Oral health problems and support as experienced by people with severe mental illness living in community-based subsidised housing - a qualitative study

Abstract

The purpose of this study was to explore how persons with severe mental illness (SMI) experience oral health problems (especially dry mouth), and weigh the support they received in this regard from professionals and staff at community-based congregate housing through a controlled intervention programme. Oral health problems and dry mouth are found in association with apathy and indifference, cognitive deficits, and long-term medication with psycho-pharmacological drugs. The present study describes the results from one part of a longitudinal intervention programme, which sought effective ways of mitigating dry mouth through increased support with oral health problems. This part consists of 67 informal interviews with ten participants in two community-based urban housing projects between November 2006 and June 2007, with a follow-up session in December 2007. Content analysis of the results yielded five categories: The shame of having poor dental health, history of dental care, experiences of self-care, handling of oral health problems, and experiences of staff support. Poor oral health caused shame and limited participation in social activities. Participants avoided oral health issues by such circumventions as denial of a tooth ache or dental infections, or postponing oral problems with the hope that they would die away. Offers of support were frequently resisted because of unsatisfactory prior encounters with dental professionals and staff. Our findings suggest that self-care needs to be facilitated in an unobtrusive manner with minimal staff involvement, and clients should be referred to dental care providers experienced in treating people with SMI.

Psychometric characteristics of the “General Oral Health Assessment Index (GOHAI) » in a French representative sample of patients with schizophrenia

“…If left untreated, these conditions can lead to partial or total tooth loss (edentulism), thus compromising nutrition and general physical health. These patients diagnosed with serious mental illness also tend to report perceptions of poor oral health and express important care needs [17, 18]. The Quality-of-Life Scale (QLS) [19] and the Schizophrenia quality of life Scale (S- QOL) [20] have been validated for use in schizophrenic patients, but these tools do not measure OHrQOL.…”

Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy

“…Symptoms of mouth dryness include a sensation of thirst, soreness and dryness of the lips and oral mucosa [7,8]. It is associated with an increased risk of caries, oral candidiasis, removable denture intolerance, taste disturbance and pneumonia, with a subsequent risk of eating difficulties, choking, loss of appetite and malnutrition [6,[8][9][10]. Treatment protocols may include: general and local hydration, saliva substitutes and lubricants, central (pilocarpine, cevimeline) and local (sugar-free chewing-gums and candies) secretagogues, antifungal treatment, topical analgesics before meals, suppression or replacement of xerogenic drugs, dietary modification and/or dietary supplements and oral hygiene reinforced with antiseptic oral care products.…”

“…In the elderly, the main cause of xerostomia is medication and, in particular, the use of ‡4-5 drugs per day [2]. More than 500 medications are associated with xerostomia, with special emphasis placed on psychotropic drugs (anticholinergic drugs/atropinics, neuroleptics, tricyclic antidepressants, antipsychotics, benzodiazepines), followed by anti-hypertensives, diuretics, anti-neoplastics, opiates, bronchodilatators, proton pump inhibitors, antihistamines and others [6][7][8][9]16,17]. However, few medications except for true anticholinergic drugs have been demonstrated to affect salivary function and polypharmacy remains the most prevalent cause of mouth dryness [4,14,16].…”

A qualitative study of patients' knowledge and views of about oral health and acceptability of related intervention in an Australian inpatient alcohol and drug treatment facility

“…Persson et al . ). Oral health literacy was limited with the absence of pain the primary concern (McKibbin et al .…”

“…), and interacting social, practical and affective barriers, including shame, hindered access to dental services (Persson et al . , Ford et al . ).…”