Tag Archives: Ljubomir Todorović

Schizophrenia and Oral Health – Review of the Literature

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1 / Slavica Đukić Dejanović23 / Ljiljana Janković4 / Ljubomir Todorović5

1Clinic for Psychiatric Disorders “Dr Laza Lazarević”, Medical Clinical Centre, Belgrade, Serbia
2Clinic for Psychiatric Disorders “Dr Laza Lazarević” Belgrade, Serbia
3Faculty of Medical Sciences University in Kragujevac, Kragujevac, Serbia
4School of Dental Medicine University in Belgrade, Belgrade, Serbia
5Medical Academy of the Serbian Medial Society


Patients with schizophrenia, especially during period of their hospitalization, are likely to constitute a high-risk group of individuals with respect to prevalence of oral diseases. Several factors are mentioned in the manuscript that may contribute to the finding of increased prevalence of oral diseases in patients with schizophrenia. Unfortunately, some of these can be attributed to dental profession; these patients are sometimes deprived of dental service as they cannot afford the treatment due to its cost and they are even neglected sometimes by dental professionals. The idea of providing oral health care in the environment of specialized health care institutions, such as psychiatric hospitals, during periods of hospitalization, is especially emphasized.

Keywords: Schizophrenia; Oral Health Care; Caries; Periodontal Disease


  1. World Health Organization. Promoting mental health: concepts, emerging evidence, practice. Geneva: World Health Organization; 2005.
  2. World Health Organization. Investing in mental health: Evidence for action. Geneva: World Health Organization; 2003.
  3. Morales-Chavez MC, Rueda-Delgado YM, Pena-Orozco DA. Prevalence of bucco-dental pathologies in patients with psychiatric disorders. J Clin Exp Dent, 2014; 6(1):7-11. [Crossref]
  4. Bernaud-Gounot V, Kovess-Masfety, Perrus C, Trohei G, Richard F. Oral health status and treatment needs among psychiatric inpatients in Rennes, France: a cross-sectional study. BMC Psychiatry, 2013; 13:227.
  5. Velasco-Ortega E, Segura-Egea JJ, Cordoba-Arenas S, Jimenez-Guerra A, Monsalve-Guil L, Lopez-Lopez J. A comparison of the dental status and treatment needs of older adults with and without mental illness in Sevilla, Spain. Med Oral Patol Oral Cir Bucal, 2013; 18(1):e71-75. [Crossref]
  6. Rekha R, Hiremath SS, Bharath S. Oral health status and treatment requirements of hospitalized psychiatric patients in Bangalore city: a comparative study. J Ind Soc Pedod Prev Dent, 2002; 20:63-67.
  7. Cormac I, Jenkins P. Understanding the importance of oral health in psychiatric patients. Advances in Psychiatric Treatment, 1990; (5):53-60.
  8. Kilborne AM, Horvitz-Lennon M, Post EP, McCarthy JF, Cruz M, Welsh D, et al. Oral health in V e t e r a n s Affairs patients diagnosed with serious mental illness. J Public Health Dent, 2007; 67:42-48. [Crossref]
  9. Shaban A, Flisher AJ. The association between psychopathology and substance use in young people: A review of the literature. Journal of Psychoactive Drugs, 2010; 42(1):37-47. [Crossref]
  10. Rai B. Oral health in patients with mental illness. Int Dent Sci, 2008; 6:1-7.
  11. Beloica D, et al. Paediatric Dentistry. Belgrade:Elit-Medica, 2000. (in Serb)
  12. Dimitrijević B, et al. Clinical Periodontology. Belgrade: Zavod za udžbenike i nastavna sredstva, 2010. (in Serb)
  13. Vulović M, et al. Preventive Dentistry. Belgrade: Elit- Medica, 2002.(in Serb)
  14. Samaranayake LP. Essential Microbiology for Dentistry. Philadelphia: Elsevier Ltd, 2002.
  15. Velasco E, Machuca G, Martinez-Sahuquillo A, Rios V, Lacalle J, Bullon P. Dental health among institutionalized psychiatric patients in Spain. Special Care in Dentistry, 1997; 17(6):203-206.
