Table 3 Study findings
Author, Year | Findings | Quality rating | ||
|---|---|---|---|---|
Oral Health Knowledge | Oral Health Attitudes | Oral Health Practices | ||
Adams et al., 2018 [34] | Â | Oral health not a priority | Tooth brushing aids | Â |
| Â | Â | - 22% No need (to see a dentist) | - 98% owned a toothbrush | Â |
| Â | Â | - 21% Not registered with a dentist | Frequency of brushing | Â |
|  |  | - 17% Dental avoidance | - 50% brushed 2–3 times a day | High |
|  |  |  | - 4% brushed between 1–2 times a day |  |
| Â | Â | Â | - 40% brushed 1 per day-few times a week | Â |
Agarwal et al., 2021 [35] | Â | Oral health not a priority | Tooth brushing aids | Â |
| Â | Â | - 84.7% perceived oral health as having little influence on their lives | - 72.1% aid of cleaning teeth: toothbrush | Â |
| Â | Â | Â | - 77.5% rinsed mouth after every meal | Moderate |
| Â | Â | Â | - 11.7% used an aid for cleaning tongue (brush or tongue cleaner) | Â |
| Â | Â | Â | Frequency of brushing | Â |
| Â | Â | Â | - 2.7% brushed teeth twice a day | Â |
Alkan et al., 2015 [48] | Â | Â | Frequency of brushing | Â |
| Â | Â | Â | - 40.6% brushed once a day | Â |
| Â | Â | Â | - 29.9% twice a day | Â |
| Â | Â | Â | - 29.9% every other day | Moderate |
| Â | Â | Â | Dental visits | Â |
| Â | Â | Â | - 15.1% once a year | Â |
| Â | Â | Â | - 80.5% when had a problem | Â |
| Â | Â | Â | - 4.4% never visited dentist | Â |
Almomani et al., 2009 [28] | - Poor oral health knowledge scores related to questions on oral health knowledge < 45% (14.7 and 15.0/34) |  |  | High |
 Anita et al., 2019 [49] |  |  | Tooth brushing aids |  |
| Â | Â | Â | - 11% required assistance in brushing teeth and brushed teeth once a day | Â |
| Â | Â | Â | - 89% cleaned teeth with no assistance | Â |
| Â | Â | Â | Frequency of brushing | Moderate |
| Â | Â | Â | - 10% cleaned twice a day | Â |
| Â | Â | Â | - 4% were irregular in cleaning their teeth | Â |
Bertaud-Gounot et al., 2013 [50] | Â | Â | Frequency of brushing | Â |
| Â | Â | Â | - 65% brushed once a day | Â |
| Â | Â | Â | - 18.2% brushed less than once a day | High |
| Â | Â | Â | - 12.6% never brushed | Â |
Bjorkvik et al., 2021 [40] | Â | Impact of mental illness- Reduced adherence to oral health care when feeling hopeless or experiencing suicidal ideation - Some participants expressed difficulty in planning dental appointments when going through bad periods or being depressed | Barriers to accessing dental care Practical barriers - Some participants expressed difficulties making a dental appointment - Transport and getting there on time was also identified as a barrier by some participants | Poor |
Gurbuz, 2011 [55] | Â | Â | Frequency of brushing - 37.6% several times a week - 62.4% seldom/never brushed | Moderate |
Hall et al., 2018 [45] | Â | Â | Barriers to accessing dental care Cost - 39% identified cost as a barrier, - 22% lack of perceived need - 8% avoiding due to anticipated problems Practical barriers - 7.4% had a fear or dislike of dentists - 2.7% transportation - 12.5% Uncertainty about coverage or difficulty accessing providers | Poor |
Hede, et al., 1992 [30] | Preventative oral health care - 80% agreed toothbrushing mattered in dental health - 75% believed that you can improve your dental health - 55% agreed that they expect to lose most of their teeth in their lifetime Side effects of psychotropic medications - 86% were not aware that medication they receive may create cavities | Â | Frequency of brushing - 59% claimed to brush their teeth twice a day - 24% claimed they brushed their teeth one a day - 17% claimed that they seldomly or never brushed their teeth Dental Visit - 66% attended the dentist regularly | Poor |
Hede, B. 1995 [36] |  | Oral health not a priority- 45% of participants stated that they perceived that they needed dental treatment (due to the oral health symptoms they were experiencing) | Frequency of brushing Regular brushing - 42% with schizophrenia, - 75% with affective psychosis - 77% with reactive psychosis - 52% with personality disorder - 58% other Neglect of toothbrushing - 39% with schizophrenia, - 42% with affective psychosis - 39% with personality disorders - 31% with reactive psychosis - 27% with other Dental visits Constant regular dental visits = 31% - 70% Affective psychosis - 23% Personality disorder - 29%, Reactive psychosis - 24% other | High |
Ho et al., 2018 [42] | Â | Impact of mental illness- Coping with their mental health condition/dealing with life stressors made attending to preventive oral health routine challenging (managing their own lives and living with mental illness was a barrier to improving oral health competing priorities), even though they had intention to attend to OH | Barriers to accessing dental care Cost - Some participants expressed that they would often live with dental pain than seek treatment due to the cost associated with dental care - Participants avoided seeking a dental opinion as they feared they were unable to pay the dental bill Dental fear - Many participants expressed dental fear and anxiety as a barrier to accessing regular dental care Poor communication with dentists and health care providers - Participants that had high levels of oral health literacy, miscommunication between dental practitioner and patient still occurred - Some participants expressed that they felt that language used by dental professionals made them feel uncomfortable | Poor |
