Cochrane · intervention · CD008802
Oral health education (advice and training) for people with serious mental illness
Khokhar, MA, Khokhar, WA, Clifton, AV, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
26
current version
GRADE rated
5
No studies
17
Included studies
3
as reported
No studies 17 · 65.4%Ungraded 4 · 15.4%Very low 2 · 7.7%Low 0 · 0%Moderate 3 · 11.5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People with serious mental illness; majority aged 18 to 65 years, preferably as defined by NIMH 1987, or with diagnosed schizophrenia, schizophrenia-like disorders, bipolar disorder, or serious affective disorder; dual diagnoses (plus substance abuse) eligible; dementia, personality disorder and mental retardation excluded | Three included RCTs, 1358 participants total; Almomani 2006 (n=50) and Almomani 2009 (n=60) each <100 participants, ISRCTN63382258 a cluster RCT (1248 enrolled; 1682 implied denominator for leaving the study early); all participants had schizophrenia; both sexes; USA (2 studies, same community centre) and UK (1 study) |
| Intervention | Oral health advice/training (educative component, preventative aim, ethos of self-empowerment; training = a process of learning particular skills to maintain one's own oral health); Monitoring (any means of observation, supervision, keeping under review, measuring or testing at intervals) | Oral health education (Almomani 2006, n=50); Motivational interview + oral health education (Almomani 2009, n=60); Monitoring (ISRCTN63382258, n=1682) |
| Comparison | Standard care (oral health advice and monitoring not specifically emphasised beyond usual care); interventions could also be compared with each other | Standard care (n=50); Oral health education (n=60); No monitoring (n=1682) |
| Outcomes | Primary: Oral health (not owning a toothbrush; not seen a dentist in past year; not brushing teeth twice a day; not flossing twice a day; incidence of pain or infection related to dental caries; oral health knowledge score); Quality of life (change in independence; change in ADL skills; chronic pain; immobility; change in earnings/employment; change in social status; healthy days; general quality of life change/endpoint); Dental state (no clinically important change in plaque index; any change in plaque index; teeth lost due to decay; change in dental caries; periodontal disease; oral infections). Secondary: Global state; Mental state; Adverse events; Death (natural, suicide); Service use; Leaving the study early; General functioning; Social functioning; Economic (increased costs of health care) | Dental state: average score modified Quigley-Hein Plaque Index (n=96); Knowledge: Oral Health Knowledge Questionnaire (n=56); Self regulation: Treatment Self Regulation Questionnaire (n=56); Leaving the study early (n=1792) |
| Study designs | Randomised controlled trials (and economic evaluations conducted alongside included RCTs); quasi-randomised studies excluded | RCT (n=3): two parallel-group (Almomani 2006; Almomani 2009) and one cluster-randomised (ISRCTN63382258) |
| Timing | Four time periods: immediate (within one week); short-term (one week to six months); medium-term (six months to one year); long-term (over one year) | Immediate/post-intervention plus follow-up: 4 weeks (Almomani 2006); 8 weeks (Almomani 2009); 12 months (ISRCTN63382258) |
Search date: 2015-11. Databases: Cochrane Schizophrenia Group's Study-Based Register of Trials (compiled from MEDLINE, EMBASE, AMED, BIOSIS, CINAHL, PsycINFO, PubMed, and clinical trials registries)
Questions and results
Show all 3 versionsOral health education (advice and training) vs Standard care (oral health advice not specifically emphasised beyond usual care)
Population: People with serious mental illness (all included participants had schizophrenia); majority aged 18 to 65 years per NIMH 1987, or with diagnosed schizophrenia, schizophrenia-like disorders, bipolar disorder, or serious affective disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early | RR 1.67 [0.45, 6.24] 120 per 1000 vs 200 per 1000 | 1 study · 50 participants | Moderate Downgraded: risk of bias |
Dental state: No clinically important change in plaque index | MD -0.5 [-0.62, -0.38] | 1 study · 40 participants | Very low Downgraded: indirectness |
Oral health: Not brushing teeth twice a day | No study reported useable data | 0 studies | No studies |
Adverse events: Clinically important specific adverse events | No study reported useable data | 0 studies | No studies |
Oral health: Not having seen a dentist in the past year | No study reported useable data | 0 studies | No studies |
Service use: Emergency medical/dental treatment | No study reported useable data | 0 studies | No studies |
Economic: Increased costs of health care | no estimate extracted | 0 studies | No studies |
Quality of life: Chronic pain | No study reported useable data | 0 studies | No studies |
Motivational interview plus oral health education vs Oral health education
Population: People with serious mental illness (all included participants had schizophrenia); majority aged 18 to 65 years per NIMH 1987, or with diagnosed schizophrenia, schizophrenia-like disorders, bipolar disorder, or serious affective disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early | RR 3.00 [0.33, 27.23] 33 per 1000 vs 36 per 1000 | 1 study · 60 participants | Moderate Downgraded: risk of bias |
Self regulation: Average score (Treatment Self Regulation Questionnaire, high score = good) Autonomous | MD 0.7 [-0.43, 1.83] | 1 study · 56 participants | Ungraded |
Adverse events: Clinically important specific adverse events | No study reported useable data | 0 studies | No studies |
Service use: Emergency medical/dental treatment | No study reported useable data | 0 studies | No studies |
Dental state: No clinically important change in plaque index | MD -0.6 [-1.02, -0.18] | 1 study · 56 participants | Very low Downgraded: risk of bias, indirectness |
Quality of life: Chronic pain | No study reported useable data | 0 studies | No studies |
Self regulation: Average score (Treatment Self Regulation Questionnaire, high score = good) External | MD 0.2 [-0.93, 1.33] | 1 study · 56 participants | Ungraded |
Self regulation: Average score (Treatment Self Regulation Questionnaire, high score = good) Introjected | MD 1.1 [0.22, 1.98] | 1 study · 56 participants | Ungraded |
Knowledge: Average score (Oral Health Knowledge Questionnaire, high score = good) | MD 5.4 [3.71, 7.09] | 1 study · 56 participants | Ungraded |
Oral health: Not brushing teeth twice a day | No study reported useable data | 0 studies | No studies |
Oral health: Not having seen a dentist in the past year | No study reported useable data | 0 studies | No studies |
Monitoring (any means of observation, supervision, keeping under review, measuring or testing at intervals) vs No monitoring
Population: People with serious mental illness (all included participants had schizophrenia); majority aged 18 to 65 years per NIMH 1987, or with diagnosed schizophrenia, schizophrenia-like disorders, bipolar disorder, or serious affective disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life: Chronic pain | No study reported useable data | 0 studies | No studies |
Adverse events: Clinically important specific adverse events | No study reported useable data | 0 studies | No studies |
Dental state: No clinically important change in plaque index | See comment; Not estimable; 0 (0 studies); no study reported useable data | 0 studies | No studies |
Oral health: Not brushing teeth twice a day | No study reported useable data | 0 studies | No studies |
Oral health: Not having seen a dentist in the past year | No study reported useable data | 0 studies | No studies |
Service use: Emergency medical/dental treatment | No study reported useable data | 0 studies | No studies |
Leaving the study early | RR 1.07 [1.00, 1.14] 645 per 1000 vs 690 per 1000 | 1 study · 1682 participants | Moderate Downgraded: risk of bias |