A Qualitative Study on the Knowledge and Opinions of Outpatient Schizophrenia Patients Regarding Oral and Dental Health, Brushing Habits, Dental Anxiety, and Dental Treatments

A Qualitative Study on the Knowledge and Opinions of Outpatient Schizophrenia Patients Regarding Oral and Dental Health, Brushing Habits, Dental Anxiety, and Dental Treatments | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Qualitative Study on the Knowledge and Opinions of Outpatient Schizophrenia Patients Regarding Oral and Dental Health, Brushing Habits, Dental Anxiety, and Dental Treatments Fikriye Siir Aksoy Yurt, Damla Isman Haznedaroglu, Elif Ulu, Elif Ercan Devrimci, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8056250/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Oral health is a crucial but often neglected component of general health in individuals with schizophrenia. Cognitive impairment, medication side effects, poor motivation, and limited access to care contribute to inadequate oral hygiene and untreated dental problems in this population. This study aimed to explore, through a qualitative approach, the knowledge, perceptions, and experiences of outpatients with schizophrenia regarding oral and dental health, brushing habits, dental anxiety, and dental treatments. Methods This qualitative study was conducted at the Community Mental Health Center of Ege University Faculty of Medicine. Thirty adult outpatients with schizophrenia were recruited through purposive sampling. Data were collected via semi-structured, face-to-face interviews lasting 7–25 minutes, recorded and transcribed verbatim. Thematic and descriptive analyses were performed inductively. Four main themes emerged: knowledge and awareness of oral health, brushing habits, dental anxiety, and attitudes toward dental treatment. Results Participants’ awareness of oral and dental health was generally low. Most had never received oral health education and attributed dental problems to hereditary or psychological factors rather than preventive behaviors. Only two participants reported regular toothbrushing, and floss use was rare. Dental anxiety was common, mainly due to past painful experiences, fear of extractions, or environmental triggers such as sounds and odors in clinics. Although most participants recognized the importance of oral hygiene, barriers such as forgetfulness, low motivation, and dry mouth limited regular care. Access to dental services was often hindered by long waiting times in public hospitals, and participants primarily relied on family, friends, or social media for oral health information rather than professionals. Conclusions Outpatients with schizophrenia demonstrated limited knowledge, irregular oral care routines, and substantial dental anxiety, highlighting the need for targeted and holistic oral health education programs. Integrating structured reminder systems and simplified educational tools into psychiatric care may help sustain behavioral changes. Improved service accessibility and enhanced dentist–patient communication are essential to promote oral health equity in this vulnerable group. Trial registration This study was approved by the Ege University Scientific Research and Publication Ethics Committee (12/04, 01.09.2025) Schizophrenia Oral health Dental anxiety Qualitative study Introduction Oral health is an important part of holistic health. It directly affects overall quality of life over time. In 2016, the World Dental Federation (FDI) stated that oral health is a key part of both physical and mental health [ 1 ]. Individuals with psychiatric disorders are reported to have worse oral health than those without such disorders [ 2 , 3 ]. However, oral health often receives little attention in the assessment of psychiatric disorders [ 4 – 8 ]. Schizophrenia is a severe mental disorder that affects thinking, perception, self-experience, cognition, motivation, emotions, and behavior [ 9 ]. Patients with schizophrenia often have more tooth decay and periodontal disease, partly due to impaired executive function, poor nutrition and oral hygiene, reluctance to seek dental care, high sugary drink consumption, substance misuse, financial barriers, and dentists' reluctance to treat them [ 10 – 13 ]. There are few studies on oral and dental health, brushing habits, dental anxiety, and the subjective views of outpatients with schizophrenia regarding dental treatments [ 14 – 16 ]. This qualitative study aims to explore in depth the knowledge, attitudes, and experiences of outpatients with schizophrenia with respect to oral and dental health. Materials and Methods This study assessed outpatient schizophrenia patients’ knowledge and awareness of oral health, brushing habits, dental anxiety, and attitudes toward dental care. This qualitative study was conducted at the Community Mental Health Center of the Ege University Faculty of Medicine, where one-on-one interviews were held in designated rooms. The participants, all schizophrenia patients who regularly visit the Center and receive outpatient treatment, were selected via purposive sampling, a nonprobability sampling method [17]. The participants were adults with different professions, education levels, and genders to increase data diversity. Before patients joined the study, they received information about it. All interviews took place with consent on the same day. The researcher conducted all the in-depth interviews. The environments were free from external influences and without manipulation. The interviews were recorded. They lasted 7–25 minutes each, totaling 550 minutes. All the interviews took place at the Community Mental Health Center, which was familiar to the participants and was regularly attended by them. This made it easier for participants to share their opinions in a comfortable setting [18]. The first part of the interviews collected demographic information. The second part focused on four main themes: "knowledge and awareness of oral and dental health," "brushing habits," "dental anxiety," and "approaches to the treatment decision-making process." Open-ended questions were used to gather detailed information on these topics. Purposive sampling continued until data saturation. Thirty participants were interviewed, after which the process ended. Ethical Approval The research