Effect of dental hygiene care program on dental plaque control in patients with mental disorders

Abstract

According to the results of the 2011 Survey of Mental Disorders in Korea, the lifetime prevalence rate of mental disorders is 14.4%, which increased by 14.3% compared to that of 2006. With this dramatic increase in the prevalence of mental disorders, social interests have been interesting, as have the social costs, such as health insurance and medical aid costs. Most drugs for mental disorders have side effects such as xerostomia, dysgeusia, glossitis, and gingivitis. In particular, xerostomia is known to be a representative symptom adversely affecting oral health status. Medications for the mentally ill have been continuously increasing with the ensuing increase of serious side effectson the oral environment. Moreover, their oral hygiene tends to be neglected due to a lack of interest in their own health management and insensitivity to the necessity of dental care, as demonstrated by the results of the studies conducted on patients with mental disorders that their oral health status, including caries occurrence, oral hygiene, and periodontal state, is greatly inferior to that of the general population. For the prevention of oral diseases in the mentally ill, it is necessary to provide them with oral health care education and professional oral hygiene management. The education program design should take into account the extremely short attention span of this patient group as well as the possibility of involving caregivers and periodical repetition. Despite this necessity, oral health management tends to be dismissed as an unimportant issue, especially in the case of inpatients, and there are hardly any intervention studies assessing the effects of such education. This study was conducted to improve the oral health status of patients with mental disorders and prevent oral diseases by designing a dental hygiene care program that takes into account their specific

characteristics, assessing the effects of the education program, and presenting guidelines for real-life application. Subjects were 73 patients suffering from schizophrenia, depression, bipolar disorder, schizoaffective disorder, and organic affective disorders who participated in the daytime program at a mental health center in Gangwon Province and inpatients under medication therapy at a nearby psychiatric hospital. They were divided into three groups: Group A (n=23) received oral health education via video, professional toothbrushing, and a brochure; Group B (n=22) received the same video-assisted training sessions and brochure; and Group C (n=28) received only the educational brochure. The intervention lasted three months during which three training sessions and assessments were performed at the interval of four weeks. An interview questionnaire survey was conducted with regards to oral health-related knowledge, attitude, behavior, subjectively perceived xerostomia, oral health-related quality of life, and satisfaction about the present program. The patient hygiene performance (PHP) index (Podshadely&Haley1968) was used as a plaque index. A five min stimulated salivary flow rate was measured, and CariviewⓇ, Dentocult LBⓇ were used to assess caries activity. Repeated measure ANOVA, chi-square test, and paired t-test were performed using the IBM SPSS version 20, in which p<0.05 was considered significant.. A total of 73 subjects (men 49.3%; women 50.7%) completed the entire program in Group A (n=23), Group B (n=22), and Group C (n=28). The predominant age bracket was the forties, with 38.7%, while the twenties accounted for only 5.5%. A total of 87.7% of the subjects were beneficiaries of the national medical care scheme. There were no statistically significant inter group differences in general characteristics and schizophrenia accounted for 89.0%. Oral

health-related knowledge and attitude scores significantly increased after the intervention and the daily toothbrushing frequency increased from 2.29 to 2.46, without being statistically significant. Post-intervention plaque index significantly decreased in all three groups compared to baseline values: 41.9%, 50.1%, and 30.1% in Groups A, B, and C, respectively but no significant differences were found among the groups (p=0.342). he stimulated salivary flow rate slightly increased in all three groups in the 4th session, but without any statistical significance. Subjective symptoms of xerostomia tended to decrease, but the reduction was not statistically significant. The oral health-related quality of life evaluated with GOHAI showed a slight increase from 3.31 at baseline to 3.56 after the program, but without being statistically significant. Additionally, while Group C scored 0.01 point less after the education program, Group A scored higher by 0.22 point. By scoring 0.55 point higher, Group B demonstrated a significantly increased oral health-related quality of life. A dental hygiene care program with 4-week intervals, using a short educational video (within 10 min) and brochure, was effective in lowering the plaque index of the patients with mental disorders. However, the effects on xerostomia and caries activity were not statistically significant. The indirect education using the brochure alone also had the effect of decreasing plaque by 30.1%. However, no considerable effects were demonstrated in the improvement of oral health-related knowledge, attitude, xerostomia, and oral health-related quality of life. Therefore, it will be necessary to undertake education programs focusing on oral health-related behaviors in order to improve the oral health of the mentally ill in the future study. Indirect education, such as brochure distribution, should also be

considered. A long-term evaluation of the dental hygiene care program will also need to be performed. Additionally, further research focusing on the measures to alleviate xerostomia is necessary as well as research that considers other factors, such as a long-term evaluation of the program, and disease and medication types.