Kisely Steve, Baghaie Hooman, Lalloo Ratilal, Siskind Dan, Johnson Newell W
From the School of Medicine (S.K., D.S.), The University of Queensland, Woolloongabba, Australia; Griffith Health Institute (S.K., N.W.J.), Gold Coast, Queensland, Australia; Schools of Population Health and Dentistry (H.B.), University of Queensland, Herston, Queensland, Australia; and Australian Centre for Population Oral Health (R.L.), School of Dentistry, The University of Adelaide, South Australia, Australia.
Psychosom Med. 2015 Jan;77(1):83-92. doi: 10.1097/PSY.0000000000000135.
Psychiatric patients have increased comorbid physical illness. There is less information, however, on dental disease, especially tooth decay, despite life-style risk factors or psychotropic-induced dry mouth in this population. Importantly, poor oral health can predispose people to chronic physical disease leading to avoidable admissions to hospital for medical causes.
Using MEDLINE, PsycInfo, EMBASE, and article bibliographies, we undertook a systematic search for studies from the last 25 years regarding the oral health of people with severe mental illness (SMI). Results were compared with the general population. The two outcomes were total tooth loss (edentulism) and dental decay measured through the following standardized measures: the mean number of decayed, missing, and filled teeth or surfaces.
We identified 25 studies that had sufficient data for a random-effects meta-analysis. These covered 5076 psychiatric patients and 39,545 controls, the latter from either the same study or community surveys. People with SMI had 2.8 the odds of having lost all their teeth compared with the general community (95% confidence interval [CI] = 1.7-4.6). They also had significantly higher decayed, missing, and filled teeth (mean difference = 5.0, 95% CI = 2.5-7.4) and surfaces scores (mean difference = 14.6, 95% CI = 4.1-25.1).
The increased focus on the physical health of people with SMI should encompass oral health. Possible interventions could include oral health assessment conducted using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral.
精神科患者合并躯体疾病的情况增多。然而，关于牙科疾病，尤其是龋齿的信息较少，尽管该人群存在生活方式风险因素或精神药物引起的口干。重要的是，口腔健康状况不佳会使人们易患慢性躯体疾病，导致因医疗原因而不必要地住院。
我们利用医学文献数据库（MEDLINE）、心理学文摘数据库（PsycInfo）、荷兰医学文摘数据库（EMBASE）以及文章参考文献，对过去25年中关于重度精神疾病（SMI）患者口腔健康的研究进行了系统检索。将结果与普通人群进行比较。两个结果指标分别是全口牙齿缺失（无牙症）和通过以下标准化测量方法测得的龋齿情况：龋失补牙或牙面的平均数量。
我们确定了25项有足够数据进行随机效应荟萃分析的研究。这些研究涵盖了5076名精神科患者和39545名对照者，后者来自同一研究或社区调查。与普通人群相比，SMI患者全口牙齿缺失的几率高出2.8倍（95%置信区间[CI]=1.7 - 4.6）。他们的龋失补牙和牙面得分也显著更高（平均差值=5.0，95%CI = 2.5 - 7.4）以及（平均差值=14.6，95%CI = 4.1 - 25.1）。
对SMI患者身体健康的更多关注应包括口腔健康。可能的干预措施包括使用非牙科人员可完成的标准检查表进行口腔健康评估、口腔卫生帮助、医源性口干的管理以及早期牙科转诊。
