79 Oral Health Interventions in Patients with a Mental Health Disorder Introduction The World Health Organisation (WHO) emphasises that oral health is integral and essential to general health and wellbeing [1,2]. Oral health is improved in the general population, but vulnerable patients (e.g., patients diagnosed with mental health disorders) have not benefited from the worldwide improvement in oral health [3]. Poor oral health is associated with diabetes (both type 1 and 2) [4], respiratory disease and abdominal obesity It might also be related to cardiovascular diseases [4–7], but cigarette smoking might influence this relationship [8]. Nearly 20% of the population worldwide suffers from a mental health disorder [9,10], and this outlines the importance of oral health in patients diagnosed with a mental health disorder [11] who are exposed to more oral health risk factors [3,11–14]. Several risk factors of poor oral health in patients with a mental health disorder were described [15]. Many patients consume medication such as antipsychotics, antidepressants, and lithium. A dry mouth [16,17] is a side-effect of the medication which can increase plaque [18–21]. Next, oral health will be worsened by the consumption of sugary sweets and sugary drinks [22], which are more frequently used in patients with a mental health disorder. Inadequate oral health self-management, a lower tooth brushing frequency, a lack of motivation for proper oral hygiene and health care habits and poor psychosocial functioning are known as other barriers for adequate oral health in patients diagnosed with a mental health disorder [15–17,23]. Bad breath (halitosis) may lead to poor self-image, low self-esteem, decreased self-confidence, social phobia, loneliness, depression and suicidal intents in the general population [24,25]. Thus, poor oral health affects quality of life and daily functioning in the general population and especially in patients with a mental health disorder [1,2]. As a consequence, patients living with severe mental illness (SMI) (e.g., schizophrenia or related psychotic disorders, bipolar disorder,) are almost three times more likely to have lost all of their teeth compared to the general population [26]. It is evident that routine and effective oral care is necessary for maintaining oral health of in- and outpatients [27]. Mental health professionals (e.g., nurses) have an important role in the care for (out)patients with a mental health disorder. There4
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