Psikiyatrik Hastalarda Ağız Sağlığı

Ağız sağlığı, genel sağlık ve yaşam kalitesinin önemli bir belirleyicisi olmasına karşın psikiyatrik hastalık sürecinde düşük bir önceliği vardır. Kronik psikiyatrik hastalıklar ve tedavileri, ağız sağlığı için doğal riskler taşımaktadır. Hem hastalık hem de farmakolojik tedavi şekilleri, çok sık olarak klinikte diş çürükleri, periodontal hastalıklar ve kserostomi gibi sorunlara ve yan etkilere yol açar. İleri yaş, cinsiyet, hastanede yatış süresi, hastalık süresi, psikiyatrik teşhis, psikotropik ilaçlar kötü ağız sağlığının en sık belirleyici faktörlerdir. Kötü ağız hijyeni, sigara, karbonatların fazla alınması, ağız sağlığı gereksinimlerinin yeterince algılanmaması, hastalığın ve psikiyatrik tedavinin süresi ve diş tedavi hizmetlerinden yetersiz yararlanma, bu özel topluluktaki ağız sağlığının kötü olma riskini artırmaktadır. Bu yazıda, ağız sağlığı yönünden hastanede yatan psikiyatrik hastalarda, koruyucu diş hekimliği programlarının yanısıra psikiyatrik rehabilitasyon programları ile ağız-diş sağlığı eğitimi köprüsünün önemi vurgulanmıştır. Ayrıca psikiyatrik hastalıkların ağızdaki belirtileri, psikiyatrik tedavide kullanılan ilaçların ağız sağlığı üzerindeki etkileri ve psikiyatri hastalarında ağız sağlığını etkileyen faktörler tartışılmıştır.

Oral Health in Psychiatric Patients

Although oral health is a major determinant of general health and quality of life, it has a low priority in the context of mental illness. Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Both the disease itself and its various pharmacologic management modalities lead to a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. Older age, female gender, length of hospitalization, duration of mental illness, psychiatric diagnosis are the most discussed predictors for adverse dental outcomes in the reviewed studies. Poor oral hygiene, higher intake of carbonates, smoking, poor perception of oral health self-needs, length of psychiatric disorder, length of psychotropic treatment, and less access to dental care pose at high risk for poor oral health among this population. This article emphasizes the importance of preventive dentistry programs to improve dental healthcare psychiatric chronic inpatients and the significance of bridging dental health education to psychiatric rehabilitation programs. In this review, general information concerning the oral manifestations of mental illness, effect of medication of mental illness on oral health, the factors affecting oral health among this special population have been provided.

___

  • Nordenram G, Ronnberg L, Winblad B. The perceived importance of appearance and oral function, comfort and health for severely demented persons by relatives, nursing staff and hospital dentists Gerodontology 1994; 11:18-24.
  • Petersen PE. The world oral health report 2003: Continuous improvement of oral health in the 21st century - the approach of the WHO global oral health program. Community Dent Oral Epidemiol 2003; 31(Suppl 1):3-23.
  • Little JW. Anxiety disorders: Dental implications. Gen Dent 2003; 51:562-568.
  • Matevosyan NR. Oral health of adults with serious mental illnesses: A review. Community Ment Health J 2010; 46:553-562.
  • McCreadie RG, Stevens H, Henderson J, Hall D, McCaul R, Filik R et al. The dental health of people with schizophrenia. Acta Psychiatr Scand 2004; 110:306-310.
  • Tang WK, Sun FC, Ungvari GS, O'donnell D. Oral health of psychiatric in-patients in Hong Kong. Int J Soc Psychiatry 2004; 50:186-191.
  • Wright EF, Thompson RL, Paunovich ED. Posttraumatic stress disorder: Considerations for dentistry. Quintessence Int 2004; 35:206-210.
  • Kumar M, Chandu GN, Shafiulla MD. Oral health status and treatment needs in institutionalized psychiatric patients: One year descriptive cross sectional study. Indian J Dent Res 2006; 17: 171-177.
  • Friedlander AH, Liberman RP. Oral health care for the patient with schizophrenia. Spec Care Dentist 1991; 11:179-183.
