Barriers and facilitators and interventions to improve oral health in people with Severe Mental Illness: A Scoping Review

Abstract

People living with severe mental illness (SMI)—principally schizophrenia-spectrum, schizoaffective and bipolar disorders—experience pronounced oral-health inequalities, including higher burdens of caries, periodontal disease and tooth loss. Daily self-care is disrupted by symptoms, cognitive load, and side effects of psychotropic medications (e.g., xerostomia), while fear, stigma and fragmented dental pathways deter help-seeking. This scoping review aimed to synthesize recent evidence (January 2021–May 2025) on (1) reported barriers and facilitators to maintaining oral health and accessing dental care among adults with SMI, and (2) interventions to improve oral-health outcomes and/or engagement with dental services. Following Arksey & O’Malley and Levac frameworks, searches were conducted in Ovid MEDLINE and EMBASE. Eight studies met inclusion criteria: four qualitative studies and four interventional evaluations (UK, France, Sweden, India, USA). Barriers included individual factors (low energy, side-effects, dental fear), interpersonal challenges (lack of practical support), and system-level obstacles (subsidy complexity, poor service integration). Facilitators were skills coaching, accompaniment, named referral routes, and sensory-aware appointment slots. Interventions showed mixed results: inpatient group brushing programmes reduced plaque at 12 weeks; a co-produced outpatient education programme did not improve periodontal indices; peer-support and link-worker models improved literacy, booking and attendance but lacked long-term clinical endpoints. Evidence suggests that supervised technique training and relational navigation may enhance engagement, while education alone may be insufficient. Future research should focus on hybrid effectiveness–implementation trials with ≥12-month clinical follow-up, oral health–related quality of life, cost, and equity outcomes.