Oral Health Interventions in Patients with a Mental Health Disorder: A Scoping Review with Critical Appraisal of the Literature

Abstract

Poor oral health affects quality of life and daily functioning in the general population and especially in patients with mental health disorders. Due to the high burden of oral health-related quality of life in patients with a mental health disorder, it is important for nurses to know how they can intervene in an early phase. The aim of this systematic scoping review was to identify and appraise oral health interventions in patients with a mental health disorder. A systematic scoping review with a critical appraisal of the literature was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews and their checklists. MEDLINE, CINAHL, PsycINFO and reference lists were searched from their inception until December 2020. Results: Eleven quantitative studies were included in the review: four randomized controlled trials, six quasi-experimental studies and one cohort study. Studies focused on interventions for patients (n = 8) or focused on patients together with their professionals (n = 3). Four types of oral health interventions in mental health were found: (I) educational interventions; (II) physical interventions; (III) interventions combining behavioural and educational elements and (IV) interventions combining educational and physical elements. All studies (n = 11) had an evaluation period ≤12 months. Nine studies showed an effect on the short term (≤12 months) with regard to oral health knowledge, oral health behaviour, or physical oral health outcomes (e.g., plaque index). Two studies showed no effects on any outcome. Overall, the methodological insufficient to good. Conclusion: Four types of interventions with positive effects (≤12 months) on oral health knowledge, oral health behaviour, and physical oral health outcomes in different diagnostic patient groups were found. Due to the heterogeneity in both interventions, diagnostic groups and outcomes, one golden standard oral health intervention cannot be advised yet, although the methodological quality of studies seems sufficient. Developing an integrated oral health toolkit might be of great importance in mental health considering its potential effect on oral health-related quality of life.

Mental Disorders and Oral Diseases: Future Research Directions

“…For example, a Cochrane review concluded that providing oral health education alone for people with SMI does not lead to a clinically meaningful improvement in oral health outcomes (Khokhar et al 2016). These findings were consistent with the findings of recent evidence syntheses showing educational, behavioral, and other combined interventions delivered to people with mental disorders did not have clinically meaningful effects (Kuipers et al 2021; Macnamara et al 2021). A summary of these interventions is presented in Table 1.…”

A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder

“…The results of this study showed that some MHNs felt responsible to act on oral health issues, and several MHNs in certain situations felt responsible but were still uncomfortable acting on oral health. Oral health issues are important, as related risk factors are known to contribute to a lower quality of life and reduced life expectancy [ 8 , 9 , 10 , 11 , 12 , 13 ]. Since the MHN profession is underpinned by the concept of a holistic vision of care [ 18 , 47 , 48 ], it is important that the integration of physical issues, such as oral health, is addressed as a matter of priority.…”

“…An unhealthy lifestyle is an important cause of the gap in mortality. Several studies among patients with (severe) mental illness showed that oral health and oral-health-related quality of life are substandard within the unhealthy lifestyle domain [ 8 , 9 , 10 , 11 , 12 , 13 ].…”

“…Therefore, MHNs feel that it is inconvenient to uphold what these guidelines prescribe. A recent scoping review examined the educational, behavioral, and physical interventions to improve oral health among patients diagnosed with a mental health disorder [ 11 ]. An important conclusion of this review was that, despite the importance of good oral hygiene, few interventions have been developed for MHNs.…”

Management of Dental Patients With Mental Health Problems in Special Care Dentistry: A Practical Algorithm

“…The types of oral health interventions are educational, physical, a combination of behavioural and educational elements, and a combination of educational and physical elements [25]. However, no single intervention can suit all groups of individuals due to the diversity of mental health problems.…”