  16. Zusman SP, Ponizovsky AM, Dekel D, Masarwa A, Ramon T, Natapov L, Grinshpoon A. An assessment of the dental health of chronic institutionalized patients with psychiatric disease in Israel. Spec Care Dentist, 2010; 30(1):18-22.
  17. Teng PR, Su JM, Chang WH, Lai TJ. Oral health of psychiatric inpatients: a survey of central Taiwan hospitals. General Hospital Psychiatry, 2011; 33:253-259. [Crossref]
  18. Al Mobeeriek AA. Oral health status among psychiatric patients in Riyadh, Saudi Arabia. West Indian Med J, 2012; 61(5):549-554.
  19. Ujaoney S, Motwani MB, Khairkar PH, Dewgekar SS, Bang G. Oral health status and dental treatment needs in institutionalized versus non-institutionalized psychiatric patients. Journal of Disability and Oral Health, 2010; 11(4):163-170.
  20. Lewis S, Jagger RG, Treasure E. The oral health of psychiatric in-patients in South Wales. Special Care Dentist, 2001; 21(5):182-186.
  21. Ramon T, Grinshpoon A, Zusman SP, Wiezman A. Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel. Eur Psychiatry, 2003; 18(3):101-105. [Crossref]
  22. Kisely S, Quek LH, Pais J, Lalloo R, Johnson NW, Lawrence D. Advanced dental disease in people with severe mental illness: systematic review and meta-analysis. BJP, 2011; 199:187-193. [Crossref]
  23. Jayakumar HL, Jyothi D, Manesch Chandra K, Pallavi HN. Periodontal health among elderly psychiatric patients in Bangalore city-India. Pakistan Oral and Dental Journal, 2011; 31(1):128-136.
  24. Tang WK, Sun FCS, Ungvari GS, O’Donnell D. Oral health of psychiatric in-patients in Hong Kong. Int J Soc Psychiatry, 2004; 50:186-191. [Crossref]
  25. Gowda EM, Bhat PS, Swamy MM. Dental health requirements for psychiatric patients. MJAFI, 2007; 63:328-330.
  26. Adeniyi AA, Ola BA, Edeh CE, Ogunbanjo O, Adewuya AO. Dental status of patients with mental disorders in a Nigerian teaching hospital: a preliminary survey. Spec Care Dentist, 2011; 31(4):134-137.
  27. Kebede B, Kemal T, Abera S. Oral health status of patients with mental disorders in Southwest Ethiopia. PLoS ONE, 2012; 7(6):e39142.
  28. Kumar M, Chandu GN, Shafiulla MD. Oral health status and treatment needs in institutionalized psychiatric patients: one year descriptive cross sectional study. Indian Journal of Dental Research, 2006; 17(4):171-177.
  29. Gopalakrishnapillai AC, Radhakrishnanlyer R, Kalantharakath T. Prevalence of periodontal disease among inpatients in a psychiatric hospital in India. Spec Care Dentist, 2012; 32(5):196-204.
  30. Velasco E, Bullon P. Periodontal status and treatment needs among Spanish hospitalized psychiatric patients. Spec Care in Dentist, 1999; 19(6):254-258.
  31. Ministry of Health, Serbia. National guideline of good clinical practice for diagnostics and theraphy of schizophrenia. Available from: http://www.batut.org.rs/download/aktuelno/klinicka%20praksa/Shizofrenija.ppd (in Serb).
  32. Kučukalić A, et al. Guideline for therapy of schizophrenia. Sarajevo, Bosnia and Herzegovina; 2006. (in Bosnian).
  33. Sadock BJ, Sadock VA. Kaplan and Sadock’s comprehensive textbook of psychiatry – 9th edition. Lippincott Williams and Williams, 2009.
