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Mental Disorders, SevereNCT05545228

The Mouth Matters in Mental Health Study

A study testing Link work intervention in people with Mental Disorders, Severe, run by Lancaster University at 5 sites in United Kingdom.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

To investigate the feasibility and acceptability of a link work intervention to increase planned dental care visits for patients with severe mental illness, and through this to improve their oral health. 1. To understand what constitutes best practice when delivering link work around dental visiting. 2. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Mental Disorders, Severe
What is being tested?
Link work intervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
79 participants
Where
5 sitesUnited Kingdom
Study dates
1 Sep 2022to Jul 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Aged >18 years
  • Able to provide informed consent
  • Receipt of care from a Community Mental Health Team (or equivalent service) or Early Intervention Team at the point of referral
  • No routine and planned dental appointment in the past 3 years. The person should not have accessed a dental service (e.g. high street dentist, special care dentist service) for routine or planned dental care in the past 3 years. This would include any dental examination, diagnosis, advice or treatment (e.g. fillings, root canal, extractions, crowns, dentures, bridges) resulting from a routine (non-emergency) appointment at a dental service. The researchers do not consider emergency dental care (e.g. attendance at A\&E, dental hospital) within this definition, although any follow-up routine and planned appointments with a dentist would exclude the person from taking part.

Who cannot join

  • Inpatient status on a psychiatric or secure ward. The researchers will allow participants in supported living to take part as long as they are in receipt of care from a Community Mental Health Team (or equivalent service) or Early Intervention for Psychosis Service
  • Immediate risk to self or others operationalised as the presence of active intent or planning to harm oneself or others in the near future (e.g. next month). Where individuals are excluded on this basis, with the person's consent, the researcher will aim to re-contact them and the referrer in approximately 1 month's time (or a time period agreed in collaboration with the individual) to determine if the risk has subsided to a point where they are now eligible.
  • Enrolled in a dental trial

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United Kingdom5 sites
  • Pennine Care NHS Foundation Trust

    Ashton-under-Lyne, Great Manchester, OL6 7SR

  • Lancaster University

    Lancaster, Lancashire, LA1 4YW

  • Greater Manchester Mental Health NHS Foundation Trust

    Manchester, Great Manchester, M25 3BL

  • University of Manchester

    Manchester, Greater Manchester, M13 9PL

  • Lancashire and South Cumbria NHS Foundation Trust

    Preston, Lancashire, PR2 8DW

Other trials in United Kingdom

About this study

Official title: A Randomised Feasibility Trial of an Intervention Using Mental Health Support Workers as Link Workers to Improve Dental Visiting in People With Severe Mental Illness: The Mouth in Mind Study

To investigate the feasibility and acceptability of a link work intervention to increase planned dental care visits for patients with severe mental illness, and through this to improve their oral health.

  1. To understand what constitutes best practice when delivering link work around dental visiting.
  2. To identify what training needs exist for support workers around link work.
  3. To determine whether patients with SMI are willing to be randomised to a trial targeting dental visiting.
  4. To understand whether it is feasible to collect clinical outcome and planned dental appointment data in this population.
  5. To explore if, and how, patients with severe mental illness engage with a link work intervention.
  6. To understand the potential factors impacting (e.g. facilitators and barriers) acceptability and delivery.
Read the detailed description

Background and study aims

Severe mental ill health (SMI) affects around 1% of the population. It includes depression, psychosis, and bipolar disorder. People with experience of SMI are more likely to have problems with their teeth and gums. This includes more missing, filled, and decayed teeth than people without SMI. Having poor oral health can impact a lot of everyday activities like eating, speaking and smiling. It can affect how patients see themselves and their mental health.

Dentists can treat many early teeth and gum problems. However, very few people with SMI attend regular dental appointments. Instead, they are more likely to seek help when in crisis and invasive treatments are the only option. Accessing a dentist for people with SMI can be difficult for lots of reasons. People can feel helpless, fearful, or unmotivated to attend. They can have difficulty booking, planning, and getting to appointments. They may struggle to pay for or access free dental care. Unfortunately, existing dental initiatives have not addressed the barriers facing this group. They do not help people with SMI to attend the dentist.

The investigators want to help people with SMI to access dental care. The study will use mental health support workers who are already working in the National Health Service (NHS). They will link people receiving care from mental health teams with dental services. The support workers will help people to book, plan, and attend regular dental appointments. They will support patients to apply for financial support. People call this type of support link work. Research has indicated that link work can increase dental visits in people who might not normally attend. Mental health support workers already do link work for other appointments. Link work has been used to help other vulnerable groups of people (e.g. children) around dental care. However, this will be the first use of link work to help people with SMI to attend the dentist.

