67 Risk Factors and Oral Health-Related Quality of Life In this study, we dichotomized the risk factors. A limitation could be the level of the risk factors (e.g., how much alcohol). These were not taken into account in this study. We could not use the OHIP-49 to calculate the prevalence and the odds ratios in this study as previous studies studied no cut-off points. These were available for the OHIP-14 in previous studies (Slade et al., 2004; Sanders et al., 2009; Lam et al., 2019). Therefore, the OHIP-14 was applied to this part of the analysis. It is unknown if this affected the results. Recommendations The findings in this study indicate the importance of using educational and behavioural interventions to improve oral health knowledge and motivation in patients diagnosed with a psychotic disorder (first-episode). Literature showed effective interventions regarding oral health in patients diagnosed with a psychotic disorder [27–30], however the stage a psychotic disorder was in [19] and the effect thereof on OHRQoL were not identified. There is a need for studies exploring what kind of treatment can improve OHRQoL in young adults in general, and patients diagnosed with a psychotic disorder (first-episode) especially. This means that further research should be continued, and such research should take the stage of the psychotic disorder and the effect thereof on OHRQoL into account. The results of this study were discussed with an expert by experience, three mental health nurses, and professionals from KieN Early Intervention Service Leeuwarden, the Netherlands. The results of the discussion were that mental health nurses state that there is an unintended lack of awareness among mental health nurses regarding the importance of oral health and oral health care. This is based on a lack of knowledge among mental health nurses, as well as a lack of suitable interventions, to be aware of the risk factors and its influence on oral health. Guidelines for lifestyle and patients diagnosed with a psychiatric disorder are lacking. The only guideline, developed for people diagnosed with a severe mental illness state that there must be “some attention to oral health”. Because there are no interventions described for this population (or similar populations), many mental health nurses feel to be shy of action. Therefore, an oral health care training for mental health nurses is 3
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