  34. Đukić Dejanović S. Psychiatry. Kragujevac: University of Kragujevac; 2006. (in Serb)
  35. DimićPotić J. Basics of Psychiatry for Dental Medical Students. Belgrade: Zavod za udžbenike i nastavna sredstva, 2000. (in Serb).
  36. Marić J. Clinical Psychiatry. Belgrade: Megraf; 2005. (in Serb)
  37. Yang J, Chen T, Sun L, et al. Potential metabolite markers in schizophrenia. Mol Psychiatry, 2013; 18 (1):67-78. [Crossref]
  38. Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia “just a fact”. Fourth clinical features and conceptualization. Schizophr Res, 2009; 110(1-3):1-23. [Crossref]
  39. World Health Organization. International statistical classification of diseases and related health problems -10th revision. 2010.
  40. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM IV). Text revision 4th ed. Washington, D.C. American Psychiatric Press, Inc. 2000.
  41. Griffiths J, Jones V, Leeman I, Lewis D, Patel K, Wilson K, Blankenstein R. Oral health care for people with mental health problems-guidelines and recommendations. British Society for Disability and Oral Health Work Group, 2000; 1-20.
  42. Evans CA, Kleinman DV. The surgeon general report on America’s oral health. J Am Dent Assoc, 2000; 131(12):1721-1728.
  43. Nikolić Jakoba N. Characterisation of Toxic Activity of Aggregatibacter Actinomycetemcomitans. Belgrade: PhD Thesis; 2012. (in Serb)
  44. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet, 2007; 369:51-59. [Crossref]
  45. Đajić D, et al. Atlas of Mouth Diseases and Periodontology. Belgrade: ElitaMedica; 2001. (in Serb)
  46. Kossioni AE, Kossionis GE, Polychronopoulou A. Oral health status of elderly hospitalized psychiatric patients. Gerodontology, 2012; 29:272-283. [Crossref]
  47. Jyoti B, Muneeshwar PD, Srivastava R, Singh AR, Kiran M, Simlai J. Oral health status and treatment needs of psychiatric inpatients in Ranchi, India. JIAOMR, 2012; 24(3):177-181. [Crossref]
  48. Farhadmoillashahi L, Lashkaripour K, Bakhshani NM, Faghihinia M. Dental health status in hospitalized psychiatric patients in Sistan and Baluchestan province, Iran. Health Scope, 2014; 3(4):e21626.
  49. Thomas A, Lavrentzou E, Karouzos C, Kontis C. Factors that influence the oral condition of chronic schizophrenia patients. Spec Care Dentist, 1996; 16(2):84-86.
  50. Nikfarjam M, Parvin N. Oral health status in three long term care units of schizophrenic patients in Chaharmahal-Bakhtiatiprovice, Iran. Iran Red Cres Med, 2013; 15(4):371-372.
  51. Sjögren R, Nordström G. Oral health status of psychiatric patients. Journal of Clinic Nursing, 2000; 9(4):632-638.
  52. Chu KY, Yang NP, Chou P, Chiu HJ, Chi LY. Comparison of oral health between inpatients with schizophrenia and disabled people or the general population. Journal of the Formosan Medical Association, 2012; 111:214-219. [Crossref]
  53. Shetty S, Bose A. Schizophrenia and periodontal disease: An oro-neural connection? A cross-sectional epidemiological study. Journal of Indian Society of Periodontology, 2014; 18(1):69-73.
  54. Friendlander AH, Liberman RP. Oral health care for the patients with schizophrenia. Spec Care Dentist, 1991; 11(5):179-183.
  55. Jovanović S, Gajić I. Oral health in individuals with psychotic disorders. Stom Glas S, 2008; 55:180-187. (in Serb)
  56. Friendlander AH, Norman DC. Late-life depression: psychopathology, medical interventions, and dental implications. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 2002; 94:404-412. [Crossref]
  57. Arthur H, Friedlander DD, Stephen R, Marder MD. The psychopathology, medical management and dental implication of schizophrenia. J Am Dent Assoc, 2002; 133:603-610.
