Effect of implementing dental services in Israeli psychiatric hospitals on the oral and dental health of inpatients

Objective: Psychiatric disorders (schizophrenia, mood disorders, and organic brain disorders) and their treatment may lead to oral diseases, but assessment of dental status and oral care needs among patients with these disorders is lacking. This study reports changes in dental health and oral care needs of psychiatric inpatients after 1998, when psychiatric hospitals in Israel were required to provide regular dental examinations and treatment for every inpatient hospitalized longer than a year. Methods: Two epidemiological cohorts from 1997 and 2006 representing long-term psychiatric inpatients before (N=431) and after (N=254) the reform of dental services were compared on the standardized criteria of the Decayed, Missing, and Filled Teeth (DMFT) index scores and DMFT component scores, as well as on the use of and need for dentures. Results: Compared with the prereform cohort, the postreform cohort had fewer decayed teeth and lower DMFT index scores. These differences were independent of gender and clinical diagnosis. No between-cohort differences were found in the use of and need for dentures. On-site dental services were more effective than outsourced services in improving dental health. Conclusions: The results suggest a substantial improvement in the dental health of this at-risk population after the dental reform in psychiatric hospitals. However, oral health needs are still not fully met, and therefore, additional organizational efforts for further prevention and treatment of dental diseases are required.