followed the Declaration of Helsinki and publication ethics, with approval from the Ege University Scientific Research and Publication Ethics Committee (01.09.2025, 12/04, Protocol No: 3009). The participants provided written informed consent after the purpose of the study was explained. Data Analysis The data were analyzed via an inductive approach and descriptive analysis. After the interviews were transcribed, the researcher coded and categorized them into four main themes. These findings were then interpreted thematically, with direct quotes included to increase representativeness. Results There were 15 female and 15 male participants. The average age was 39.7±12.22 years, ranging from 22-70 years. Six participants (20%) were married. Five (16.67%) completed primary school, two (6.67%) completed secondary school, and 13 (43.33%) completed high school. Three (10%) had associate degrees, and seven (23.33%) had bachelor's degrees. Theme 1. Level of Knowledge and Awareness Regarding Oral and Dental Health Only six participants were aware of the importance of oral and dental health. This awareness did not come from systematic information or specific sources. None of the participants had any previous training on oral or dental health. They based their opinions on personal experience or general health knowledge. "No one ever taught me how to brush my teeth or why oral health is important. These topics were never discussed at home. I do not remember it being taught at school either. I try to find information online when I need it." (M, 28) "I have never received any training on how to brush my teeth in my life. Neither my family nor my parents taught me this at school. Additionally, my parents do not brush their teeth very often." (F, 32) Half of the participants (n=15) knew that cavities can damage oral and dental health. Of these, 11 believed that cavities are genetic and unpreventable. Three attributed them to food, and one attributed them to psychological factors. "Even if we brush our teeth five times a day, tooth decay is genetic. That is why my teeth are so decayed. In fact, everyone in my family has decayed teeth. No matter what we do, we cannot get rid of it. It is like our family's fate." (F, 48) "No matter how much care I took since I was little, my teeth were always prone to decay. It is as if I had weak teeth from birth. " (F, 43) "I have had cavities since I was little. My teeth were already weak, and no matter how much I brushed them, they would not hold. I guess that is just how my teeth are." (F, 30) "I used to eat a lot of wafers. They would even stick to my teeth. Then, I realized that they were the cause of my cavities." (M, 61) “I know that chocolate and sugar rot the teeth, but I still cannot stop eating them.” (F, 45) "After eating sugary things, the inside of my teeth hurts. Therefore, as soon as sugar touches my teeth, tooth decay begins." (F, 31) "I think the real cause of cavities is anger. Whenever I'm feeling down, I feel like a new cavity is forming in my mouth." (M, 54) The participants did not know about preventive oral and dental health practices by dentists. Knowledge about gum disease was even lower than their knowledge of tooth decay (n=2). Awareness usually comes from personal experience or one’s immediate family. "I do not want to brush my teeth because my gums bleed so much when I brush my teeth. I do not think this bleeding is normal." (E, 43) "I once saw a toothpaste commercial where a person's eyes were bleeding, and they immediately went to the dentist. The commercial staff then asked why they did not visit the dentist when their gums bleed. I was very impressed by that commercial. I go to the dentist regularly and pay attention to bleeding gums." (M, 42) Theme 2. Brushing Habits Most participants (n=24) know teeth should be brushed to protect oral and dental health. However, they do not brush due to lack of opportunity, forgetting, tiredness, or reluctance. Only two participants brush their teeth regularly. "I know I have to brush my teeth, but I never do. Because I forget. Sometimes I remember, but then I do not feel like it." (M, 50) "Even if I see the toothbrush in the bathroom, I find it difficult to brush. It is as if even picking up the toothbrush is a big task. In addition, when I start brushing, I want it to be over immediately." (M, 23) “Sometimes when I eat junk food, I want to brush my teeth right afterward, but if I'm out or do not have a brush with me, I just stop and then it is forgotten.” (M, 42) "I know that cleaning my teeth is important, but I cannot take action. Sometimes, even if I think about brushing, I cannot stop myself." (F, 31) "I feel like I should brush it off, but most of the time I forget about it. Even if I do remember, I do not feel like it." (M, 28) "Brushing my teeth is very important to me. I brush my teeth after every meal. Sometimes, if I'm not sure I have brushed them, I brush them again." (F, 47) "Cleaning my teeth is a way of relaxing for me. Sometimes I brush the same area over and over again." (F, 39) The general consensus among participants (n=20) regarding the frequency of daily tooth brushing was that it should be performed twice. Some participants (n=4) thought that brushing should be performed three or more times a day, whereas others (n=6) thought that brushing was not necessary. "I set a timer while brushing my teeth. I do not stop brushing until I see the two-minute timer on my phone. This is a habit from my youth. Whenever the alarm I set on my phone goes off, I rinse my mouth. I brush each tooth individually, looking at it in the mirror." (M, 53) "I have been brushing my teeth three times a day since I was young. I cannot sleep without brushing my teeth." (M, 45) "I brush my teeth 4-5 times a day. I feel clean when I brush them." (F, 50) "I never brush my teeth. Brushing seems difficult and unnecessary. Sometimes my mother forces me to brush. I do not let her." (M, 37) "I'm afraid that if I brush my teeth, my enamel will be damaged. Brushing is not necessary for cleanliness." (F, 70) “I only brush my teeth if I have a toothache, but other than that, there is no need to brush.” (E, 37) When the participants' toothpaste and flossing habits were questioned, some participants (n=3) did not like to use toothpaste, and only one participant used dental