From an empty review to a full trial:

not a painful extraction

Hannah Jones1,2, Clive E Adams2, Jayne Simpson1, Graeme Tosh3,

Andrew Clifton4, Waqqas Khokhar5, Patrick Callaghan6, Peter Liddle7

If you would like more information about the dental trial please contact: Hannah Jones, The Sir Colin Campbell Building B7, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU. Tel: 0115 82 31267 Email: Hannah.Jones@nottingham.ac.uk Website: http://www.clahrc-ndl.nihr.ac.uk

Cochrane Review: Oral health advice for people with serious

mental illness

Trial: The three shires early intervention dental trial: A real

world cluster randomised controlled trial (ISRCTN63382258)

TABLE 1. TRIAL DESIGN

Design Cluster Randomised Controlled Trial

Setting Early Intervention in Psychosis teams in Nottinghamshire,

Derbyshire and Lincolnshire

Duration 12 months

Participants Early Intervention for Psychosis Teams, all care coordinators and all

service users in teams

Intervention Staff dental awareness training + dental checklist for service users

vs. standard care

Outcomes Registered with a dentist, visited a dentists within the last year,

routine check up within last year, owning a toothbrush, cleaning teeth

twice a day

BACKGROUND

People with serious mental illness are more likely to experience oral disease and

have greater oral treatment needs than the general population.

Oral health has never been seen as a priority in people suffering with serious

mental illness.

Poor oral health has a serious impact on quality of life, everyday functioning, social

inclusion and self-esteem.

The search identified 2382 references (from 1558 studies).

Only one study was suitable for further examination.

This was excluded as it did not fulfil the review's criteria.

All relevant randomised clinical trials.

Cochrane Schizophrenia Group Trials Register (October 2009).

To assess the effects of oral health advice in reducing morbidity in people with

serious mental illness.

OBJECTIVES

SEARCH METHODS

SELECTION CRITERIA

RESULTS

CONCLUSIONS

FURTHER RESEARCH

Trials were possible but none had been undertaken.

We have been supported by NIHR Collaborations for Leadership in Applied Health

Research and Care (CLAHRC) – Nottinghamshire, Derbyshire, Lincolnshire to

design and conduct a relevant study.

Current guidance to give advice on oral health to people with serious mental

illness is not based on best possible evidence.

Further research is indicated.

FIGURE 1. TRIAL PROCESS

EIP teams in Nottinghamshire, Derbyshire

and Lincolnshire

(N=10; n=1037)

Randomisation

(block, cluster by shire)

Dental Intervention

(N=5)

Dental Awareness Training +

Modified Oral Health

Checklist

12 month follow up

Modified Oral Health

Checklist

Oral Impacts on Daily

Performance +

Detailed dental data (random

sample of service users from

all teams n=50)

Standard Care

(N=5)

Continue with treatment as

usual for 12 months

12 month follow up

Dental Awareness Training +

Modified Oral Health

Checklist

Oral Impacts on Daily

Performance +

Detailed dental data (random

sample of service users from

all teams n=50)

All EIP teams in Nottinghamshire, Derbyshire and

Lincolnshire have been invited to be involved in the trial.

Half will be allocated to receive the intervention and

half will be allocated to the control

Intervention teams will receive a one-off 30-minute

dental awareness training session and be asked to use

the checklist (see illustration) at the start of the trial and

again 12 months later.

Control teams will continue to deliver standard care

for 12 months and then will also receive the dental

awareness training session and will be asked to use the

checklist.

We acknowledge the support of the National Institute for Health Research, through the Mental Health Research Network.

This poster presents independent research commissioned by the National Institute for Health research (NIHR). The views expressed

in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Hannah Jones is completing a PhD at the University of Nottingham, funded by CLAHRC-NDL, supervised by Professor Clive Adams,

that is based on the Dental Trial.

ACKNOWLEDGEMENTS

PROGRESS

In February 2012 the 10 early intervention in psychosis teams caring for a total of

1037 people were randomised.

Khokhar WA, Clifton A, Jones H, Tosh G. Oral health advice for people with serious mental illness. Cochrane Database of Systematic

Reviews 2011;(11). [DOI: 10.1002/14651858.CD008802.pub2; Other: CD008802]

British Society for Disability and Oral Health (BSDH). Oral health care for people with mental health problems guideline and

recommendations. Report of BSDH Working Group 2000.

Stiefel DJ, Truelove EL, Menard TW, Anderson VK, Doyle PE, Mandel LS. A comparison of the oral health of persons with and

without chronic mental illness in community settings. Special Care in Dentistry 1990;10(1):6-12.

REFERENCES

1CLAHRC-NDL, University of Nottingham. 2Cochrane Schizophrenia Group, University of Nottingham. 3General Adult

Psychiatry, East Midlands Workforce Deanery. 4School of Health, Community & Education Studies, Northumbria University. 5Bradgate Mental Health Unit, Leicestershire Partnership Trust, Leicester, UK. 6School of Nursing, Midwifery & Physiotherapy,

University of Nottingham. 7School of Community Health Sciences, University of Nottingham.

OBJECTIVES

To see whether staff dental awareness training + a simple one page dental checklist

can improve the oral health of people with a serious mental illness in

Nottinghamshire Derbyshire and Lincolnshire Early Intervention for Psychosis (EIP)

teams by 1 year.

METHODS

The intervention and methods were designed after considerable consultation with all

relevant stakeholders – clinicians, managers, commissioners and service users.