108 Chapter 4 with SMI (psychotic disorders, personality disorders, mood disorders, anxiety disorders, autism spectrum disorders, eating disorders, and substance abuse disorders). There are constantly new insights regarding oral health. A recent study for example showed the effectiveness of a mechanical and ultrasonic toothbrush on oral biofilm removal [63]. This highlights the proactive approach for clinical and home management through the use of mechanical or ultrasonic toothbrushes in outpatients and inpatients with a mental health disorder. Furthermore, a recent study on students of Lee et al. [64] showed that ingestion of the oral probiotic Weissella cibaria can help reduce subjective halitosis and improve oral-health-related quality of life. However, this was not tested as intervention in patients with a mental health disorder. Therefore, further research on the use of oral probiotic Weissella cibaria could be interesting. A significant effect associated with the mechanical toothbrush is found on gingival index [50]. The problem that arises in these studies, is the unknown effects of dental health education and behavioural interventions over a longer period of time. Interventions were measured during a period between four weeks and ≤12 months. Kay and Locker [57] concluded in a systematic review about dental health education among the general population that effects are probably short-lived. However, this study is not very recent and focussed on the general population, and not specifically on people with a mental health disorder. Long-term effects of oral health interventions in patients with a mental health disorder are not known. Thus, future studies should consider measuring the impact of oral health interventions on oral health status as well as knowledge and behaviour changes over a longer period of time, in line with and depending on the needs of patients. Competences of Mental Health Professionals in Studied Interventions Professionals who were involved in care for patients in the included studied were nurses. According to De Mey et al. [28] the non-participation of mental health nurses is a concern. At the end of their study, 50% of the mental health nurses took part in the project and the active commitment was even lower. To care for and motivate patients regarding their oral health is imperative, and part of mental health nurses’ tasks in their daily contact with patients with SMI. Recent research shows that patients after a first episode psychosis or SMI are not always able to take care of their oral health, and this should be included in the daily work of nurses [13]. Mental health nurses do not apply motivational and supportive interventions
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