floss. "My mouth is very dry. Toothpaste dries it out even more. I'd like to use toothpaste because it tastes and smells great, but I do not use it because it dries my mouth." (M, 19) "The taste of toothpaste lingers in my mouth, which bothers me. That is why I sometimes brush with just water, but that might be why cavities increase." (F, 51) "I used not to trust hospitals and doctors. I still sometimes do not trust toothpaste. Now I trust doctors, but I do not want to use toothpaste. Sometimes I brush without toothpaste, sometimes I do not brush at all." (M, 30) “I have been flossing every evening for almost three years since my periodontist showed me how to use dental floss.” (E, 33) Theme 3. Dental Anxiety Dental anxiety is an anxiety condition characterized by an excessive and irrational fear of dental treatments, affecting millions of people worldwide [19]. Within the context of dental anxiety, a significant portion of participants (n=18) were found to have significant anxiety about dental visits. This anxiety appears to be largely rooted in past negative experiences (e.g., painful treatment, lack of communication). Only four participants reported regular dental checkups, while the others stated they only visit when necessary. Furthermore, some participants (n=5) stated that factors in the clinical environment, such as odors, the sounds of instruments, or the dentist's approach, triggered their anxiety. "I never tell the dentist that my teeth hurt. Otherwise, he will pull my teeth, and it will hurt a lot. I would rather have my teeth hurt a little like this than have them pulled." (M, 32) "I heard that teeth become loose after tartar removal. That is why I do not want to have it cleaned. I think they might start moving the teeth." (M, 44) "Every time I go to the dentist, there is a problem. I do not even want to go anymore." (M, 52) "One time, he did not even let me know when he was giving me an injection. It hurt so bad, I never want to go back since that day." (M, 34) "When I walk in and see the dental chair, I feel numb. However, when I chat with the doctor, I feel slightly more relaxed." (F, 40) “I am terrified of going to the dentist because it will hurt.” (F, 26) "Going to the dentist is so scary. I feel like they're going to rub it in my face that my teeth are bad. I do not like the sound of those tools at all." (M, 45) "I cannot immediately trust a doctor I see for the first time. That is why I postpone the examination." (F, 35) "I do not go to the dentist even when there's pain. I'm afraid he will pull it out, so I just put up with it." (F, 41) "Going to the dentist does not scare me at all. Because I know a dentist, he always motivates me. That is why going there seems different and fun to me." (F, 28) Theme 4. Dental Treatments With respect to access to dental care, most participants (n=27) stated that they applied to public hospitals but had difficulty finding appointments at official institutions. Some (n=4) stated that in emergencies, they sought treatment directly through emergency rooms or dentist acquaintances. "I'm trying to make an appointment at the state hospital, but there's no room in the system. They do not even care when I go to the emergency room. I have to wait." (F, 36) "I do not understand the appointment system; it just never works out. In the end, I had to go to a private place near our house. (F, 29) "When my pain became so severe, I went straight to the emergency room. The doctor immediately prescribed an antibiotic, but it did not help. I still have to wait for the actual treatment." (M, 40) "When I could not make an appointment, I asked for help from a relative who was a dentist, and he arranged it. Otherwise, it would have been very difficult for me to reach him on my own." (F, 51) "It used to be easy, but now it is almost impossible to find time through the central appointment system. Every time I look, it says it is full." (M, 33) The majority of participants (n=21) stated that they obtained information about dental treatments, mainly from their close circle, personal experiences or social media; the number of those who received information directly from health professionals was quite limited. "Frankly, everything I learned about teeth, I heard from my mother and friends. Nobody goes to the doctor and asks each one individually anyway." (F, 35) "I usually watch videos shared by dentists online. From there, I more or less understand what needs to be done." (M, 24) "When my tooth starts to hurt, I first try my own methods. Sometimes I use natural remedies I find online. If the pain becomes unbearable, I have to visit the dentist. I do not normally like going to the hospital." (M, 29) "I had treatment last year, and after my experience there, I understood some things. Frankly, I had no knowledge before that." (M, 39) "My cousin has been receiving dental treatment for years, and I learn a lot from him. He even tells me where to go with his guidance." (M, 31) Discussion Qualitative research is an approach that examines individuals' experiences, perceptions, and the ways they make sense of the world in which they live and aims for detailed analysis of phenomena rather than statistical generalization [20, 21]. The main goal is not to access numerical data, but to present participants' thoughts, experiences, and observations in a realistic and descriptive manner. This research method, which is generally used in the social sciences, makes a significant contribution to finding solutions to problems created by rapid changes and complex situations in the field of health by drawing on individuals' experiences [22, 23]. In this context, the study employed a purposive sampling method to select individuals who could provide detailed information on the subject, and in-depth interviews were used during the data collection process. The interviews were conducted around predetermined topics; the order of the questions was changed when necessary, and additional questions were asked to deepen the answers [24]. As in similar studies, the collected data were examined via an inductive approach and descriptive analysis; responses were coded and categorized under four main themes, and direct quotes were added to preserve the strength of the participants' statements [21]. The findings indicate that knowledge and