  • Watt JA, el-Guebaly N. The chronic mental patient: The position of the Canadian Psychiatric Association. Can J Psychiatry 1981; 26:494-501.
  • Stiefel DJ, Truelove EL, Menard TW, Anderson VK, Doyle PE, Mandel LS. A comparison of the oral health of persons with and without chronic mental illness in community settings. Spec Care Dentist 1990; 10:6-12.
  • Angelillo IF, Nobile CG, Pavia M, De Fazio P, Puca M, Amati A. Dental health and treatment needs in institutionalized psychiatric patients in Italy. Community Dent Oral Epidemiol 1995; 23:360-364.
  • Hede B. Dental health behavior and self-reported dental health problems among hospitalized psychiatric patients in Denmark. Acta Odontol Scand 1995; 53:35-40.
  • Whyman RA, Treasure ET, Brown RH, MacFadyen EE. The oral health of long term residents of a hospital for the intellectually handicapped and psychiatrically ill. N Z Dent J 1995; 91:49-56.
  • Cormac I, Jenkins P. Understanding the importance of oral health in psychiatric patients. Advances in Psychiatric Treatment 1999; 5:53-60.
  • Almomani F, Williams KB, Catley D, Brown C. Effects of an oral health promotion program in people with mental illnesses. J Dent Res 2009; 88:648-652.
  • Muhvic-Urek M, Uhac I, Vuksic-Mihaljevic Z, Leovic D. Oral health status in war veterans with post-traumatic stress disorder. J Oral Rehabil 2007; 34:1-8.
  • Stewart R, Hirani V. Dental health and cognitive impairment in an English National survey population. J Am Geriatr Soc 2007; 55:1410-1414.
  • DeBate RD, Plichta SB, Tedesco LA, Kerschbaum WE. Integration of oral health care and mental health services: Dental hygienists’ readiness and capacity for secondary prevention of eating disorders. J Behav Health Serv Res 2006; 33:113-125.
  • Dumitrescu AL, Dogaru CB, Dogaru CD. Instability of self-esteem and affective lability as determinants of self-reported oral health status and oral health-related behaviors. J Contemp Dent Pract 2008; 9:38-45.
  • Brufau-Redondo C, Martin-Brufau R, Corbalan-Velez R, Conception-Salesa De A. Burning mouth syndrome. Actas Dermosifiliogr 2008; 99:431-440.
  • Longley AJ, Doyle PE. Mental illness and the dental patient. J Dent Hyg 2003; 77:190-204.
  • Robb ND, Smith BGN, Geidrys-Leeper E. The distribution of erosion in dentitions of patients with eating disorders. Br Dent J 1995; 178:171-175.
  • Velasco E, Machuca G, Martinez-Sahuquillo A, Rios V, Lacalle J, BulloAn P. Dental health among institutionalized psychiatric patients in Spain. Spec Care Dentist 1997; 17:203-206.
  • Rekha R, Hiremath SS, Bharath S. Oral health status and treatment requirements of hospitalized psychiatric patients in Bangalore city: a comparative study. J Indian Soc Pedod Prev Dent 2002; 20:63-67.
  • Ramon T, Grinshpoon A, Zusman SP, Weizman A. Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel. Eur Psychiatry 2003; 18:101-105.
  • Gurbuz O, Alataş G, Kurt E, Doğan F, İşsever H. Oral health and treatment needs of instituonalized chronic psychiatric patients in Istanbul, Turkey. Community Dent Health 2010; 27:151-157.
  • Gowda EM, Bhat PS, Swamy MM. Dental health requirements for psychiatric patients. Medical Journal Armed Forces India 2007; 63:328-330.
  • Kenkre AM, Spadigam AE. Oral health and treatment needs in institutionalized psychiatric patients in India. Indian J Dent Res 2000; 1:5-11.
  • Vigild M, Brinck JJ, Christensen J. Oral health and treatment needs among patients in psychiatric institutions for the elderly. Community Dent Oral Epidemiol 1993; 21:169-171.
