65 Risk Factors and Oral Health-Related Quality of Life This study shows that patients diagnosed with a psychotic disorder (first-episode), in general, have more risk factors (smoking, sugary food/drinks, low frequency of brushing, short duration of brushing, not enough financial means) compared to their peers. This means that oral health awareness training would be beneficial for all young people, especially those diagnosed with a psychotic disorder (first-episode). At this moment, no oral health interventions are available. However, oral health education, the use of a mechanical toothbrush, reminder systems, and brief motivational interviewing sessions in patients diagnosed with SMI or psychotic disorders showed to be effective [27–30]. In all samples, oral health knowledge and oral health status (Quigley Hein plaque index) improved significantly. There is no evidence if OHRQoL improved for these populations. The results in OHRQoL showed that the case group scored significantly poorer in the dimensions psychological discomfort, physical disabilities, psychological disabilities, and in the overall OHIP-49 score. This could be an effect of antipsychotic medication, however the objective of this study could not facilitate adding medication as a confounder. The multiple linear regression analysis showed that 14% of the variance in the outcome could be explained by the variables included in the model. Even though there are significant differences between the two study groups in the outcome for OHRQoL, the factors included in the model have limited exploratory value in explaining outcome differences. Additionally, in this research, patients diagnosed with a psychotic disorder (first-episode) were included. However, these patients might have been more ill than expected. Furthermore, the independent variables included in the analysis did not constitute all factors affecting the OHRQoL. Considering that the mentioned risk factors explained 14% of variance in the outcome of OHRQoL, more insight is needed to identify additional factors affecting OHRQoL. Introducing the risk factors in stage 2 of the regression, illicit drugs contribute to poor OHRQoL. This concurs with recent studies [14,31]. Using illicit drugs causes xerostomia (dry mouth). Xerostomia is an important risk factor for dental caries. Additionally, xerostomia is a debilitating condition in itself causing discomfort and reduced quality of life [14,31,32]. The results of this study show some unexpected outcomes. Introducing the risk factors in stage 2 of the regression, drinking alcohol, and not having an insurance for oral health care were beneficial risk factor for improving OHRQoL. The literature has shown individuals with alcohol abuse have been found to be at high risk of oral 3
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