101 Oral Health Interventions in Patients with a Mental Health Disorder tional interventions focused on staff [45]. One quasi-experimental study reported behavioural and educational elements in an intervention in patients with SMI [49]. In the study of Adams et al. [45], Early Intervention Psychosis (EIP) teams received dental awareness training (and an information sheet) during a multidisciplinary team meeting (approximately 30 min). This training for teams included information about the trial and checklists for patients. Patients received a dental checklist in order to improve oral health behaviour. However, due to missing data in follow-up (e.g., high turnover of staff members), evidence could not be studied [45]. In the study of Almomani et al. [46], outpatients with psychotic or mood disorder received dental education, oral hygiene instructions, and reminders (a reminder system and a once-a-week phone call) from a dental hygienist to provide positive feedback and to underline the study instructions. The effects of these interventions were measured with the plaque index score (pre- and post-intervention). Results show that oral health in the intervention group improved significantly regarding plaque accumulation and knowledge level relative to the members of the control group (F = 5.32, p = .026, η2 = 0.1), who only received a mechanical toothbrush [46]. In the study of Almomani et al. [47], outpatients with SMI (schizophrenia, bipolar disorder and depression) received brief motivational interviewing (MI) sessions (15–20 min, frequency is unknown) prior to an educational session (with focus on information about the effects of SMI on oral health, exploring advantages of good oral hygiene and disadvantages of bad oral hygiene, motivation, confidence, and personal values related to oral health). Patients (intervention and control group) received pamphlets with information from the educational session and an instruction on how to use a mechanical toothbrush, a reminder system, and once-a-week telephone calls [47]. In the MI group, oral health knowledge in the intervention group improved significantly 4–8 weeks after baseline. The MI group showed significantly less plaque 8 weeks after baseline compared to the education group. Additionally, on the plaque index, there was a large interaction effect (η2 = 0.8). One of the limitations in this study is the lack of follow-up over a two-month time frame. Additionally, it is not known if these effects would be maintained over an extended period. 4
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