102 Chapter 4 One study reported an RCT with an oral health promotion programme with group and individual components in outpatients with SMI [48]. In this 12-week experimental study, the intervention group received group oral health education in five sessions with an interval of 2 weeks. The intervention group received pictures of the Bass toothbrushing technique procedure that were posted on the mirror in the bathroom of participants. Songs with a message of the benefits of toothbrushing were broadcasted five times each day (upon waking up, after each meal, and before going to sleep) [48]. The individual interventions included instructions from a trained nurse. Tokens were used after the nurses had checked the accomplishment of successful toothbrushing. The control group received usual nursing care. After 12 weeks, the mean dental plaque index significantly improved in the intervention group (p < 0.001). Oral health knowledge, oral health attitude, and oral health behaviour were statistically improved in the intervention group after 12 weeks (p < 0.001). Consumption of sugary beverage and dentist-visiting behaviour did not show a significant change [48]. One quasi-experimental study reported an intervention combining behavioural and educational elements in patients with SMI [49]. In this study, with random assignment at the level of treatment centre, participants were assigned to four study groups. Group A received oral hygiene education and a battery-operated toothbrush. Group B received only the same battery-operated toothbrush as Group A. Group C received the oral hygiene education as well as a manual toothbrush. Group D received only the same manual toothbrush as Group C. Participants in Groups A and C received oral hygiene instructions [54]. Participants were observed while performing oral hygiene with their toothbrushes in the dental chair of their dentist. Dental plaque index and individual modifications were made for participants in Groups A and C when needed. All participants were provided with an evaluation and instruction per visit. They received and were instructed to use Crest Cavity Protection toothpaste for the duration of the study. Participants received a calendar with the four study weeks and stickers were provided to each participant. Participants were asked to perform oral care twice daily (morning and before bedtime) and affix a sticker to the calendar for that particular day. Smoking status (current smoker and never smoked) was assessed [49]. A statistically significant effect is found on the type of toothbrush participants used (p < 0.05). Interaction of home care instructions and type of toothbrush were not found. This study showed a significant effect on gingival index associated with the mechanical toothbrush
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