ARTICLE INFO

Article Type

Original Research

Authors

Rezaei   1 (M.)
Golkari   A. (2 )
Lavaee   F. (* )






(* ) Oral Medicine Department, Dental Medicine School, Shiraz University of Medical Sciences, Shiraz, Iran
(2 ) Oral Health and Social Dentistry Department, Dental Medicine School, Shiraz University of Medical Sciences, Shiraz, Iran
(M.) Oral Medicine Department, Dental Medicine School, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence

Address: Oral Medicine Department, Dental Medicine School, Shiraz University of Medical Sciences, Qasr-e- Dasht Street, Shiraz, Iran
Phone: +98 7116319309
Fax: +98 7136270325
fatemeh.lavaee@yahoo.com

Article History

Received:  July  13, 2014
Accepted:  December 8, 2014
ePublished:  February 19, 2015

BRIEF TEXT


Psychiatric disorders as complications due to war such as depression with different levels and post-traumatic stress disorders are observed in the veterans more than other psychiatric disorders [1]. Antidepressants, anti-seizure medications, and mood balancing medications Consumption leads to different oral and teeth complications [2, 3]. Decayed, missing, and filled teeth index (DMFT), bleeding index (BI), and plaque index are used to investigate oral and tooth health.

DMFT index has been reported 15.5% [4], 12.8% [5], and 19.1% [6]. The index has been reported 17.02% [7]. Unhealthy gums and periodontal indices in the hospitalized psychiatric patients are obviously more than healthy persons [8]. The index in the psychiatric patients is 14.2% [9]. No study has yet been done to determine the oral health situation of the veterans in Shiraz Township, Iran. Only limited dentistry studies on psychiatric veterans have been done in Iran.

The aim of this study was to evaluate oral health status of the psychiatric veterans in Shiraz.

This is a descriptive cross-sectional study.

Psychiatric veterans referred to Jannat Medical Center, Shiraz, Iran, were studied in 2013-14.

80 persons were selected using achievable sampling method. The inclusion criteria were no confounding systemic disease like diabetes, which could affect dental-oral health, or no congenital malformations of teeth. The exclusion criteria were no willingness to participate or complete edentulous.

Data were collected using a checklist to record age, type and length of the medications consumption, the number of decayed, missing, or filled teeth, bleeding during probing, index of dental mass and plaque, the degree and severity of tooth mobility, and the frequency and type of oral soft tissue lesions including white and red lesions, exophytic lesions, pigmentation lesions, and mouth ulcerations. To investigate DMFT index, the number of decayed teeth (finding the hole in teeth), missing teeth (only due to caries), and filled teeth were recorded using a mirror and cotton rolls. (No X-ray photography in DMFT determination.) To investigate the index of tooth plaque control, each patient having been asked to chew one disclosing tablet, the number of stained tooth surfaces was counted after some minutes. Then, dividing it by total tooth surfaces, the index was determined [10]. To determine bleeding index while probing, interdental gum areas were observed, using a periodontal probe, and the areas with bleeding during probing were marked and their number was recorded on the checklist [11]. Simplified oral hygiene index (OHIS) was determined, based on Greene and Vermillion’s method. The index is a combination of debris amount and mass. The sum of two indices showed OHIS [12, 13]. Data were analyzed using SPSS 17 software and Spearman’s Non-parametric Correlational Test.

