Oral health, coping strategies and neuropsychological determinants in patients with schizophrenia: A systematic review.
DOI:
https://doi.org/10.51168/sjhrafrica.v6i12.2482Keywords:
Dental, psychiatry, neurological, quality of life, stressAbstract
Background
Individuals with schizophrenia experience a high burden of oral disease due to psychotropic medication effects, impaired self-care, cognitive dysfunction, and social marginalization. Psychological determinants, including coping strategies and neuropsychological functioning, may influence oral health behaviour and treatment outcomes in this population.
Methodology
A systematic literature search was performed in PubMed, Scopus, and the Cochrane Library. Prospective and retrospective studies published in English evaluating oral health status, coping strategies, psychological determinants, or neurocognitive correlates among individuals diagnosed with schizophrenia were included. Editorials and conference abstracts were excluded. Studies were screened using predefined inclusion and exclusion criteria. Owing to heterogeneity in outcome measures and study designs, findings were synthesized narratively.
Results
Fifty records were identified, of which twenty full-text articles were assessed for eligibility. Ten studies met the inclusion criteria. Evidence consistently demonstrated increased dental caries, periodontal disease, xerostomia, and reduced preventive dental attendance among individuals with schizophrenia. Psychological determinants, including coping strategies, resilience, sense of coherence, self-esteem, hope, and neuropsychological functioning, were associated with oral health behaviour. Maladaptive coping and dental stress correlated with poor oral hygiene and delayed dental care. Studies also indicated that collaborative care involving dental and psychiatric professionals improved treatment engagement and rehabilitation outcomes.
Conclusions
Coping strategies and neuropsychological functioning influence oral health behaviour among individuals with schizophrenia. Interdisciplinary psychiatric–dental care models may improve oral health outcomes and quality of life.
Future research
Future research should focus on longitudinal studies examining neuropsychological determinants of oral health behaviour and the effectiveness of integrated rehabilitation-based oral health interventions.
References
Denis F, Goueslard K, Siu-Paredes F, Amador G, Rusch E, Bertaud V, et al. (2020) Oral health treatment habits of people with schizophrenia in France: A retrospective cohort study. PLoS ONE 15(3): e0229946. https://doi.org/10.1371/journal.pone.0229946 PMid:32150582 PMCid:PMC7062238
Jablensky A. Epidemiology of schizophrenia: the global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci. 2000; 250(6):274-285. https://doi.org/10.1007/s004060070002 PMID: 11153962 PMid:11153962
Kurtz MM, Wexler BE, Fujimoto M, Shagan DS, Seltzer JC. Symptoms versus neurocognition as predictors of change in life skills in schizophrenia after outpatient rehabilitation. Schizophr Res. 2008; 102(1-3):303. https://doi.org/10.1016/j.schres.2008.03.023 PMID: 18495433 PMid:18495433 PMCid:PMC2519168
Arnaiz A, Zuma'rraga M, Dı'ez-Altuna I, Uriarte JJ, Moro J, Pe'rez-Ansorena MA. Oral health and the symptoms of schizophrenia.Psychiatry Res. 2011;30; 188(1):24-8.https://doi.org/10.1016/j.psychres.2010.09.012 PMid:21055830
Vrbova K, Prasko J, Holubova M, Slepecky M, Ociskova M. Positive and negative symptoms in schizophreniaand their relation to depression, anxiety, hope, self-stigma, and personality traits-a cross-sectional study.Neuro Endocrinol Lett. 2018; 39(1):9-18. PMID: 29604619 https://doi.org/10.26226/morressier.5a7070e4d462b80290b566dc
Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J. 2005; 150:1115-21. https://doi.org/10.1016/j.ahj.2005.02.007 PMid:16338246
Denis F, Goueslard K, Siu-Paredes F, Amador G, Rusch E, Bertaud V, et al. (2020) Oral health treatment habits of people with schizophrenia in France: A retrospective cohort study. PLoS ONE 15(3): e0229946. https://doi.org/10.1371/journal.pone.0229946 PMid:32150582 PMCid:PMC7062238
Paredes, F. S., Rude, N., Moussa-Badran, S., Pelletier, J.-F., Rat, C., & Denis, F.(2019). Coping strategies for oral health problems by people with schizophrenia. Translational Neuroscience, 10(1), 187-194. doi:10.1515/tnsci-2019-0033 PMid:31410302 PMCid:PMC6689214
Jablensky A. Epidemiology of schizophrenia: the global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci. 2000;250(6):274-285. https://doi.org/10.1007/s004060070002 PMid:11153962
De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Moller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications, and disparities in health care. World Psychiatry. 2011; 1:52-77.https://doi.org/10.1002/j.2051-5545.2011.tb00014.x PMid:21379357 PMCid:PMC3048500
Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J. 2005; 150:1115-21.https://doi.org/10.1016/j.ahj.2005.02.007 PMid:16338246
Capasso RM, Lineberry TW, Bostwick JM, Decker P a., St. Sauver J. Mortality in schizophrenia and schizoaffective disorder: An Olmsted County, Minnesota cohort: 1950-2005. Schizophr Res. 2008; 98:287-94. https://doi.org/10.1016/j.schres.2007.10.005 PMid:18031996
Joukamaa M, Heliovaara M, Knekt P, Aromaa A, Raitasalo R, Lehtinen V.Schizophrenia, neuroleptic medication and mortality. Br J Psychiatry.2006; 188:122-7.https://doi.org/10.1192/bjp.188.2.122 PMid:16449697
Bertaud-Gounot, V., Kovess-Masfety, V., Perrus, C., Trohel, G., Richard, F., 2013. Oral health status and treatment needs among psychiatric inpatients in Rennes, France: a cross-sectional study. BMC Psychiatry 13 (1), 227.https://doi.org/10.1186/1471-244X-13-227 PMid:24053587 PMCid:PMC3856526
AIvarez-Arenal, A., Alvarez-Riesgo, J., Lopez, J., Vazquez, J., Vigil,M., 1996. DMFT and treatment needs in the adult population of Oviedo, Spain. Community Dent. Oral Epidemiol. 24 (1), 17-20.https://doi.org/10.1111/j.1600-0528.1996.tb00805.x PMid:8833508
Arnaiz, A., Zumárraga, M., Díez-Altuna, I., Uriarte, J.J.,Moro, J., Pérez-Ansorena, M.A., 2011.Oral health and the symptoms of schizophrenia. Psychiatry Res. 188 (1), 24-28.https://doi.org/10.1016/j.psychres.2010.09.012 PMid:21055830
Azodo, C.C., Ezeja, E.B., Omoaregba, J.O., James, B.O., 2012. Oral health of psychiatric patients: the nurse's perspective. Int. J. Dent. Hyg. 10 (4), 245-249.https://doi.org/10.1111/j.1601-5037.2011.00537.x PMid:22192470
Baghaie, H., Kisely, S., Forbes, M., Sawyer, E., Siskind, D.J., 2017. A systematic review and meta-analysis of the association between poor oral health and substance abuse. Addiction 112 (5), 765-779. https://doi.org/10.1111/add.13754 PMid:28299855
Beck, J.D., Offenbacher, S., 2005. Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease. J. Periodontol. 76 (11-s), 2089-2100. https://doi.org/10.1902/jop.2005.76.11-S.2089
Bertaud-Gounot, V., Kovess-Masfety, V., Perrus, C., Trohel, G., Richard, F., 2013. Oral health
Ruengtrakul S. Schizophrenia. In the Textbook of Psychiatry. 9th ed. Bangkok: Ruankaew Printing; 2005. p. 83-96. (in Thai)
Friedlander AH, Marder SR. The psychopathology, medical management, and dental implications of schizophrenia. J Am Dent Assoc 2002;133(5): 603-10. https://doi.org/10.14219/jada.archive.2002.0236 PMid:12036166