Who can participate?

People with a severe mental health difficulties currently accessing secondary care mental health services at the point of referral (e.g. community mental health team, early intervention for psychosis service), but who have not had a routine dental appointment in the past three years.

What does the study involve?

Participants will be randomly allocated to receiving treatment as usual or treatment as usual plus the link work intervention. This will be decided by chance. The investigators will measure how often people in both groups visit the dentist. They will also assess the state of their teeth and gums. They will collect this data when people come into the study and after nine months. The authors will offer interviews to patients and staff involved in the trial to understand how they found their involvement.

What are the possible benefits and risks of participating?

The intervention aims to support people to access dental services. However, it is currently untested, which is the reason for doing the research.

When is the study starting and how long it is expected to run for?

Recruitment for the trial is starting in September 2022 and will run for seven months. The whole project is scheduled to finish in April 2024.

Who is funding the study?

The National Institute of Health Research (NIHR) Health and Social Care Delivery Research (HS\&DR) scheme are funding the project.

Being tested
Link work intervention
Keywords
Mental Health, Oral Health, Dentistry
Medical subject headings
Mental Disorders, Psychological Well-Being

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Link work interventionBehavioural

    Intervention from a link worker to support participants to access dental services.

Study groups in NCT05545228
Study groupRoleWhat they receive
Intervention groupExperimentalParticipants will receive treatment as usual plus a link work intervention to support access to dental services.
Receives: Behavioral: Link work intervention
Treatment as usual groupNo interventionParticipants to receive treatment as usual and will not receive the intervention.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recruitment rates - feasibility criteria

    Data on ability to recruit randomise 84 participants to target in a 7-month recruitment window. Green ≥80%. Amber 60-79%. Red ≤59%.

    Measured: 7 months

  2. Visiting data - feasibility criteria

    Percentage of participants with available data on dental visiting via self-report or BSA data. Green ≥90%. Amber 60-89%. Red ≤59%.

    Measured: 9 months

  3. Clinical exam - feasibility criteria

    Percentage of participants completing the dental examination. Green ≥80%. Amber 60-79%. Red: ≤59%.

    Measured: 9 months

  4. Adherence to intervention - feasibility criteria

    Percentage of participants receiving intervention ≥1 sessions during nine month window. Green ≥80%. Amber 60-79%. Red ≤59%.

    Measured: 9 months

  5. Intervention and trial protocol - feasibility criteria

    Qualitative data to understand the acceptability and feasibility of the procedures, assessments, and intervention to inform a full trial and service delivery. This will be via qualitative interviews with service users (participants), research staff (link workers, research assistants), and key stakeholders (referrers, managers, commissioners). Audio recordings of sessions and field notes will also be analysed.

    Measured: 9 months

  6. Safety of intervention - feasibility criteria

    Monitoring and review of research related serious adverse events (SAEs). The Trial Steering Committee (TSC) will oversee SAEs across treatment arms. The authors will discontinue the trial if the intervention or procedures elevate risk.

    Measured: 9 Months

Secondary outcomes (16)
  1. Brief Pain Inventory - short form

    A questionnaire to assess orofacial pain.

    Measured: Baseline and 9 month assessments

  2. Manchester Orofacial Pain Disability Scale

    Pain related disability

    Measured: Baseline and 9 month assessments

  3. Oral Health Impact Profile

    Oral health related quality of life

    Measured: Baseline and 9 month assessments

  4. Confidence around dental visiting

    Item asking about confidence in visiting the dentist. "How confident are you that you will be able to attend a dental appointment?" (1, no confident; 7, very confident)

    Measured: Baseline and 9 month assessments

  5. Rosenberg Self-esteem Scale (RSES)

    Assessing self-esteem

    Measured: Baseline and 9 month assessments

  6. Modified Dental Anxiety Scale

    Assessing dental anxiety

    Measured: Baseline and 9 month assessments

  7. Patient Health Questionnaire (PHQ)

    Assessing depression

    Measured: Baseline and 9 month assessments

  8. EuroQol 5 Dimension (EQ-5D-5L)

    Assessing quality of life

    Measured: Baseline and 9 month assessments

  9. The number of eligible participants able to access free or subsidised dental care

    Assessing ability to successfully access free or subsidised dental care collected via the business services authority and self-report.

    Measured: Baseline and 9 month assessments

  10. The number of planned dental appointments attended

    The research team will record and report the number of routine dental appointments attended, recorded by both the business services authority and self-report.

