This article will be made Open Access on the publisher's webpage (follow the DOI link) on the 8 September 2016.Background
People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time,
but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general
population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life,
affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often
not seen as a priority in people suffering with serious mental illness.
Objectives
To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness.
Search methods
We searched the Cochrane Schizophrenia Group’s Trials Register (5November 2015), which is based on regular searches ofMEDLINE,
EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type,
or publication status limitations for inclusion of records in the register.
Selection criteria
All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious
mental illness.
Data collection and analysis
We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an
intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed
a fixed-effect model for analyses. We assessed risk of bias for included studies and created ’Summary of findings’ tables using GRADE.
Main results
We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the
key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse
events, and service use. Data for leaving the study early and change in plaque index scores were provided.
Oral health education compared with standard care
When ’oral health education’ was compared with ’standard care’, there was no clear difference between the groups for numbers leaving
the study early (1 RCT, n = 50, RR 1.67, 95%CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important
change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear
if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may
have implications regarding improvement in oral hygiene.
Motivational interview + oral health education compared with oral health education
Similarly, when ’motivational interview + oral health education’ was compared with ’oral health education’, there was no clear difference
for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental
state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60
95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding
improvement in oral hygiene.
Monitoring compared with no monitoring
For this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring
the ’no monitoring’ group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are
problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but
also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection
of the acceptability of the monitoring to patients. For this comparison, no data were available for ’no clinically important change in
plaque index’.
Authors’ conclusions
We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful
outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and
Oral Health working group until better evidence is generated. Pioneerin