The mean age was 53.69±6.30years (minimum 41 and maximum 67 year-old). Mean hospitalization length for the veterans in the medical center was 14.4±9.2years. All the veterans were using medications. The most common medications were the tranquilizers (91%), antidepressants (82.1%), and antipsychotics (52.8%), respectively. The most common degrees of tooth mobility were “zero” (73.5%) and then, “2” (14.2%). Only 2.6% of patients had severe tooth mobility (“3”). Mean value of bleeding index in the veterans was 58.3±29.7%. Mean value of OHIS was 2.63±0.33OHIS. The index of tooth plaque control was 76.1±20.2%. 85.9% of the patients had no oral and mucosal lesions. The most common oral lesions were mucosal ulceration (7.7%), pigmentation lesions (3.8%), and white and red lesions (2.7%), respectively. DMFT was 23.7±6.2. Frequency and percentage of the decayed, missing, and filled teeth were determined (see the diagrams 1, 2, and 3, bellow). There was no significant correlation between age and DMFT, OHIS, and BI indices. There was a positive and significant correlation between consumption of antipsychotics medications and DMFT and OHIS indices. Nevertheless, there were no significant correlation between consumption of either tranquilizers or antidepressants and DMFT and OHIS. There was no significant correlation between BI and type of the consumed medication. There was no significant correlation between medication consumption length and OHIS, DMFT, and BI. There was no significant correlation between OHIS and BI and DMFT. There was a positive significant correlation between BI and DMFT.

The veterans referred to Jannat Medical Center had a very bad oral health situation. Oral health of psychiatric patients has been in a very bad situation and they need dentistry heal. The DMFT indices of other studies [4-6, 14] confirm this need, like the present study. The index has been reported 6.1 and 1.8±0.92 by two other studies [15, 16]. Mean scores of plaque index in patients and healthy persons groups have been 1.25 and 1.09, respectively [7]. Patients exposed to mustard gas need many dentistry treatments and educations [17]. There is no difference between DMFT index in patients with post-traumatic stress disorders and healthy persons, while the number of the decayed and missing teeth of the patients and their filled teeth are more and less, respectively [18]. The number of filled teeth in the healthy persons group is more [19]. The patients have less filled and decayed teeth and more missing teeth [6]. 56% of patients with post-traumatic stress disorders are in bad oral health situation. There is a significant difference between two plaque indices and number of the healthy persons and the patients [18]. Regarding the severity of health problems, this is consistent with the present study. Different mass indices, reported by different studies, have been 43.8%, 61.8%, and 10.1%, while the latter value is alongside reported improper oral health and much decay [4, 9, 20]. OHIS has been reported 4.2, which is more than the result of the present study; and while there was no significant correlation between age and OHIS. OHIS has been reported 3.3 [4, 16]. 0.9%, 5.4%, and 8.5% of persons has had healthy gum [4, 5, 9]. Tolerable levels of gum diseases have been observed and reported. There has been no difference between the numbers of filled and missing teeth in psychiatric patients. In addition, there has been no difference between patients and healthy persons in gingivitis and gum attachment loss [21]. Bleeding and DMFT indices in patients group has been more than healthy group [22]. 85% of the patients had no oral lesions, while ulcerations (7.7%), pigmentation lesions (3.8%), and white and red lesions (2.7%) were the most common lesions, successively. Mucositis, ulcerations, and Candida albicans have been reported the most common lesions [17]. Oral lesions and mucositis are the most common lesions [18]. Oral lesions prevalence has been 72.8%, including pigmentation lesions (45.7%) and ulcerations (28.6%) [23]. Removal of the papillae of the dorsal surface of the tongue, inflammation of the lip corners, coated tongue, increased pigmentation, gingival enlargement, and ulcerations due to bruxism are the most common oral lesions [5]. Mucosal, lips, and tongue lesions have been reported, as well [21]. Antidepressants and antipsychotics Consumption has been reported as the causes to increase tooth diseases in the hospitalized psychiatric patients. Antipsychotics consumption positively and significantly increased DMFT and OHIS.

The results ought to be compared with a control group matched for age and sex. The study should be done in other psychiatric patients’ hospitals to provide practical plans to enhance their oral health.

Lack of control group composed of healthy persons matched for age and sex was one of the limitations of the present study.

Oral health situation of the hospitalized psychiatric veterans is weak. DMFT index of the veterans is very high. The direct correlation between bleeding index and DMFT index shows poor oral health in the patients.

The researchers feel grateful to Research Deputy of Shiraz University of Medical Sciences, Student Research Committee, and Dr. Vosough.

Non-declared

All procedures were approved by the Ethics Committee of Shiraz University of Medical Sciences.

The study was funded by the Research Deputy of Shiraz University of Medical Sciences.


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