awareness of oral and dental health are generally low. Awareness of gum disease is quite limited compared with that of dental caries. This may be because cavities are more common in childhood and can cause pain [25]. It is thought that the participants lacked knowledge about preventive measures such as fissure sealants and fluoride application, which may be due to the low rate of dental visits during childhood. While tooth brushing is known to be important for oral health, there is uncertainty about the ideal brushing frequency, and flossing is generally not included in daily care routines. Furthermore, various difficulties are encountered in maintaining existing oral care habits regularly [12]. Individuals with mental disorders face various barriers to accessing oral and dental health services. Psychiatric illnesses such as schizophrenia, depression, or anxiety disorders make it difficult for individuals to maintain regular oral care behaviors, whereas psychosocial factors such as fear of the dentist, low pain tolerance, past negative dental experiences, and a sense of loss of self-control during treatment can also lead to avoidance of dental treatment [26]. The participants stated that they knew the importance of brushing their teeth, but they were unable to maintain this behavior for reasons such as "not wanting to," "forgetting," or "not being able to take action. "One reason is that antipsychotic and antidepressant medications frequently used in these individuals reduce salivary flow, causing dry mouth, which can pave the way for both dental caries and periodontal problems [27-29]. The increased prevalence of tooth loss, edentulism, and related functional impairments in these patients leads to negative consequences not only for oral health but also for overall health and quality of life. Therefore, when planning oral health interventions for individuals with mental disorders, it is important to address both psychiatric and dental needs holistically [30]. Today, individuals frequently obtain information about oral and dental health through the internet and media [31, 32]. However, participants believe that this information does not always provide them with solutions. This suggests that access to digital information has increased, but uncertainties regarding health literacy and trust persist. Increasing digital health literacy and guiding individuals to reliable sources are considered crucial. The development of specialized, simplified, and visually- focused content for these individuals would be beneficial. Furthermore, while trust in institutions is a determining factor in seeking treatment, challenges such as overcrowding and long waiting times in public institutions lead some individuals to seek private services. These findings point to the need for improvement at both the individual and systemic levels. Conclusion This study qualitatively examined the knowledge, attitudes, and behaviors of outpatients with schizophrenia regarding oral and dental health, shedding light on significant gaps in this area. The study findings revealed that participants' knowledge of oral health was inadequate and that their awareness, particularly regarding tooth decay and periodontal disease, was quite low. Daily oral care habits were irregular, flossing was uncommon, and brushing habits were frequently forgotten. The participants cited a lack of education and inadequate reminder mechanisms regarding oral and dental health as the most significant barriers to oral care. The study's data demonstrate that oral and dental health is not a choice but rather a behavior shaped by accessibility and education. The study also revealed that participants largely access oral health information through their families or close friends, the media, and the internet, but they have limited trust in these sources. Social recommendations and trust in the institution were found to be decisive factors in choosing a dentist and choosing a healthcare provider. Difficulties accessing public oral and dental health services also influence patient behavior. These findings demonstrate the need to develop targeted, sustainable, and accessible oral health education programs for individuals with mental health disorders. Furthermore, integrating reminder strategies into daily life can create lasting changes in these individuals' oral health behaviors. Access to healthcare, quality of care, and strengthening the patient‒physician relationship are among the key elements that enhance the success of this process. Declarations Acknowledgements Not applicable. Authors’ contributions FSAY and EED, collected and analyzed the data, and drafted the initial version of the manuscript. DİH, contributed to participant recruitment and clinical evaluation, and supervised the psychiatric aspects of the research. EU, contributed to the methodological design of the qualitative study, conducted the transcription of interviews, and assisted with thematic data analysis. MT, provided supervision throughout the study process, critically revised the manuscript, and approved the final version. AD, conceived and designed the study, contributed to the overall study design, provided academic supervision. All authors read and approved the final manuscript. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability No datasets were generated or analysed during the current study. Ethics approval and consent to participate For the study, ethical committee approval was obtained from Ege University Faculty of Dentistry Scientific Research and Publication Ethics Committee dated 01.09.2025, with the permission number 12/04. Consent for publication Not applicable. Competing interests The authors declare no competing interests References Glick M, Williams DM, Kleinman DV, et al. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. J Am Dent Assoc . 2016;147(12):915–917. Scrine C, Durey A, Slack-Smith L. Enhancing oral health for better mental health: exploring the views of mental health professionals. Int J Ment Health Nurs . 2018;27(1):178–186. McCreadie RG, Stevens H, Henderson J, Hall D, McCaul R, Filik R, et al. The dental health of people with schizophrenia. Acta Psychiatr Scand . 2004;110(4):306–310. Arnaiz A, Zumárraga M, Díez-Altuna I, et al. Oral health and the symptoms of schizophrenia. Psychiatry Res . 