53 Risk Factors and Oral Health-Related Quality of Life Introduction Oral health is an important factor in general health and wellbeing [1]. The WHO emphasises that oral health is essential to general health [2] and oral health is a determining factor for quality of life [3]. In the last years, oral health is improved in the general population, but vulnerable patients (e.g. patients diagnosed with a mental health disorder) have not benefited of the worldwide improvement in oral health and remain disadvantaged [4]. Impacts of diseases are categorised in the WHO’s international classification of general health [5] and are categorised in a hierarchy, ranging from internal symptoms, which primarily affect the individual (e.g. pain), to limitations that are (also) associated with social roles (e.g. family). Poor oral health has a significant impact on the individual and his environment [3]. Since 1995, the Healthcare Institute of the Netherlands has periodically examined the development of oral health and the preventive dental behaviour of juveniles [6]. The outcomes for 17- and 23-year-olds showed that oral health had stagnated or even deteriorated compared to the same study in 2011. Some differences, in all age categories, are attributable to socioeconomic status (SES): the lower the SES group, the poorer the oral health. Furthermore, the increase in (erosive) dental wear is a cause for concern: 20% of the 17-year-olds and more than half of the 23-year-olds show wear and tear of the dental bone. Of these groups, 13% of the young adults (>17 years) indicated that they had occasionally postponed dental treatment due to financial considerations. Some young adults will receive information on oral health from their oral health professionals, however not on a structural basis. Another part of the group may not receive adequate information, which, from the perspective of public oral health, is an alarming development [6]. In the Netherlands, there are guidelines for oral health and oral health care in young children, however no guidelines are available for oral health in (vulnerable) young adults, e.g., patients diagnosed with a psychotic disorder (first-episode). To date, no research has been conducted on oral health in patients diagnosed with a psychotic disorder (first-episode). A recent study indicates that patients are hardly concerned with their oral health, there is a lack of awareness and patients are not able to adequately attend to their oral health [7]. Studies on patients diagnosed 3
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