Determinants of Poor Dental Care in Patients With Schizophrenia: A Historical, Prospective Database Study

Background: Oral health status is poor and a disregarded health issue among patients with schizophrenia that is associated with the risk for additional social stigmatization and potentially fatal infections.

Method: A historical, prospective database study of dental visits, utilizing the Danish National Patient Registry, of 21,417 patients with ICD-10-diagnosed schizophrenia in the year 2006 and of 18,892 patients for the 3-year period of 2004-2006 was conducted. Multiple logistic regression analyses were used to identify risk factors for lack of dental care.

Results: Only 43% of patients with schizophrenia (9,263/21,417)—compared to an annual dental visit rate of 68% in the general adult Danish population (2,567,634/3,790,446)—visited the dentist within 12 months in 2006 (OR = 2.8; 95% CI, 2.7-2.9; P < .0001). Moreover, only 31% of schizophrenia patients complied with a regular annual dental check-up visit between 2004 and 2006. Nonadherence to annual dental visits was consistently predicted by substance abuse diagnosis, involuntary legal status, living in an institution, admission to a psychiatric facility for a minimum of 30 days, and male sex, whereas clozapine treatment, atypical antipsychotic treatment, at least monthly outpatient visits, and age > 50 years were associated with a lower risk for inappropriate dental care.

Conclusions: Patients with schizophrenia visit dentists much less frequently than the general population in the same country. Health professionals should pay more attention to the dental health care of patients with schizophrenia, actively encourage patients to regularly visit the dentist, and establish a formal collaboration with dentists to improve the dental health aspects of this disadvantaged patient group.

J Clin Psychiatry

Submitted: April 30, 2009; accepted August 25, 2009.

Online ahead of print: June 15, 2010 (doi:10.4088/JCP.09m05318yel).

Corresponding author: Jimmi Nielsen, MD, Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, PO Box 210, DK-9100 Aalborg, Denmark (jin@rn.dk).