2011;188(1):24–28. Gurbuz O, Alatas G, Kurt E, et al. Periodontal health and treatment needs among hospitalized chronic psychiatric patients in Istanbul, Turkey. Community Dent Health . 2011;28(1):69–74. Gurbuz O, Altınbas K, Kurt E. Oral health in psychiatric patients. Curr Approaches Psychiatry . 2011;3(4):628–646. Kisely S. No mental health without oral health. Can J Psychiatry . 2016;61(5):277–282. Kenny A, Dickson-Swift V, Gussy M, et al. Oral health interventions for people living with mental disorders: protocol for a realist systematic review. Int J Ment Health Syst . 2020;14:24. World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems. 11th ed. Geneva: WHO; 2022. Matevosyan NR. Oral health of adults with serious mental illnesses: a review. Community Ment Health J . 2010;46(6):553–562. Bardow A, Nyvad B, Nauntofte B. Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ. Arch Oral Biol . 2001;46(5):413–423. Lewis S, Jagger RG, Treasure E. The oral health of psychiatric in-patients in South Wales. Spec Care Dentist . 2001;21(5):182–186. Ramon T, Grinshpoon A, Zusman SP, Weizman A. Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel. Eur Psychiatry . 2003;18(3):101–105. Arnaiz A, Zumarraga M, Diez-Altuna I, Uriarte JJ, Moro J, Perez-Ansorena MA. Oral health and the symptoms of schizophrenia. Psychiatry Res . 2011;188(1):24–28. doi:10.1016/j.psychres.2010.09.012 Lopes AG, Ju X, Jamieson L, et al. Oral health-related quality of life among Brazilian adults with mental disorders. Eur J Oral Sci . 2021;129(1):e12774. Soares GH, Bado FMR, Lopes AG, et al. Structure and replicability of oral health related quality of life networks across patients with schizophrenia and the general community. Community Dent Oral Epidemiol . 2023;51(1):1–10. Yağar F, Dökme S. Niteliksel araştırmaların planlanması: araştırma soruları, örneklem seçimi, geçerlik ve güvenirlik. Gazi Sağlık Bil Derg . 2018;3(3):1–9. Creswell JW, Poth CN. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. 4th ed. Thousand Oaks (CA): Sage Publications; 2018. Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents: a systematic review. Eur J Paediatr Dent . 2017;18(2):121–130. doi:10.23804/ejpd.2017.18.02.07 Hoepfl MC. Choosing qualitative research: a primer for technology education researchers. J Technol Educ . 1997;9(1):49–63. Yıldırım A, Şimşek H. Nitel araştırma yöntemleri. 10th ed. Ankara: Seçkin Yayıncılık; 2016. p.48. ISBN: 9789750239991. Sönmez S, İlgün G. Nitel araştırma yöntemlerinin sağlık hizmetleri bağlamında incelenmesi. Balıkesir Univ J Soc Sci Inst . 2018;21(40):375–400. Sevencan F, Çilingiroğlu N. Sağlık alanındaki araştırmalarda kullanılan niteliksel veri toplama yöntemleri. Toplum Hekimliği Bülteni . 2007;26(1):1–6. Karataş Z. Sosyal bilimlerde nitel araştırma yöntemleri. Sosyal Hizmet E-Dergi . 2015;1(1):62–80. Buğdaycı R, Şaşmaz T, Uludoğan C, Kurt A, Öner S, Yapıcı G, et al. İlköğretim birinci sınıf öğrencilerinde diş çürüğü sıklığı ve etkileyen faktörler. Turk J Public Health . 2019;17(3):228–237. Alqahtani F, Al Khalifah G, Oyebode O, Orji R. Apps for mental health: an evaluation of behavior change strategies and recommendations for future development. Front Artif Intell . 2019;2:30. Afroz T, Beyene J, Zaheer K, et al. Oral health care challenges in individuals with severe mental illness: a qualitative meta-synthesis. Front Oral Health . 2025;6:1655450. doi:10.3389/froh.2025.1655450 Abou-Ayash S, Paolone G, Panetta F, et al. Oral adverse effects of antipsychotic medications: a case/noncase analysis of EudraVigilance data. Clin Oral Investig . 2024;28(5):2689–2699. doi:10.1007/s00784-023-05449-1 Mishu MP, Riaz Faisal M, Macnamara A, Delgado E, Stansfield E, Gilbody S, et al. A qualitative study exploring the barriers and facilitators for maintaining oral health and using dental service in people with severe mental illness: perspectives from service users and service providers. Int J Environ Res Public Health . 2022;19(7):4344. doi:10.3390/ijerph19074344 Bermúdez Bejarano E, Bermúdez Sánchez JA. Factors that influence the appearance of dental anxiety and fear in daily dental practice in patients with mental disorders. Ann Psychiatry Treatm . 2024;8(1):27–32. Tengilimoglu D, Sarp N, Yar CE, Bektaş M, Hidir MN, Korkmaz E. The consumers’ social media use in choosing physicians and hospitals: the case study of the province of Izmir. Int J Health Plann Manage . 2017;32(1):19–35. Alkadhi OH, Aleissa NK, Almoharib MK, Buquayyid SA. Influence of social media on patients for choosing dental clinics: a cross-sectional survey. J Clin Diagn Res . 2020;14(1):32–34. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Jan, 2026 Reviews received at journal 31 Dec, 2025 Reviews received at journal 18 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviews received at journal 13 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviews received at journal 13 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor invited by journal 20 Nov, 2025 Editor assigned by journal 17 Nov, 2025 Submission checks completed at journal 17 Nov, 2025 First submitted to journal 07 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8056250","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":561978346,"identity":"975f3984-cc96-4e4b-ac73-d8ae703b6dcb","order_by":0,"name":"Fikriye Siir Aksoy Yurt","email":"data:image/png;base64,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","orcid":"","institution":"Ege University","correspondingAuthor":true,"prefix":"","firstName":"Fikriye","middleName":"Siir Aksoy","lastName":"Yurt","suffix":""},{"id":561978347,"identity":"cf671f6c-3fc8-4ff7-98d9-0609c74c67d4","order_by":1,"name":"Damla Isman Haznedaroglu","email":"","orcid":"","institution":"Ege University","correspondingAuthor":false,"prefix":"","firstName":"Damla","middleName":"Isman","lastName":"Haznedaroglu","suffix":""},{"id":561978348,"identity":"89d57e67-cf9a-4584-88d5-b6b8292abb6a","order_by":2,"name":"Elif Ulu","email":"","orcid":"","institution":"Ege University","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"","lastName":"Ulu","suffix":""},{"id":561978352,"identity":"c520132d-d67e-413c-a8c9-533c67d7b6d5","order_by":3,"name":"Elif Ercan Devrimci","email":"","orcid":"","institution":"Ege