  58. Sreebny LM, Banoczy J, Baum BJ, Edgar WM, Esptein JB, Fox PC, Lamas M. Saliva: its role in health and disease. Int Dent J, 1992; 42:291-304.
  59. Jovanović S, Milovanović SD, Gajić I, Mandić J, Latas M, Janković Lj. Oral health status of psychiatric in-patients in Serbia and implications for their dental care. Croat Med J, 2010; 51:443-450. [Crossref]
  60. Tani H, Uchida H, Suzuki T, Shibuya Y, Shimanuki H, Watanabe K, et al. Dental conditions in inpatients with schizophrenia: a large-scale multi-site survey. BMC Oral Health, 2012; 12:32.
  61. Clark DB. Dental care for the patient with bipolar disorders. J Can Dent Assoc, 2003; 69(1):20-24.
  62. Morio KA, Marshall TA, Qian F, Morgan TA. Comparing diet, oral hygiene and caries status of adult methamphetamine users and nonusers: a pilot study. J Am Dent Assoc, 2008; 139:171-176. [Crossref]
  63. Kossioni AM, Kossionis GE, Polychronopoulou A. Variation in oral health parameters between older people with and without mental disorders. Spec Care Dentist, 2013; 33(5):232-238.
  64. Thomas A, Lavrentzou E, Karouzos C, Kontis C. Factors which influence the oral condition of chronic schizophrenia patients. Spec Care Dentist, 1996; 16(2):84-86.
  65. Hede B. Oral health in Danish hospitalized psychiatric patients. Community Dentistry and Oral Epidemiology, 1995; 23(1):44-48. [Crossref]
  66. Barnes GP, Allen EH, Parker WA, Lyon TC, Armentrout W, Cole JS. Dental treatment needs among hospitalized adult mental patients. Spec Care Dent, 1988; 8:173-177.
  67. Matevosyan NR. Oral health of adults with serious mental illness: a review. Community Ment Health J, 2010; 46:553-562.
  68. Stevens T, Spoors J, Hale R, Bembridge H. Perceived oral health needs in psychiatric in-patients: impact of a dedicated dental clinic. The Psychiatrist, 2010; 34:518-521.
  69. Bardow A, Nyvad B, Nauntofte B. Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ. Arch Oral Biol, 2001; 46:413-423. [Crossref]
  70. Janardhanan T, Cohen CI, Kim S, Rizvi BF. Dental care and associated factors among older adults with schizophrenia. JADA, 2011; 142(1):57-65.
  71. Mirza I, Day R, Phelan M, Wulff-Cochrane V. Oral health of psychiatric in-patients: a point prevalence survey of an inner-city hospital. Psychiatric Bulletin, 2001; 25:143-145. [Crossref]
  72. Shah VR, Jain P, Patel N. Oral health of psychiatric patients: A cross-sectional comparison study. Dent Res J (Isfahan), 2012; 9(2):209-214. [Crossref]
  73. Aurer A. Risk factors of systematic diseases and periodontitis. Medix, 2003; 50:117-118.
  74. Angelillo IF, Grasso GM, Sagliocco G. Dental health in a group of drug addicts in Italy. Community Dentistry and Oral Epidemiology, 1991; 19(1):36-37. [Crossref]
  75. Harris CK, Warnakulasuriya KAAS, Johnson NW. Oral and dental health in alcohol misusers. Community Dental Health, 1996; 13:199-203.
  76. Znegin AZ, Yanik K, Celenk P, Unal-Erzurumlu Z, Yilmaz H, Bulut N. Oral hygiene and oral flora evaluation in psychiatric patients in nursing homes in Turkey. Nigerian Journal of Clinical Practice, 2015; 18(6):751-756. [Crossref]
  77. Arnaiz A, Zumarraga M, Diez-Altuna I, Uriarte JJ, Moro J, Perez-Ansorena MA. Oral health and the symptoms of schizophrenia. Psychiatry Research, 2011; 188:24-28. [Crossref]
  78. Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia. J Gen Intern Med, 2006; 21:1133-1137. [Crossref]
  79. Schmidt LM, Hesse M, Lykke J. The impact of substance use disorders on the course of schizophrenia – A 15-year followup study: dual diagnosis over 15 years. Schizophr Res, 2011; 130:228-33. [Crossref]
  80. Turkington A, Mulholland CC, Rushe TM, Anderson R, McCaul R, Barret SL, Barr RS, Cooper SJ. Impact of persistent substance misuse on 1-year outcome in firstepisode psychosis. Br J Psychiatry, 2009; 204:295-305.
