impact of oral problems on their day-to-day lives. The poor baseline oral health status seen in this group further highlights their unmet dental treatment need. Furthermore, not only does providing oral health care to these individuals improve their oral health and well-being, but it may also improve their mental health, through improved quality of life and better engagement in mental health services.