University","correspondingAuthor":false,"prefix":"","firstName":"Elif","middleName":"Ercan","lastName":"Devrimci","suffix":""},{"id":561978357,"identity":"a06272d3-f6cf-4cec-97d4-99fdec2f8c15","order_by":4,"name":"Murat Turkun","email":"","orcid":"","institution":"Ege University","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Turkun","suffix":""},{"id":561978358,"identity":"3fe7b690-4187-4cb9-923d-f2a1b6828522","order_by":5,"name":"Aysegul Demirbas","email":"","orcid":"","institution":"Ege University","correspondingAuthor":false,"prefix":"","firstName":"Aysegul","middleName":"","lastName":"Demirbas","suffix":""}],"badges":[],"createdAt":"2025-11-07 10:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8056250/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8056250/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98496102,"identity":"85b7b938-39fe-4447-b11d-382684429599","added_by":"auto","created_at":"2025-12-18 09:02:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40375,"visible":true,"origin":"","legend":"","description":"","filename":"AQualitativeStudyontheKnowledgeandOpinionsofOutpatientSchizophreniaPatientsRegardingOralandDentalHealthBrushingHabitsDentalAnxietyandDentalTreatments.14.11.2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-8056250/v1/5aca06ae73b50f1ab40f1ff0.docx"},{"id":98496106,"identity":"cc44d290-3f7e-46c6-a73a-0ff74bc2a0c6","added_by":"auto","created_at":"2025-12-18 09:02:44","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8728,"visible":true,"origin":"","legend":"","description":"","filename":"dfc433820fae40338acc8548b0d6c80a.json","url":"https://assets-eu.researchsquare.com/files/rs-8056250/v1/6bb0a2207624d02cde764039.json"},{"id":98496104,"identity":"a9a7ae26-34f6-461e-aefb-39503a2395d0","added_by":"auto","created_at":"2025-12-18 09:02:44","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81208,"visible":true,"origin":"","legend":"","description":"","filename":"dfc433820fae40338acc8548b0d6c80a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8056250/v1/360904d9cb47f3351586b7b0.xml"},{"id":98496103,"identity":"8ac75567-c502-45ce-8329-44e13c6730b5","added_by":"auto","created_at":"2025-12-18 09:02:44","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78324,"visible":true,"origin":"","legend":"","description":"","filename":"dfc433820fae40338acc8548b0d6c80a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8056250/v1/42059a974f403b00b25a5b66.xml"},{"id":98496105,"identity":"f4027eb6-4e42-4edb-abe5-e0faea6dca1d","added_by":"auto","created_at":"2025-12-18 09:02:44","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92002,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8056250/v1/e47e72f887faaadf0f18ff58.html"},{"id":98624831,"identity":"2ab9c4fc-41eb-4761-90b4-ae8b2123d98c","added_by":"auto","created_at":"2025-12-19 17:08:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":540505,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8056250/v1/d10a7f07-4434-41be-9f0c-8dbf12b511b4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Qualitative Study on the Knowledge and Opinions of Outpatient Schizophrenia Patients Regarding Oral and Dental Health, Brushing Habits, Dental Anxiety, and Dental Treatments","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral health is an important part of holistic health. It directly affects overall quality of life over time. In 2016, the World Dental Federation (FDI) stated that oral health is a key part of both physical and mental health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIndividuals with psychiatric disorders are reported to have worse oral health than those without such disorders [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, oral health often receives little attention in the assessment of psychiatric disorders [\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSchizophrenia is a severe mental disorder that affects thinking, perception, self-experience, cognition, motivation, emotions, and behavior [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Patients with schizophrenia often have more tooth decay and periodontal disease, partly due to impaired executive function, poor nutrition and oral hygiene, reluctance to seek dental care, high sugary drink consumption, substance misuse, financial barriers, and dentists' reluctance to treat them [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are few studies on oral and dental health, brushing habits, dental anxiety, and the subjective views of outpatients with schizophrenia regarding dental treatments [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This qualitative study aims to explore in depth the knowledge, attitudes, and experiences of outpatients with schizophrenia with respect to oral and dental health.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis study assessed outpatient schizophrenia patients\u0026rsquo; knowledge and awareness of oral health, brushing habits, dental anxiety, and attitudes toward dental care.\u003c/p\u003e\n\u003cp\u003eThis qualitative study was conducted at the Community Mental Health Center of the Ege University Faculty of Medicine, where one-on-one interviews were held in designated rooms. The participants, all schizophrenia patients who regularly visit the Center and receive outpatient treatment, were selected via purposive sampling, a nonprobability sampling method [17].\u003c/p\u003e\n\u003cp\u003eThe participants were adults with different professions, education levels, and genders to increase data diversity. Before patients joined the study, they received information about it. All interviews took place with consent on the same day. The researcher conducted all the in-depth interviews. The environments were free from external influences and without manipulation. The interviews were recorded. They lasted 7\u0026ndash;25 minutes each, totaling 550 minutes.\u003c/p\u003e\n\u003cp\u003eAll the interviews took place at the Community Mental Health Center, which was familiar to the participants and was regularly attended by them. This made it easier for participants to share their opinions in a comfortable setting [18]. The first part of the interviews collected demographic information. The second part focused on four main themes: \u0026quot;knowledge and awareness of oral and dental health,\u0026quot; \u0026quot;brushing habits,\u0026quot; \u0026quot;dental anxiety,\u0026quot; and \u0026quot;approaches to the treatment decision-making process.