Is oral health an important factor for mental health among people in custody in Scottish prisons?

ABSTRACT - 350 words maximum covering: Background: A psychosocial needs assessment survey was conducted across Scottish prisons as part of the Scottish Oral Health Improvement Prison Programme’s (SOHIPP) development of the ‘Mouth Matters’ oral health intervention. The survey highlighted, that people in custody had a high prevalence of tooth decay and unmet treatment needs. Participants experienced high levels of depression, reported high drug use and had greater dental anxiety. It is known that extreme dental fear and drug use affect oral health and access to dental services, what was not known was how depression was related to drug use and dental anxiety and how they impacted upon decayed and missing teeth. Understanding the role of NCDs such as dental caries and depression was recognized by SOHIPP as being of central importance if [1] oral health was to be an integral part of prison public health and [2] if oral health service to meet the oral health and health needs of people in custody. Research Objectives or Program Description: The aim was to determine the impact of depression, dental anxiety and drug use upon prisoner’s experience of decayed and missing teeth. Methods or Activities: A convenience sample of prisoners across three Scottish prisons completed a questionnaire to measure depression [Centre for Epidemiological Studies Depression Scale (CES-D)] and dental anxiety [Modified Dental Anxiety Scale (MDAS)]. Three questions assessed drug use: experience of drug use, injecting drug use and rehabilitation. The oral examination assessed decay into dentine (D3cv) and missing teeth (MT) in the four quadrants (D3cvMT). Latent variable path analysis investigated the impact of depression on D3cvMT. Results or Evaluation: 342 prisoners participated, with 298 complete data sets. Depression was associated with decayed and missing teeth through an indirect pathway (total standardized indirect effects = 0.09, p < 0.01) via the latent variable drug use and dental anxiety (X2 (60) = 74.188, p = 0.103; RMSEA: 0.03; CFI: 0.995 and Tucker-Lewis index: 0.993). Conclusions or Implications: Conclusion: Decayed into dentine and missing teeth among people in custody was predicted by depression, drug use and dental anxiety. Implications: oral health is an integral part of prison public health; it is central to rehabilitation; multidisciplinary working with oral health as a central driver.