Guidelines for Orthodontic Management of Individuals With Mental Illness Using Psychiatric Medication: A Systematic Review

Abstract

The majority of mentally challenged individuals anticipate treatment with inflated levels of concern more than conventional orthodontic patients. However, there are no systematic reviews on behavioral modification techniques and orthodontic therapy for people with mental illness. Therefore, the goal of the review was to highlight the orthodontic concerns for people with mental disabilities with the intent to address the problems that emerge when providing orthodontic care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and population, exposure, and outcome (PEO) criteria were followed in conducting the review. An electronic search was performed in the PubMed, Scopus, EMBASE, Cochrane Oral Health Group, and Dentistry and Oral Science Source databases searched through EBSCO and Google Scholar for potentially relevant publications in the English language from January 2002 to December 2022. Studies reporting behavioral modification strategies and/or physical constraints used during orthodontic treatment of mentally challenged patients were included in the review. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and research reviews and synthesis. The initial electronic and manual search yielded 233 articles. After eliminating duplicates and reviewing the title/abstracts, 75 articles were selected for independent full-text review. Based on the eligibility criteria, 12 studies were finally chosen for qualitative synthesis. Four of these studies were case reports, while eight were comprehensive reviews. The JBI critical assessment criteria for case reports revealed that two studies had moderate-quality evidence, one case report with high-quality evidence and the other with low-quality evidence. The quality of the selected comprehensive literature reviews assessed using JBI critical assessment for reviews and research syntheses was judged to have poor-quality evidence. A thorough literature search on the topic did not reveal a single systematic review, and all of the reviews that were chosen were exhaustive. Parental cooperation and patient motivation are crucial components of a successful treatment regimen. A better prognosis is determined by the choice of appropriate orthodontic mechanotherapy along with the utilization of an array of behavior modification modalities and the availability of a team with expertise.

Keywords: behavior modification; evidence-based dentistry; intravenous sedation; mental illness; orthodontic guidelines; special health care needs; systematic review.

Figure 1. PRISMA flowchart of the included studies (adapted from the 2009 PRISMA flow diagram)