Original article Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel T. Ramon a, *, A. Grinshpoon b , S.P. Zusman a , A. Weizman c a Israel Ministry of Health, Division of Dental Health, 2 Ben Tabai Street, Jerusalem 93591, Israel b Ministry of Health, Mental Health Services, Jerusalem, Israel c Geha Psychiatric Hospital and Felsenstein Medical Research Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Received 6 October 1999; received in revised form 19 November 2002; accepted 29 November 2002 Abstract The aim of the study was to examine the oral health and treatment needs of chronically hospitalized psychiatric patients in Israel. Ten percent of the patients hospitalized for more than 2 years in the 18 psychiatric institutions in Israel were selected at random. The dental status (DMF-T index) was calculated, demographic and medical data were retrieved from the files. Of the 431 patients examined (250 men, 181 women, average age 54 years) 312 patients had only partial natural dentition. The average DMF-T score was 26.74 (out of 32), one of the highest in the literature. The caries component accounted for 2.3% of the DMF-T, the missing teeth component 72% and the restored teeth component 5%. There was an adverse correlation between age and caries and between duration of hospitalization and number of teeth. The average number of carious and missing teeth was higher than in the healthy population. No all-edentulous patients had dentures. These findings confirm the urgent need for an intervention program to improve dental health care in high-risk, difficult-to-treat, psychiatric chronic inpatients. © 2003 Éditions scientifiques et médicales Elsevier SAS. All rights reserved. Keywords: Oral health; Dental status; Chronic psychiatric patients; Schizophrenia 1. Introduction Little emphasis has been placed on the maintenance of oral health in psychiatric patients, who tend to be confined to hospital for longer periods than other chronic patients who have a lower index of recovery. In Israel, hospitalized psychi- atric patients are entitled to a range of health services. In the majority of mental health hospitals, however, there are no suitable dental clinics, and lack of funds and poor accessibil- ity preclude the administration of regular dental treatment. Furthermore, patient self-care is hampered by lack of moti- vation due to personality defects, lack of concern with per- sonal hygiene, apathy, fear, mobility difficulties and the ef- fect of psychiatric medication. Therefore, while some patients with caring families and means may receive reasonable dental care, the remainder are generally given first aid only (pain killers or antibiotics). Compounding the problem are the special skills dentists need to cope with the specific problems these patients present, and the little incentive for dentists to enter this field. Some of the dental problems of psychiatric patients are caused directly by psychiatric medications that affect the central autonomic nervous system [25]. For example, the Phenothiazine chlor- promazine reduces salivary secretion and causes xerostomia, which in turn can lead to speech difficulties, acute staphylo- coccal parotitis [4], increase in oral moniliasis, and difficul- ties in swallowing; food remains adherent to the teeth, result- ing in rampant caries. Other dental problems are an indirect result of extrapyramidal Parkinson-like or akathisic side ef- fects of psychiatric medications (which can, for example, make the use of removable dentures difficult) [15], and the drugs used to treat them, which themselves cause xerostomia [8]. Besides xerostomia, dental findings include damage to the soft tissues, sensation of burning in the oral cavity, den- ture stomatitis, glossitis [21], fissured or atrophic tongue, nonspecific inflammation of the mouth (stomatitis), gingivi- tis and oral ulcers [8,17]. Biochemical, immunological or microbiological changes in the composition of the saliva * Corresponding author. E-mail address: tirza.ramon@moh.health.gov.il (T. Ramon). European Psychiatry 18 (2003) 101–105 www.elsevier.com/locate/eurpsy © 2003 Éditions scientifiques et médicales Elsevier SAS. All rights reserved. DOI: 1 0 . 1 0 1 6 / S 0 9 2 4 - 9 3 3 8 ( 0 3 ) 0 0 0 2 3 - 3