Avoidable emergency department presentations for dental comorbidities of psychiatric disorders: A population-based record-linkage analysis

Medical profile of patients referred to an Australian postgraduate oral surgery clinic

BACKGROUND AND OBJECTIVES

Thorough knowledge of a patient's medical history and medications is necessary for providing safe oral surgery care, and may be considered a form of risk management. This study investigated the prevalence of medical conditions and medication types in patients referred to an Australian postgraduate oral surgery clinic over 2 years.

MATERIALS AND METHODS

A retrospective cross-sectional study of the clinical records of 233 randomized patients referred to the Griffith University (Queensland, Australia) postgraduate oral surgery clinic in 2018 and 2019 was performed. Medical conditions and medications were counted and categorized, and descriptive statistics were generated.

RESULTS

In all, 133 patients (57%) had at least one medical condition. 58% of them (77) had two or more categories of medical conditions, representing nearly a third (33.0%) of all sampled patients. The most prevalent category of medical conditions was psychiatric (25.3%), followed closely by cardiovascular (24.5%) diseases. Cardiovascular medications were the most prevalent, comprising 23.6% of all medications recorded, followed by psychotropics (18.3%).

CONCLUSION

Over half of patients referred to the postgraduate oral surgery clinic had at least one systemic medical condition. Nearly a third of patients referred had at least two distinct systemic medical conditions. With an ageing population and the accompanying rise in multimorbidity globally, dental school curricula must adapt to prepare students to meet these challenges in their careers.

Why and how we can use data linkage in oral health research: a narrative review

OBJECTIVES

Poor oral health, impacting health and wellbeing across the life-course, is a costly and wicked problem. Data (or record) linkage is the linking of different sets of data (often administrative data gathered for non-research purposes) that are matched to an individual and may include records such as medical data, housing information and sociodemographic information. It often uses population-level data or 'big data'. Data linkage provides the opportunity to analyse complex associations from different sources for total populations. The aim of the paper is to explore data linkage, how it is important for oral health research and what promise it holds for the future.

METHODS

This is a narrative review of an approach (data linkage) in oral health research.

RESULTS

Data linkage may be a powerful method for bringing together various population datasets. It has been used to explore a wide variety of topics with many varied datasets. It has substantial current and potential application in oral health research.

CONCLUSIONS

Use of population data linkage is increasing in oral health research where the approach has been very useful in exploring the complexity of oral health. It offers promise for exploring many new areas in the field.

Mental Disorders and Oral Diseases: Future Research Directions

The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.

Prevalence of dental disorders among people with mental illness: An umbrella review

OBJECTIVE

Psychiatric patients have increased rates of comorbid physical illness. There are less data on dental disease, especially decay, despite risk factors including lifestyle and psychotropic side effects such as xerostomia. We therefore undertook an umbrella review of all meta-analyses on the association between mental illness and oral health.

METHODS

We searched PubMed, MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, Embase and CINAHL. Articles were independently assessed. Outcomes were caries, periodontal disease, erosion, and partial or total tooth loss (edentulism), measured where possible with standardised measures such as the mean number of decayed, missing and filled teeth or surfaces. Quality was assessed in line with National Institutes of Health guidelines.

RESULTS

We identified 11 meta-analyses. The most information and strongest association was between dental decay and severe mental illness or substance use, as well as erosion and eating disorders. Depressive, anxiety and eating disorders were also associated with caries, but the datasets were small. People with severe mental illness had nearly three times the odds of having lost all their teeth than the general community (odds ratio = 2.81, 95% confidence interval = [1.73, 4.57]) and those with depression between 1.17 and 1.32. Findings for periodontal disease were more equivocal, possibly because of study heterogeneity.

CONCLUSION

Mental health clinicians should screen for oral diseases when treating those with mental illness and facilitate referral to affordable dental clinics when indicated. Prevention should be a priority, including the promotion of dental care, as well as the management of xerostomia when psychopharmacologic agents are prescribed.

A study of the association between psychiatric symptoms and oral health outcomes in a population-based birth cohort at 30-year-old follow-up

OBJECTIVE

Most studies of the association between psychiatric disorders and poor oral health have been conducted in clinical settings. Where available, data from community surveys have generally been cross-sectional or considered anxiety and depression as a consequence of poor oral health, not the other way round. This study therefore used a birth cohort to assess the association of mental health, measured both cross-sectionally and longitudinally, and oral health at 30-year follow-up.

METHODS

There were 2456 adults with data on dental outcomes and oral health care at 30-year follow-up. Psychiatric morbidity was measured at both 21- and 30-year follow-up using standardised instruments including the Centre for Epidemiological Studies-Depression (CES-D) scale and Composite International Diagnostic Interview (CIDI).

RESULTS

At follow-up, 850 participants (34.6%) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One third had not visited a dental clinic in the previous two years and 40% failed to brush their teeth at least twice daily. On adjusted analyses, dental extraction and pain were significantly associated with psychiatric morbidity cross-sectionally at 30-year follow-up and also longitudinally when psychiatric symptoms were present at both 21 and 30 years old. Several cross-sectional measures of psychiatric morbidity were also associated with frequency of tooth brushing. There were no associations with dental clinic visits.

CONCLUSIONS

The study demonstrates there are associations between oral and mental health, which are not limited to clinical settings, but were observed at a population level.

A state-wide study of dental comorbidities in psychiatric disorders resulting in avoidable emergency department presentations

BACKGROUND

Attendances at emergency departments (EDs) for dental conditions are unnecessary and come at a significant cost to health services.

METHODS

A population-based record-linkage analysis of a retrospective cohort over 2 years across state-based facilities in Queensland. This was to determine if people with mental illness were more likely than the general population to attend EDs for a range of non-traumatic or avoidable dental conditions.

RESULTS

There were 1 381 428 individuals in the linked database, of whom 177 157 (13%) had a psychiatric history and 22 046 (1.5%) had one or more avoidable dental presentations. These were toothache (n = 9619), dental abscesses (n = 8449), caries (n = 1826), stomatitis (n = 1213) and gum disease (n = 939). After adjusting for confounders, psychiatric patients were significantly more likely to present with toothache, dental abscesses and caries but not stomatitis or gum disease. Depending on the dental outcome, other risk factors were male sex, lower income, rurality and Indigenous status.

CONCLUSIONS

Given these findings, possible interventions should include an increased emphasis on assessing oral health in mental health or primary care, especially in non-metropolitan areas, as well as early dental referral. Service planning for this population should including easier navigation of dental services, availability outside normal office hours and free outreach dental clinics.