  81. Manning V, Betteridge S, Wanigarante S, Best D, Strang J, Gossop M. Cognitive impairment in dual diagnosis inpatients with schizophrenia and alcohol use disorder. Schizophr Res, 2009; 114:98-104. [Crossref]
  82. Buhler B, Hambrecht M, Loffler W, Heinden W, Hafner H. Precipitation and determination on the onset and cause of schizophrenia by substance abuse – a retrospective and prospective study of 232 population-based first illness episodes. Schizophr Res, 2002; 54:243-251. [Crossref]
  83. Dervaux A, Bayle FJ, Krebs MO. Substance misuse among people with schizophrenia: similarities and differences between the UK and France. Br J Psychiatry, 2002; 180:381. [Crossref]
  84. World Health Organization. World Health Report: reducing risks, promoting healthy life. Geneva: World Health Organization. 2002.
  85. Enberg N, Wolf J, Ainamo A, Alho H, et al. Dental diseases and loss of teeth in a group of Finnish alcoholics: a radiological study. Acta Odontol Scand, 2001; 59:341-347. [Crossref]
  86. Cantwell R, Brewin I, Glazebrook C, et al. Prevalence of substance misuse in first-episode psychosis. Br J Psychiatry, 1999; 174:150-153. [Crossref]
  87. Katz G, Durst R, Shufman E, Bar-Hamburger R, Grunhaus L. Substance abuse in hospitalized psychiatric patients. IMAJ, 2008; 10:672-675.
  88. Swartz MS, Wagner HR, Swanson JW, et al. Substance use and psychosocial functioning in schizophrenia among new enrolees in the NIMH CATIE study. Psychiatr Serv, 2006; 57(8):1110-1116. [Crossref]
  89. Fowler IL, Carr VJ, Carter NJ, Levin TJ. Patterns of current and lifetime substance use in schizophrenia. Shizophr Bull, 1998; 24(3):443-455. [Crossref]
  90. McGrath J, Welham J, Scott J, Varghese D, Degenhardt L, Hayatbakhsh MR, Alati R, Williams GR, Bor W, Najman JM. Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults. Archives of General Psychiatry, 2010; 67:440-447. [Crossref]
  91. Veling W, Mackenbach JP, van Os J, Hoek HW. Cannabis use and genetic predisposition for schizophrenia: a casecontrol study. Psychological Medicine, 2008; 38:1251-1256.
  92. Chambers RA, Krystal JH, Self DW. A neurobiological basis for substance abuse comorbidity in schizophrenia. Biol Psychiatry, 2001; 50:71-83. [Crossref]
  93. Brand HS, Gonggrijp S, Blanksma CJ. Cocaine and oral health. Br Dent J, 2008; 204:365-369.
  94. Brand HS, Dun SN, Nieeuw Amerongen AV. Ecstasy (MDMA) and oral health. Br Dent J, 2008; 204:77-81.
  95. Janković Lj, et al. Oral Medicine: practicum. Belgrade: Zavod za udžbenike i nastavna sredstva. 2007. (in Serb)
  96. Dangore-Khasbage S, Khairkar PH, Degwekar SS, Bhowate RR, Bhake AS, Singh A, Lohe VK. Prevalence of oral mucosal disorders in institutionalized and noninstitutionalized psychiatric patients: a study from AVBR hospital in central India. Journal of Oral Science, 2012; 5 (1):85-91.
Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 1, Pages 15–21, ISSN (Online) 2335-0245, DOI: https://doi.org/10.1515/bjdm-2016-0002, April 2016