What can be done?
Poor dental health is preventable, but requires targeted interventions vis-à-vis high-risk groups. There is much to indicate that low priority is given to dental health when there are other and more obvious symptoms that require treatment. Moreover, we have little knowledge about the effect of interventions, and more research on individually targeted and system-oriented measures is required (19). A meta-analysis from 2016 on the benefits of motivation and training in oral hygiene for persons with mental disorders provides no definite findings (20). However, in one of the included studies Almomani et al. compared two randomised groups, both of which were provided with training as well as an electric toothbrush and a reminder to follow up their oral hygiene, but where one of the groups also undertook brief sessions with motivational interviews. Both groups had reduced amounts of plaque, but the effect lasted longer in the group that underwent the motivational interview (21).
The guidelines for examination, treatment and follow-up of persons with psychosis-type disorders recommend facilitation of routine visits to a dentist. It is emphasised that ‘When drugs with an anticholinergic effect are used, patients should be informed about the importance of good dental hygiene’ (22). Examination and treatment of the teeth should also be highlighted as a part of the routine for institutionalised patients, especially with a view to reaching those with the most serious disorders (10). Dentists have recommended the following as a simple screening procedure: Count the teeth and refer the patient to a dentist if he or she has less than 20 teeth, has front teeth missing or suffers from problems with or pain in the mouth. We recommend such a screening procedure, but this formulation is no longer found in the most recent manuals (14, 23). As a part of the package pathways for mental health and addiction, somatic health and lifestyle, some screening questions have been proposed, and we deem these to be appropriate (see Box 1) (24).
Box 1 Questions for screening of dental health in patients admitted
to institutions for mental health care or addiction (24)
Do you suffer from pain or other problems in your mouth?
When did you last see a dentist/dental hygienist?
If more than two years ago: What is the reason why you have not seen a dentist/dental hygienist for such a long time?
If anxiety is the reason why the patient has not seen a dentist/dental hygienist for more than two years, information must be provided in the referral to a dentist/dental hygienist.
Inform the patient about the opportunity for financial support to cover expenses for dental treatment.