Janardhanan et al., 2011 [59] | Â | Â | Dental visits - 24.2% one dental visit in previous year - 14.1% had at least two dental visits in previous year | High |
Kebede et al., 2012 [54] | Â | Â | Frequency of brushing - 3.8% brushed more than once a day - 7.1% brushed once a day - 87.5% brushed irregularly - 1.7% did not brush Tooth brushing technique - 52.9% had incorrect brushing technique - 47.1% had correct brushing technique | Moderate |
Khokhar, et al., 2011 [32] | Preventative oral health care 55% basic oral hygiene knowledge (brush twice/day) | Â | Tooth brushing aids - 68% of participants had access to a toothbrush Frequency of brushing - 29% basic oral hygiene practice twice daily brushing (for those with a toothbrush) Dental visits - 34% were registered with a dentist - 29% had a dentist visit within one year - 50% had their dentures checked within last five years | Poor |
Kuipers et al., 2018 [41] | Â | Oral health not a priority- All participants expressed that they did not view dental care as a priority - Some participants identified that Dental care was not a priority when experiencing psychosis | Barriers to accessing dental care Cost - Current debts and finances prevented some participants going to the dentist and/or paying for health insurance to cover dental visit | High |
Kuipers et al., 2022 [58] | Â | Â | Tooth brushing aids - 38.3% use of dental aid to brush Frequency of brushing - 49.4% low frequency brushing - 46% had short duration brushing Dental visits - 44.4% Low number of dental visits - 82.7% low number of dental hygienist visits | High |
Kuo et al., 2020 [29] | - Poor OH knowledge scoring < 50% (4.6 and 4.3/10) on questions relating to oral health knowledge | - Moderate OH attitudes scoring average 64.6% (45.9 and 47.3 out of a range of 13–65) on questions related to attitudes towards oral health | - Poor OH practices scoring < 14% (4.1 and 3.6/10) on questions related to oral health practices including tooth brushing | Poor |
Lalloo et al., 2013 [51] | Â | Â | Frequency of brushing - 52% brushed once a day - 24% twice a day Dental visits - 32% had not seen a dentist in past 2 years | High |
Lopes, 2021 [52] | Â | Â | Frequency of brushing - 37.3% brushed less than once a day - 62.5% 2 or more times a day | High |
McKibbin et al., 2015 [24] | Preventative oral health care - Participants expressed very basic understanding about oral health including brushing and flossing Side effects of psychotropic medication -Limited knowledge regarding increase risk for poor oral among adults with serious mental illness - Limited knowledge on medication side effects and impact on oral health | Â | Barriers to accessing dental care Cost - Majority of participants expressed poverty as a barrier - Participants expressed difficulty in affording toothpaste and dental floss - Some participants expressed that they were unaware of what public health insurances (such as Medicaid) would cover Practical barriers - Difficulties accessing providers that accepted public health insurances, especially in rural areas | High |
Mishu et al., 2022 [39] | Â | Impact of mental illness - Participants expressed that mental illness, including amotivation, impacted ability to maintain oral health Oral health not a priority - Participants felt that oral health was not considered important from the perspective of mental health and other health professionals - Participants expressed wanting to be involved in their dental care and planning | Barriers to accessing dental care Cost - Participants expressed not being able to afford necessities as well as dental care Dental fear - Nature of dental treatments being intrusive Practical barriers - Difficulties accessing providers due to distance and transportation Poor communication with dentists and health care providers - Dentist lack of understanding about mental illness - Negative experiences, feeling discriminated against, or misunderstood prevented participants from accessing dental services | high |
Nayak et al., 2020 [53] | Â | Â | Frequency of brushing - 68% brush once a day (48.8% depression, 8% schizophrenia, 6.8% mood disorder, 5.2% mania) - 31.2% brush twice or more a day (19.6% depression, 4% schizophrenia, 3.6% mood disorder, 4% mania) | Poor |
Ngo et al., 2018 [37] | Â | Oral health not a priority- Some participants expressed that feeling lazy was a barrier to attending oral health | Frequency of brushing - 48.9% brush twice a day Barriers to accessing dental care Practical barriers - lack of access to brushing at night (for those in wheelchairs) - long queues for brushing (limited sink numbers) | High |