  • Lewis S, Jagger RG, Treasure E. The oral health of psychiatric in-patients in South Wales. Spec Care Dentist 2001; 21:182-186.
  • Hugoson A, Ljunguist B, Breivik T. The relationship of some negative life events and psychological factors to periodontal disease in an adult Swedish population 50-80 age. J Clin Periodontol 2002; 29: 247-253.
  • Jackson E. Psychiatry and dentistry. In Comprehensive Textbook of Psychiatry, 5th edition (Eds. HI Kaplan, AM Freeman, BJ Saddock):2069-2077. Baltimore, Lippincott, Williams Wilkins, 1980.
  • Velasco E, Bullon P. Periodontal status and treatment needs among Spanish hospitalized psychiatric patients. Spec Care Dentist 1999; 19:254-258.
  • Rudolph MJ, Chikte UM. Dental caries experience and periodontal disease in institutionalised male psychiatric patients. J Dent Assoc S Afr 1993; 48:451-454.
  • Gurbuz O, Alataş G, Kurt E, Doğan F, İşsever H. Periodontal health and treatment needs of instituonalized chronic psychiatric patients in Istanbul, Turkey. Community Dent Health 2011; 28: 69-74.
  • Velasco-Ortega E, Monsalve-Guil L, Velasco-Ponferrada C, Medel-Soteras R, Segura- Egea JJ. Temporomandibular disorders among schizophrenic patients: a case-control study. Med Oral Patol Oral Cir Bucal 2005; 10:315-322.
  • Winocur E, Hermesh H, Littner D. Signs of bruxism and temporomandibular disorders among psychiatric patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103:60-63.
  • Gurbuz O, Alatas G, Kurt E. Prevalence of temporomandibular disorder signs in patients with schizophrenia. J Oral Rehabil 2009; 36;864-871.
  • Manfredini D, Bandettini Di Poggio A, Cantini E, Dell’osso L, Bosco M. Mood and anxiety psychopathology and temporomandibular disorder: a spectrum approach. J Oral Rehabil 2004; 31:933–940.
  • Özen NE. Temporomandibular bozuklukların psikiyatrik yönü ve bruksizm. Klinik Psikiyatri Dergisi 2007; 10:148-156.
  • Barnes GP, Allen EH, Parker WA, Lyon TC, Armentrout W, Cole JS. Dental treatment needs among hospitalized adult mental patients. Spec Care Dentist 1988; 8:173-177.
  • Thomas A, Lavrentzou E, Karouzos C, Kontis C. Factors which influence the oral condition of chronic schizophrenia patients. Spec Care Dentist 1996; 16:84-86.
  • Sjogren R, Nordstrom G. Oral health status of psychiatric patients. J Clin Nurs 2000; 9: 632-638.
  • Tiller S, Wilson KI, Gallagher JE. Oral health status and dental service use of adults with learning disabilities living in residential institutions and in the community. Community Dent Health 2001; 18:167-171.
  • Fiske J. The delivery of oral care services to elderly people living in a noninstitutionalized setting. J Public Health Dent 2000; 60:321-325.
  • Mester R. The psychodynamics of the dental pathology of chronic schizophrenic patients. Isr J Psychiat Relat Sci 1982; 19:255-261.
  • Boyd LD, Dwyer JT, Papas A. Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: A case study. Nutr Rev 1997; 55:362- 368.
  • Lucas VS. Association of psychotropics drugs, prevalence of denture-related stomatitis and oral candidosis. Community Dent Oral Epidemiol 1993; 21:313-316.
  • Butt GM. Drug-induced xerostomia. J Can Dent Assoc 1991; 57:391-393.
  • Haveman CW, Redding SW. Dental management and treatment of xerostomic patients. Tex Dent J 1998; 115(6):43-56.
  • Craig TJ, Richardson MA, Pass R, Haugland G. Impairment of the gag reflex in schizophrenic inpatients. Compr Psychiatry 1983; 24:514-520.
  • Arnaiz A, Zumárraga M, Díez-Altuna I, Uriarte JJ, Moro J, Pérez-Ansorena MA. Oral health and the symptoms of schizophrenia. Psychiatry Res 2011; 188:24-28.
