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
Current version onlyOral 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 |
Oral health advice (preventative information or counsel enabling the recipient to decide about their own oral health; educative component, preventative aim, ethos of self-empowerment) vs Standard care (oral health advice not specifically emphasised beyond usual care)
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
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early | no estimate extracted | 0 studies | No studies |
Oral health: Not brushing teeth twice a day | no estimate extracted | 0 studies | No studies |
Adverse events: Clinically important specific adverse events | no estimate extracted | 0 studies | No studies |
Quality of life: Chronic pain | no estimate extracted | 0 studies | No studies |
Oral health: Not having seen a dentist in the past year | no estimate extracted | 0 studies | No studies |
Service use: Emergency medical/dental treatment | no estimate extracted | 0 studies | No studies |
Dental state: No clinically important change in plaque index | no estimate extracted | 0 studies | No studies |
Economic: Increased costs of health care | no estimate extracted | 0 studies | No studies |
Oral health advice (preventative information or counsel enabling the recipient to decide about their own oral health; educative component, preventative aim, ethos of self-empowerment) vs Standard care (oral health advice not specifically emphasised beyond usual care)
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
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early | no estimate extracted | NR | No studies |
Quality of life: Chronic pain | no estimate extracted | NR | No studies |
Dental state: No clinically important change in plaque index | no estimate extracted | NR | No studies |
Economic: Increased costs of health care | no estimate extracted | NR | No studies |
Service use: Emergency medical/dental treatment | no estimate extracted | NR | No studies |
Adverse events: Clinically important specific adverse events | no estimate extracted | NR | No studies |
Oral health: Not having seen a dentist in the past year | no estimate extracted | NR | No studies |
Oral health: Not brushing teeth twice a day | no estimate extracted | NR | No studies |