Prohmpradith S, Kaewmongkol S. The effect of clozapine and factors related to periodontal status in patients with schizophrenia. J Ment Health Thai 2013; 21(3):160-70. (in Thai)
Friedlander AH, Liberman RP. Oral health care for the patient with schizophrenia. Spec Care Dent 1991;11(5):179-83.https://doi.org/10.1111/j.1754-4505.1991.tb01726.x PMid:1839864
Arnaiz A, Zumarraga M, Diez-Altuna I, Uriarte JJ, Moro J. Oral health and symptoms of schizophrenia. Psychiatry Res 2011;188(1):24-8. https://doi.org/10.1016/j.psychres.2010.09.012 PMid:21055830
Lotrakul M. Psychotropic drug. In Handbook of psychiatric medication. Bangkok: Thaihealthbook; 2007. p. 96-126. (in Thai)
Frédéric Denis, La Chartreuse Psychiatric Center, Dijon, France, Boulevard Chanoine Kir, BP 23314, 21033 Dijon Cedex, France
Hafner H, an der Heiden W. Epidemiology of schizophrenia. Can J Psychiatry. 1997;42(2):139-51. https://doi.org/10.1177/070674379704200204 PMid:9067063
Jablensky A. Epidemiology of schizophrenia: the global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci. 2000;250(6):274-85. [PubMed: 11153962].https://doi.org/10.1007/s004060070002 PMid:11153962
Ling Y, Watanabe M, Yoshii H, Akazawa K. Characteristics linked to the reduction of stigma towards schizophrenia: a pre-and-post study of parents of adolescents attending an educational program.BMCPublic Health. 2014;14:258. https://doi.org/10.1186/1471-2458-14-258 PMid:24642069 PMCid:PMC4000132
Grisso T, Appelbaum PS. Comparison of standards for assessing patients' capacities to make treatment decisions. Am J Psychiatry.1995;152(7):1033-7. https://doi.org/10.1176/ajp.152.7.1033 PMid:7793439
Tosh G, Clifton A, Bachner M. General physical health advice for people with serious mental illness. Schizophr Bull. 2011;37(4):671-3. https://doi.org/10.1093/schbul/sbr005 PMid:21471437 PMCid:PMC3122281
Gupta S, Pratibha PK, Gupta R. Necessity of oral health intervention in schizophrenic patients - A review. Nepal J Epidemiol. 2016;6(4):605-612.https://doi.org/10.3126/nje.v6i4.17254 PMid:28804672 PMCid:PMC5506385
Lang HC, Su TP: The cost of schizophrenia treatment in Taiwan. Psychiatric Services. 2004; 55(8): 928-930. https://doi.org/10.1176/appi.ps.55.8.928 PMid:15292543
Sheiham A. Oral health, general health, and quality of life. Bulletin of the World Health Organization. 2005 Sep; 83(9):644-645. PMid:16211151 PMCid: PMC2626333
Friedlander AH, Marder SR. The psychopathology, medical management, and dental implications of schizophrenia. J Am Dent Assoc. 2002 May; 133(5):603-10. https://doi.org/10.14219/jada.archive.2002.0236 PMid:12036166 https://doi.org/10.14219/jada.archive.2002.0236 PMid:12036166
Schultz SH, North SW, Shields CG. Schizophrenia: A review. Am Fam Physician. 2007 Jun; 75 (12):1821-9. PMid:17619525
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: American Psychiatric Association, 1994.
Wey, M. C., Loh, S., Doss, J. G., Abu Bakar, A. K., & Kisely, S. (2015). The oral health of people with chronic schizophrenia: A neglected public health burden. Australian & New Zealand Journal of Psychiatry, 50(7), 685-694. https://doi.org/10.1177/0004867415615947 PMid:26560842
AIHW Dental Statistics and Research Unit (2008a) The National Survey of Adult Oral Health 2004-06: New South Wales (Cat. no. DEN 176). Canberra, ACT, Australia: Australian Institute of Health and Welfare.
AIHW Dental Statistics and Research Unit (2008b) The National Survey of Adult Oral Health 2004-06: Victoria (Cat. no. DEN 181). Canberra, ACT, Australia: Australian Institute of Health and Welfare.
Ainamo J, Barmes D, Beagrie G, et al. (1982) Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). International Dental Journal 32: 281-291.