\u0026quot; Open-ended questions were used to gather detailed information on these topics.\u003c/p\u003e\n\u003cp\u003ePurposive sampling continued until data saturation. Thirty participants were interviewed, after which the process ended.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research followed the Declaration of Helsinki and publication ethics, with approval from the Ege University Scientific Research and Publication Ethics Committee (01.09.2025, 12/04, Protocol No: 3009). The participants provided written informed consent after the purpose of the study was explained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed via an inductive approach and descriptive analysis. After the interviews were transcribed, the researcher coded and categorized them into four main themes. These findings were then interpreted thematically, with direct quotes included to increase representativeness.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 15 female and 15 male participants. The average age was 39.7\u0026plusmn;12.22 years, ranging from 22-70 years.\u003c/p\u003e\n\u003cp\u003eSix participants (20%) were married. Five (16.67%) completed primary school, two (6.67%) completed secondary school, and 13 (43.33%) completed high school. Three (10%) had associate degrees, and seven (23.33%) had bachelor\u0026apos;s degrees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1. Level of Knowledge and Awareness Regarding Oral and Dental Health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly six participants were aware of the importance of oral and dental health. This awareness did not come from systematic information or specific sources. None of the participants had any previous training on oral or dental health. They based their opinions on personal experience or general health knowledge.\u003c/p\u003e\n\u003cp\u003e\u0026quot;No one ever taught me how to brush my teeth or why oral health is important. These topics were never discussed at home. I do not remember it being taught at school either. I try to find information online when I need it.\u0026quot; (M, 28)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I have never received any training on how to brush my teeth in my life. Neither my family nor my parents taught me this at school. Additionally, my parents do not brush their teeth very often.\u0026quot; (F, 32)\u003c/p\u003e\n\u003cp\u003eHalf of the participants (n=15) knew that cavities can damage oral and dental health. Of these, 11 believed that cavities are genetic and unpreventable. Three attributed them to food, and one attributed them to psychological factors.\u003c/p\u003e\n\u003cp\u003e\u0026quot;Even if we brush our teeth five times a day, tooth decay is genetic. That is why my teeth are so decayed. In fact, everyone in my family has decayed teeth. No matter what we do, we cannot get rid of it. It is like our family\u0026apos;s fate.\u0026quot; (F, 48)\u003c/p\u003e\n\u003cp\u003e\u0026quot;No matter how much care I took since I was little, my teeth were always prone to decay. It is as if I had weak teeth from birth. \u0026quot; (F, 43)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I have had cavities since I was little. My teeth were already weak, and no matter how much I brushed them, they would not hold. I guess that is just how my teeth are.\u0026quot; (F, 30)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I used to eat a lot of wafers. They would even stick to my teeth. Then, I realized that they were the cause of my cavities.\u0026quot; (M, 61)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I know that chocolate and sugar rot the teeth, but I still cannot stop eating them.\u0026rdquo; (F, 45)\u003c/p\u003e\n\u003cp\u003e\u0026quot;After eating sugary things, the inside of my teeth hurts. Therefore, as soon as sugar touches my teeth, tooth decay begins.\u0026quot; (F, 31)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I think the real cause of cavities is anger. Whenever I\u0026apos;m feeling down, I feel like a new cavity is forming in my mouth.\u0026quot; (M, 54)\u003c/p\u003e\n\u003cp\u003eThe participants did not know about preventive oral and dental health practices by dentists. Knowledge about gum disease was even lower than their knowledge of tooth decay (n=2). Awareness usually comes from personal experience or one\u0026rsquo;s immediate family.\u003c/p\u003e\n\u003cp\u003e\u0026quot;I do not want to brush my teeth because my gums bleed so much when I brush my teeth. I do not think this bleeding is normal.\u0026quot; (E, 43)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I once saw a toothpaste commercial where a person\u0026apos;s eyes were bleeding, and they immediately went to the dentist. The commercial staff then asked why they did not visit the dentist when their gums bleed. I was very impressed by that commercial. I go to the dentist regularly and pay attention to bleeding gums.\u0026quot; (M, 42)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2. Brushing Habits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants (n=24) know teeth should be brushed to protect oral and dental health. However, they do not brush due to lack of opportunity, forgetting, tiredness, or reluctance. Only two participants brush their teeth regularly.\u003c/p\u003e\n\u003cp\u003e\u0026quot;I know I have to brush my teeth, but I never do. Because I forget. Sometimes I remember, but then I do not feel like it.\u0026quot; (M, 50)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Even if I see the toothbrush in the bathroom, I find it difficult to brush. It is as if even picking up the toothbrush is a big task. In addition, when I start brushing, I want it to be over immediately.\u0026quot; (M, 23)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Sometimes when I eat junk food, I want to brush my teeth right afterward, but if I\u0026apos;m out or do not have a brush with me, I just stop and then it is forgotten.\u0026rdquo; (M, 42)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I know that cleaning my teeth is important, but I cannot take action. Sometimes, even if I think about brushing, I cannot stop myself.