    Measured: Baseline and 9 month assessments

  11. Oral health self-management - tooth brushing, mouth wash, and flossing

    'How often do you brush your teeth nowadays?' (ordinal five-point scale); 'How long do you brush your teeth for nowadays?' (ordinal five-point scale); 'How often do you clean between your teeth (inter-dental cleaning with floss, inter-dental brushes, tooth picks)?' (ordinal five-point scale); and 'Do you use a fluoride mouth-wash?' (binary)

    Measured: Baseline and 9 month assessments

  12. Self reported attendance at a planned dental appointment

    The research team will ask people the following 'Have you attended a dental service since the baseline assessment (nine months ago)? This would include a routine appointment with a dentist or special care dentistry service. It could also include a planned appointment at a dental hospital. However, it would not include an emergency dental appointment.'. Participants will also be asked to provide the dates and times of dental appointments. This outcome will be coded as whether the person has or has not accessed a planned dental appointment via self-report.

    Measured: 9 months

  13. Business services authority recorded attendance at a planned dental appointment

    NHS England collects information on visiting behaviour via the Business Services Authority. The research team will gain participants consent to extract this data, which the researchers will then match to the participants research data. The business services authority will be used to collect data on whether a planned care appointment has taken place. This data will only pick up National Health Service, and not private, dental appointments. This outcome will be coded as whether the person has or has not accessed a planned dental appointment via the business services authority data.

    Measured: 9 months

  14. Number of decayed, missing, or filled teeth (DMFT) via dental examination

    An examination for dental caries in permanent teeth will involve examining 32 teeth (i.e. all permanent teeth including wisdom teeth) with a metallic periodontal probe (Community Periodontal Index (CPI) probe) and a plane mouth mirror.

    Measured: Baseline and 9 months

  15. Pulpal involvement, ulceration due to trauma, fistula, and abscess (PUFA) via dental examination

    The PUFA score per person is calculated in the same cumulative way as for the DMFT and represents the number of teeth that meet the PUFA diagnostic criteria. Thus, for an adult in our study the score can range from 0 to 32 PUFA.

    Measured: Baseline and 9 months

  16. Modified Plaque Score via dental examination

    The locally derived system involves assessing six teeth representative of the entire dentition, for the worst plaque score on each tooth surface from visual examination and, where necessary, the use of a probe to detect the presence of plaque. These six teeth are the UL4 UL1 UR6 LL6 LR1 LR4. Each surface; Interproximal, buccal and lingual or palatal of the six teeth should be viewed in turn and the highest level of visible plaque on each surface should be scored '2'.

    Measured: Baseline and 9 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Sep 2022
  2. Study start1 Sep 2022
  3. Primary completion1 Apr 2024
  4. Study completionJul 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
A feasibility single-blinded randomised controlled trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
79 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05545228
Sponsor's protocol ID
IRAS304696
Other IDs
NIHR132853
Status last verified
May 2024
First submitted
8 Sep 2022
Last updated
7 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Palmier-Claus J, Morris A, French P, Griffiths R, Aggarwal VR, Berry K, Gkioni E, Harris R, Laverty L, Lobban F, Procter S, Kerry E, Newens C, Mupinga P, Golby R, Valemis K, Oakes L, Fazekas F, Perry A, Shiers D, Lodge C, Hilton C, Dawber A, Elliott E, Lunat F, Burnside G. A Link Work Intervention to Facilitate Dental Visiting in People With Severe Mental Illness: A Two-Arm, Multi-Site, Assessor Blind, Randomised Feasibility Trial With Dental Record Linkage. Community Dent Oral Epidemiol. 2025 Oct;53(5):580-586. doi: 10.1111/cdoe.70002. Epub 2025 Aug 4.

    PubMed 40755121
  • Hilton C, Morris A, Burnside G, Harris R, Aggarwal VR, Procter S, Griffiths R, French P, Laverty L, Lobban F, Berry K, Shiers D, Golby R, Fazekas F, Valemis K, Perry A, Newens C, Kerry E, Mupinga P, Gkioni E, Lodge C, Dawber A, Elliott E, Lunat F, Palmier-Claus J. A two-arm, randomised feasibility trial using link workers to improve dental visiting in people with severe mental illness: a protocol paper. Pilot Feasibility Stud. 2023 Sep 8;9(1):157. doi: 10.1186/s40814-023-01383-2.

    PubMed 37684682

Questions about this trial

What is this clinical trial studying?

A study testing Link work intervention in people with Mental Disorders, Severe, run by Lancaster University at 5 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 7 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recruitment rates - feasibility criteria (time frame: 7 months). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05545228, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 May 2024.

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