Angelillo IF, Nobile CG, Pavia M, et al. (1995) Dental health and treatment needs in institutionalized psychiatric patients in Italy. Community Dentistry and Oral Epidemiology 23: 360-364.https://doi.org/10.1111/j.1600-0528.1995.tb00263.x PMid:8681519
Arnaiz A, Zumarraga M, Diez-Altuna I, et al. (2011) Oral health and the symptoms of schizophrenia. Psychiatry Research 188: 24-28.https://doi.org/10.1016/j.psychres.2010.09.012 PMid:21055830
World Health Organization https://www.who.int/news-room/fact sheets/detail/schizophrenia
Calin AM, Debita M, Ciurcaru OE, Scutariu MM, Szalontay AS. Xerostomia and Hyposalivation in Patients with Physical and Psychopathological Disabilities, Rev Chimie. 2017;68(10): 2443-2447. https://doi.org/10.37358/RC.17.10.5902 https://decisionsindentistry.com/article/oral-healthcare-patients-schizophrenia/
Mihai C., Chirita R., Robu V., Untu I., Szalontay A.S. Predicting Suicide Risk among Male Offenders: The Role of Severe Personality Disorders. Revista de Cercetare si Interventie Sociala,2017; 57:28-50.
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. https://doi.org/10.4317/jced.51147 PMid:24596639 PMCid:PMC3935909
Alhaffar, Mhd Bahaa Aldin & Abbas, Ghadir & Latifeh, Youssef & Hamadah, Omar. (2018). The Oral Manifestations of Psychiatric Disorders. Oral health and dental management. 17.
World Health Organization. Cross-national comparisons of the prevalences and correlates of mental disorders. WHO international consortium in psychiatric epidemiology. Bull World Health Organ. 2000; 78: 413-426.
Lawrence D, Jablensky A, Holman C, Pinder TJ. Mortality in Western Australian psychiatric patients. Social Psychiatry and Psychiatric Epidemiology. 2000; 35: 341-347.https://doi.org/10.1007/s001270050248 PMid:11037302
Mirza I. Oral health of psychiatric in-patients: A point prevalence survey of an inner-city hospital. Psychiatric Bulletin. 2001; 25: 143-145. https://doi.org/10.1192/pb.25.4.143
Persson K, Axtelius B, Söderfeldt B, Ostman M. Oral health-related quality of life and dental status in an outpatient psychiatric population: A multivariate approach. International Journal of Mental Health Nursing. 2010; 19: 62-70. Oral health care for people with mental health problems: guidelines and recommendations. Report of the British Society for Disability and Oral Health. www.bsdh.org.uk/guidelines/mental.pdf. https://doi.org/10.1111/j.1447-0349.2009.00639.x PMid:20074205
Frederic, D., Corinne, R., Matthieu, R., Francesca, S.-P., Stephanie, T.-J., & Nathalie, R. (2018). The schizophrenia oral health profile: Development and feasibility. Translational Neuroscience, 9(1), 123-131. https://doi.org/10.1515/tnsci-2018-0019PMid:30263228 PMCid: PMC6153450
Locker D, Clarke M, Payne B. Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res. 2000;79(4):970-975.https://doi.org/10.1177/00220345000790041301 PMid:10831100
Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273(1):59-65.https://doi.org/10.1001/jama.1995.03520250075037 PMid:7996652 PMCid:PMC5283789
Kurtz MM, Wexler BE, Fujimoto M, Shagan DS, Seltzer JC. Symptoms versus neurocognition as predictors of change in life skills in schizophrenia after outpatient rehabilitation. Schizophr Res. 2008;102(1-3):303-311.https://doi.org/10.1016/j.schres.2008.03.023 PMid:18495433 PMCid:PMC2519168
Jablensky A. Epidemiology of schizophrenia: the global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci.2000;250(6):274‑285. https://doi.org/10.1007/s004060070002 PMid:11153962
Kwong VW, Chang WC, Chan GH, Jim OT, Lau ES, Hui CL, Chan SK, Lee EH, Chen EY. Clinical and treatment-related determinants of subjective quality of life in patients with first-episode psychosis. Psychiatry Res. 2017;249:39-45.https://doi.org/10.1016/j.psychres.2016.12.038 PMid:28063397
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Dr. Vijay Subramani, Dr.Karthik Shunmugavelu, Vaishnavi

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
