  • Friedlander AH, Marder SR. The psychopathology, medical management and dental implications of schizophrenia. J Am Dent Assoc 2002; 133:603-610.
  • Yaltırık M, Kocaeli H, Yargıç I. Schizophrenia and dental management. Review of the literature. Quintessence Int 2004; 35:317-320.
  • Friedlander AH, Friedlander IK, Marder SR. Bipolar I disorder: Psychopathology, medical management and dental implications. J Am Dent Assoc 2002; 133:1209- 1217.
  • Clark DC. Dental care for the patient with schizophrenia. Canadian Journal of Dental Hygiene 2008; 42:17-24.
  • Herrero R, Castellsague X, Pawlita M, Kee F, Balaram P, Rajkumar T et al. Human papillomavirus and oral cancer: The international agency for research on cancer multi center study. J Natl Cancer Inst 2003; 95:1772-1783.
  • Stevens HE. Oral candidiasis secondary to adverse anticholinergic effects of psychotropic medications. J Adolesc Child Psychopharmacol 2007; 17:145-146.
  • Papas AS, Joshi A, MacDonald SL, Maravelis-Splagounias L, Pretara-Spanedda P, Curro FA. Caries prevalence in xerostomic individuals. J Can Dent Assoc 1993; 59:171-174ç
  • Clark DC. Dental care for the patient with bipolar disorder. J Can Dent Assoc 2003; 69:20-24.
  • Aronson JK. Meyler’s Side Effects of Psychiatric Drugs, 15th edition. San Diego, Elsevier, 2009.
  • Yeşilyurt S, Aras İ, Altınbaş K, Atagün Mİ, Kurt E. Pathophysiology of clozapine induced sialorrhea and current treatment choices. Düşünen Adam Psikiyatri ve Nöro- lojik Bilimler Dergisi 2010; 23:275-281.
  • Chacko RC, Marsh BJ, Marmion J, Dworkin RJ, Telschow R. Lithium side effects in elderly bipolar outpatients. Hillside J Clin Psychiatry 1987; 9:79-88.
  • Nemeroff CB. An ever-increasing pharmacopoeia for the management of patients with bipolar disorder. J Clin Psychiatry 2000; 61(Suppl 13):19-25.
  • Elmslie JL, Mann JI, Silverstone JT, Williams SM, Romans SM. Determinants of overweight and obesity in patients with bipolar disorder. J Clin Psychiatry 2001; 62:486-491.
  • Madinier I, Berry N, Chichmanian RM. Drug-induced oral ulcerations. Ann Med Interne (Paris) 2000; 151:248-254.
  • Amann B, Hummel B, Rall-Autenrieth H, Walden J, Grunze H. Bupropion-induced isolated impairment of sensory trigeminal nervefunction. Int Clin Psychopharmacol 2000; 15:115-116.
  • Bone S, Roose SP, Dunner DL, Fieve RR. Incidence of side effects in patients on long-term lithium therapy. Am J Psychiatry 1980; 137:103-104.
  • Hogan DJ, Murphy MD, Burgess W, Epstein JD, Lane PR. Lichenoid stomatitis associated with lithium carbonate. J Am Acad Dermatol 1985; 13:243-246.
  • Bar Nathan EA, Brenner S, Horowitz I. Nonspecific stomatitis due to lithium therapy. Am J Psychiatry 1985; 142:1126.
  • Little JW, Falace DA, Miller CS, Rhodus NL. Little and Falace's Dental Management of the Medically Compromised Patient, 7th edition. St. Louis, Mosby, 2007.
  • Baldessarini RJ. Drugs and the treatment of psychiatric disorders: Psychosis and anxiety. In Goodman & Gilman’s the Pharmacological Basis of Therapeutics, 9th editon (Eds JG Hardman, LE Limbird):399-430. NewYork, McGraw Hill, 1996.
  • Scully C. Medical Problems in Dentistry, 6th edition. Philadelphia, Churchill Livingstone, 2010.
  • Blanchet PJ, Abdillahi O, Beauvais C Rompre PH, Lamarche C. Prevalence of spontaneous oral dyskinesia in the elderly: a reappraisal. Mov Disord 2004; 19:892- 896.