Nielsen et al., 2011 [60] | Â | Â | Dental visits - 43% visited the dentist within past 12 months - 31% had a regular annual dental check-up in past 3 years | High |
Persson et al., 2009 [46] |  |  | Dental visits - 77% Regular contact with a dentist - 69% said they visited a dentist a least once a year - 15% had not been to a dentist in the past 2 years Barriers to accessing dental care Cost - 17% didn’t visit dentist due to financial - 43% neglected teeth due to finances Dental fear - Low anxiety reported towards dental visits (9.12 on scale between 4–20) in participants (77%) that attended dental appointments regularly | High |
Persson et al., 2010 [22] | Â | Oral health not a priority- Participants expressed waiting until an acute oral health situation arose then choosing the least complicated way of managing this (having the tooth removed instead of undergoing a series of treatments) - Denial regarding tooth ache/dental infections and hope they would go away without treatment | Â | High |
Sogi, 2020 [38] |  | Oral health not a priority- 41.7% never felt the need - 27.1% lack of awareness | Tooth brushing aids - 75.8% used brush + paste - 12.8% used finger + powder - 4.4% used tree stick - 7% use other Frequency of brushing - 72.1% brush once a day - 4.8% brush teeth twice a day - 0.6% brush thrice a day - 22.4% brush occasionally Dental visits - 29.3% never visited dentist - 5.5% < 6 months dentist visit - 10.4% dentist visit 6–12 months - 15.2% greater than 12 months since dentist visit - 39.6% only seen dentist when there is some problem Barriers to accessing dental care Cost - 14.6% costly treatment Dental fear - 2.1% dental anxiety Practical barriers - 14.6% time constraint | Poor |
Stevens et al., 2010 [33] | - 61% could not identify a dentist to visit | Â | Tooth brushing aids - 28% of participants did not have a toothbrush/toothpaste Frequency of brushing - 30% of brushed twice a day - 40% brushed once a day - 25% brushed between daily and weekly - 5% less often than weekly Dental visits - 55% last saw a dentist over 1 year ago | High |
Tani et al., 2012 [56] | Â | Â | Frequency of brushing - 26% brushed less than once a day - 29.6% brushed once a day - 18.9% brushed twice a day - 25.5% brushed 3 or more times a day | High |
Teng et al., 2011 [31] | Preventative oral health care - 82.5% did not identify regular oral health check-ups as necessary - 50% identified dental pain as a reason to see a dentist | Â | Frequency of brushing - 49% neglected tooth brushing Dental visits - 22.5% visited dentist within 1 year - 28% had not visited the dentist in recent years - 25% consulted dentists when they suspected an oral health problem | High |
Tredget et al., 2019 [57] | Â | Â | Frequency of brushing - 50% twice daily - 31.1% daily - 9.4% every 2 days - 4.7% mouthwash only - 3.8% Never Dental visits - 50% less than 6 months - 23.6% only when there is problem - 18.9% Never - 3.8% annually - 3.8% every 2 years Barriers to accessing dental care Dental fears - 27% of patients had significant anxiety about dental care | Poor |
Villadsen et al., 2017 [43] | Â | Impact of mental illness- Symptomology of mental illness affected ability to take care of oral health Oral health not a priority- Oral health not assigned a priority among other self-care priorities | Â | High |
Waplington et al., 2000 [47] | Â | Â | Barriers to accessing dental care Cost - Two residents expressed financial reasons prevented them from attending the dentist | Poor |
Wright et al., 2021 [44] | Â | Oral health not a priority- Some participants considered oral health a low priority | Barriers to accessing dental care Cost - cost/limited income/lack of dental insurance - socioeconomic status Dental fear - dental anxiety - fear of pain - negative experiences with dental care - fear of suffocation Practical barrier - Expressed transportation as a barrier Poor communication with dentist and health care providers - perceived lack of empathy - lack of communication by dentists - lack of communication on oral health by psychiatrists | High |
Yoshii et al., 2017 [61] |  |  | Tooth brushing aids Use of fluoride toothpaste Yes = 45.8%, No = 31.7%, unaware of toothpaste content 22.5% Use of interdental brushes or floss Everyday = 14.8%, sometimes 20.4%, No = 64.8% Frequency of brushing Tooth brushing before bed Everyday M = 32.7%, F = 27.9%, Sometimes = M 11.5%, F = 4.3%, No = M 18.3%, F = 5.3% Tooth brushing after meals Ever day M = 20.1%, F = 16.4%; Sometimes M = 28.6%, F = 16.4% No M = 13.8%, F = 4.6% Of those in the program at Baseline (n = 142) Tooth brushing after meals Everyday = 38.7%, sometimes = 43.7%, No = 17.6% Tooth brushing on the go Always = 20.4%, sometimes = 26.1%, No = 53.5% Dental visits - Yearly routine dental visit Yes: M = 15.8%, F = 16.1%, No: M = 46.7%, F = 21.4% - 19% Regular basis - 21.8%, Go early when you have a concern - 49.3%, when there is a worrying symptom - 9.9% when there are multiple symptoms | High |