Leveraging big electronic data to identify oral care disparities in individuals with serious mental illness

Individuals with serious mental illness (SMI) have poorer oral health than the general population for various reasons, including poor oral hygiene, adverse effects of psychotropic medicines, stigma, fear, cognitive impairment, lack of insur¬ance coverage, and a shortage of professionals qualified to manage the oral health needs of this population. Oral health deteriorates further when care is postponed, resulting in greater treatment needs when the patient visits the dental office. This retrospective study aimed to determine differ¬ences in service return rate and frequency of visits for each of 12 American Dental Association (ADA) oral procedures in patients with and without SMI who were treated in a predoctoral dental clinic at a northeastern US dental school. This retrospective study used the dental electronic health records of 12,138 adult patients aged 18 years and over (total of 19,096 unique patient encounters) who received at least 1 comprehensive oral evaluation between January 1, 2017, and August 31, 2021. Three data processing methods were implemented to retrieve periodontal diagnoses in accordance with American Academy of Periodontology guidelines and to extract medical histories and behavioral factors from free text. Chi-square tests determined that there were statistically significant differences between the 2 groups for 4 of 12 ADA procedures, while t tests deter¬mined that the SMI group had a higher frequency of visits for 6 procedure categories. Logistic regression analysis showed that patients with an SMI had a significantly higher odds ratio of receiving 2 procedure categories (remov¬able prosthodontics and adjunctive general services). A negative binomial regression analysis was then conducted to predict the frequency of visits; patients with an SMI had a higher incidence rate ratio of receiving 4 ADA procedure categories (preventive, removable prosthodontics, oral and maxillofacial surgery, and adjunctive general services). This study identified the existence of oral healthcare disparities in a population with SMI in relation to specific ADA dental procedure categories. Improving integrated care models, interprofessional collaboration, and education of predoc¬toral dental students and licensed professionals may help alleviate some of the existing disparities.