  • Bassett A, Remick RA, Blasberg B. Tardive dyskinesia: an unrecognized cause of orofacial pain. Oral Surg Oral Med Oral Pathol 1986; 61:570-572.
  • Osborne TE, Grace EG, Schwartz MK. Severe degenerative changes of the temporomandibular joint secondary to the effects of tardive dyskinesia: a literature review and case report. Cranio 1989; 7:58-62.
  • Blanchet PJ, Rompre PH, Lavigne GJ, Lamarche C. Oral dyskinesia: a clinical overview. Int J Prosthodont 2005; 18:10-19.
  • Tublin LM. A treatment for tardive dyskinesia in a complete denture patient: a case report. N Y State Dent J 1989; 55:30.
  • Owens DG, Johnstone EC, Frith CD. Spontaneous involuntary disorders of movement: their prevalence, severity, and distribution in chronic schizophrenics with and without treatment with neuroleptics. Arch Gen Psychiatry 1982; 39:452-461.
  • Delwaide PJ, Desseilles M. Spontaneous buccolinguofacial dyskinesia in the elderly. Acta Neurol Scand 1977; 56:256-262.
  • Dinan TG, Golden T. Orofacial dyskinesia in Down’s syndrome. Br J Psychiatry 1990; 157:131-132.
  • Sutcher HD, Underwood RB, Beatty RA, Sugar O. Orofacial dyskinesia. A dental dimension. JAMA 1971; 21:1459-1463.
  • Myers DE, Schooler NR, Zullo TG, Levin H. A retrospective study of the effects of edentulism on the severity rating of tardive dyskinesia. J Prosthet Dent 1993; 69:578- 581.
  • Jankovic J. Etiology and differential diagnosis of blepharospasm and oromandibular dystonia. Adv Neurol 1988; 49:103-116.
  • Watts MW, Tan EK, Jankovic J. Bruxism and cranial-cervical dystonia: Is there a relationship? Cranio 1999; 17:196-201.
  • Gray AR, Barker GR. Idiopathic blepharospasmoromandibular dystonia syndrome (Meige’s syndrome) presenting as chronic temporomandibular joint dislocation. Br J Oral Maxillo fac Surg 1991; 29:97-99.
  • Jankovic J, Ford J. Blepharospasm and orofacialcervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol 1983; 13:402-411.
  • Clark DB. Dental care for the psychiatric patient: chronic schizophrenia. J Can Dent Assoc 1992; 58:912-916.
  • Buchanan RW, Carpenter WT. Schizophrenia and other psychotic disorders. In Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 8th edition (Eds BJ Sadock, VA Sadock):1329-1330. Philadelphia, Lippincott Williams and Wilkins, 2005.
  • Clark GT, Ram S. Four oral motor disorders: bruxism, dystonia, dyskinesia and drug- induced dystonic extrapyramidal reactions. Dent Clin North Am 2007; 51:225-243.
  • Bader G, Lavigne G. Sleep bruxism; an overview of an oromandibular sleep movement disorder. Sleep Med Rev 2000; 4:27-43.
  • Kuloğlu M, Ekinci O. Psikiyatride bruksizm. Yeni Symposium 2009; 47:218-224.
  • Winocur E, Gavish A, Voikovitch M Emodi-Perlman A, Eli I. Drugs and bruxism: a critical review. J Orofac Pain 2003; 17:99-111.
  • Gerber PE, Lynd LD. Selective serotonin-reuptake inhibitor induced movement disorders. Ann Pharmacother 1998; 32:692-698.
  • Wise M. Citalopram-induced bruxism. Br J Psychiatry 2001; 178:182.
  • Bostwick JM, Jaffee MS. Buspirone as an antidote to SSRI induced bruxism in 4 cases. J Clin Psychiatry 1999; 60:857-860.
  • Ak M, Gülsün M, Uzun Ö, Gümüş HÖ. Serotonin geri alım engelleyicilerinin neden olduğu bruksizm: İki olgu. Klinik Psikofarmakoloji Bülteni 2009; 19(Ek 1):114-116.