42 Vol. 67, No. 1, Winter 2007 Abstract Objectives: We evaluated patient and medication treatment factors associated with self-reported oral health status in patients diagnosed with serious mental illness (SMI) in a large, national sample of patients in the Veterans Affairs (VA) health system. Methods: 4,769 patients (mean age = 55, 7.8 percent women) were included from the VA’s 1999 National Psychosis Registry (NPR) for whom the oral health information gathered by the VA’s Large Health Survey of Veterans was avail- able. Current (1999) psychotropic medication data were ascertained from the NPR. Multivariable logistic regression analyses were used to determine the patient factors (e.g., sociodemographic, enabling, and treatment factors) associated with poor or fair overall dental health, and with having tooth or mouth problems that made it dif- ficult to eat. Results: While 61.0 percent of persons with SMI self-reported fair to poor dental health, 34.1 percent reported that oral health problems made it difficult for them to eat. Patients who were not employed, experiencing financial strain, who smoked, who were prescribed tricyclic antidepressants, or prescribed selective serotonin reuptake inhibitors were more likely to report poor or fair dental health. These variables were also associated with having tooth or mouth problems. Conclusions: Suboptimal oral health was self-reported with substantial pre- valence among patients with SMI, a problematic finding given its consequences for general health, social functioning, and quality of life. Greater efforts are needed to improve oral health outcomes among patients with SMI by facilitating access to dental care and addressing mutable factors such as smoking and medication side effects. Key Words: mental disorders, pharmacotherapy, oral health clinical needs of persons with SMI (4). Poor oral health is especially pronounced among patients with SMI who have received long-term psychiatric treatment (10–14), espe- cially extended inpatient care (15), a setting that often portends poor access to dentists. The link between SMI and poor oral health has been attributed to impaired functioning and neglect of self-care, resulting in patients who may not have the means to perform adequate plaque control. In addition, certain psychotropic medications [e.g., chlorpromazine, tricyclic anti- depressants (TCAs), and many others] can produce xerostomia and inhibit bone generation (16), which can lead to increased risk of dental caries, gingivitis, and periodontal disease (4, 12). For example, studies suggest that chlorpromazine may be associated with inhibited bone mineral deposits (17, 18), and anti- convulsants can be associated with bone loss (19). While small clinical studies have documented poor oral health status in patients with chronic schizophre- nia (12, 16) and poor periodontal treatment outcomes in patients with clinical depression (20), few have investigated the patient or treatment factors associated with poor oral health in persons with SMI within population-based, routine care set- Send correspondence and reprint requests to Amy M. Kilbourne, PhD, MPH, Associate Professor of Psychiatry, VA Ann Arbor HSRD/SMITREC (11H), 2215 Fuller Road, Ann Arbor, MI 48105. Tel.: 734-761-2210; Fax: 734-761-2617; e-mail: Amy.Kilbourne@va.gov. Amy M. Kilbourne, John F. McCarthy, and Frederic C. Blow are with the VA National Serious Mental Illness Treatment Research and Evaluation Center; Ann Arbor, MI and the Department of Psychiatry, University of Michigan; Ann Arbor, MI. Marcela Horvitz-Lennon and Mario Cruz are with the Department of Psychiatry, University of Pittsburgh; Pittsburgh, PA. Edward P. Post is with the VA National Serious Mental Illness Treatment Research and Eval- uation Center and the Department of Medicine, University of Michigan; Ann Arbor, MI. Deborah Welsh is with the VA National Serious Mental Illness Treatment Research and Evaluation Center; Ann Arbor, MI. Manuscript received: 6/13/06; accepted for publication: 9/28/06. No claim to original US government works ©2007, American Association of Public Health Dentistry DOI: 10.1111/j.0022-4006.2007.00007.x Oral Health in Veterans Affairs Patients Diagnosed with Serious Mental Illness Amy M. Kilbourne, PhD, MPH; Marcela Horvitz-Lennon, MD; Edward P. Post, MD, PhD; John F. McCarthy, PhD; Mario Cruz, MD; Deborah Welsh, MS; Frederic C. Blow, PhD Introduction Persons with serious mental illness (SMI), including bipolar dis- order and schizophrenia, experience significant functional disability, high rates of general health problems, and premature mortality (1, 2). In addi- tion, advanced dental disease and poor oral health are highly prevalent in patients with schizophrenia (3, 4) and bipolar disorder (5). Poor oral health can be associated not only with serious health problems such as coronary heart disease (6, 7), stroke (6, 7), poorly controlled diabetes (8), and respiratory disease (9) but can also compound the difficulties that persons with SMI have in obtaining employment and potentially social reintegration (4). These persons often lack access to dental care, stemming from few financial resources and a scarcity of dentists who are familiar with the complex