\u0026quot; (F, 31)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I feel like I should brush it off, but most of the time I forget about it. Even if I do remember, I do not feel like it.\u0026quot; (M, 28)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Brushing my teeth is very important to me. I brush my teeth after every meal. Sometimes, if I\u0026apos;m not sure I have brushed them, I brush them again.\u0026quot; (F, 47)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Cleaning my teeth is a way of relaxing for me. Sometimes I brush the same area over and over again.\u0026quot; (F, 39)\u003c/p\u003e\n\u003cp\u003eThe general consensus among participants (n=20) regarding the frequency of daily tooth brushing was that it should be performed twice. Some participants (n=4) thought that brushing should be performed three or more times a day, whereas others (n=6) thought that brushing was not necessary.\u003c/p\u003e\n\u003cp\u003e\u0026quot;I set a timer while brushing my teeth. I do not stop brushing until I see the two-minute timer on my phone. This is a habit from my youth. Whenever the alarm I set on my phone goes off, I rinse my mouth. I brush each tooth individually, looking at it in the mirror.\u0026quot; (M, 53)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I have been brushing my teeth three times a day since I was young. I cannot sleep without brushing my teeth.\u0026quot; (M, 45)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I brush my teeth 4-5 times a day. I feel clean when I brush them.\u0026quot; (F, 50)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I never brush my teeth. Brushing seems difficult and unnecessary. Sometimes my mother forces me to brush. I do not let her.\u0026quot; (M, 37)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I\u0026apos;m afraid that if I brush my teeth, my enamel will be damaged. Brushing is not necessary for cleanliness.\u0026quot; (F, 70)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I only brush my teeth if I have a toothache, but other than that, there is no need to brush.\u0026rdquo; (E, 37)\u003c/p\u003e\n\u003cp\u003eWhen the participants\u0026apos; toothpaste and flossing habits were questioned, some participants (n=3) did not like to use toothpaste, and only one participant used dental floss.\u003c/p\u003e\n\u003cp\u003e\u0026quot;My mouth is very dry. Toothpaste dries it out even more. I\u0026apos;d like to use toothpaste because it tastes and smells great, but I do not use it because it dries my mouth.\u0026quot; (M, 19)\u003c/p\u003e\n\u003cp\u003e\u0026quot;The taste of toothpaste lingers in my mouth, which bothers me. That is why I sometimes brush with just water, but that might be why cavities increase.\u0026quot; (F, 51)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I used not to trust hospitals and doctors. I still sometimes do not trust toothpaste. Now I trust doctors, but I do not want to use toothpaste. Sometimes I brush without toothpaste, sometimes I do not brush at all.\u0026quot; (M, 30)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I have been flossing every evening for almost three years since my periodontist showed me how to use dental floss.\u0026rdquo; (E, 33)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3. Dental Anxiety\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDental anxiety is an anxiety condition characterized by an excessive and irrational fear of dental treatments, affecting millions of people worldwide [19].\u003c/p\u003e\n\u003cp\u003eWithin the context of dental anxiety, a significant portion of participants (n=18) were found to have significant anxiety about dental visits. This anxiety appears to be largely rooted in past negative experiences (e.g., painful treatment, lack of communication). Only four participants reported regular dental checkups, while the others stated they only visit when necessary. Furthermore, some participants (n=5) stated that factors in the clinical environment, such as odors, the sounds of instruments, or the dentist\u0026apos;s approach, triggered their anxiety.\u003c/p\u003e\n\u003cp\u003e\u0026quot;I never tell the dentist that my teeth hurt. Otherwise, he will pull my teeth, and it will hurt a lot. I would rather have my teeth hurt a little like this than have them pulled.\u0026quot; (M, 32)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I heard that teeth become loose after tartar removal. That is why I do not want to have it cleaned. I think they might start moving the teeth.\u0026quot; (M, 44)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Every time I go to the dentist, there is a problem. I do not even want to go anymore.\u0026quot; (M, 52)\u003c/p\u003e\n\u003cp\u003e\u0026quot;One time, he did not even let me know when he was giving me an injection. It hurt so bad, I never want to go back since that day.\u0026quot; (M, 34)\u003c/p\u003e\n\u003cp\u003e\u0026quot;When I walk in and see the dental chair, I feel numb. However, when I chat with the doctor, I feel slightly more relaxed.\u0026quot; (F, 40)\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;I am terrified of going to the dentist because it will hurt.\u0026rdquo; (F, 26)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Going to the dentist is so scary. I feel like they\u0026apos;re going to rub it in my face that my teeth are bad. I do not like the sound of those tools at all.\u0026quot; (M, 45)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I cannot immediately trust a doctor I see for the first time. That is why I postpone the examination.\u0026quot; (F, 35)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I do not go to the dentist even when there\u0026apos;s pain. I\u0026apos;m afraid he will pull it out, so I just put up with it.\u0026quot; (F, 41)\u003c/p\u003e\n\u003cp\u003e\u0026quot;Going to the dentist does not scare me at all. Because I know a dentist, he always motivates me. That is why going there seems different and fun to me.\u0026quot; (F, 28)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4. Dental Treatments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith respect to access to dental care, most participants (n=27) stated that they applied to public hospitals but had difficulty finding appointments at official institutions. Some (n=4) stated that in emergencies, they sought treatment directly through emergency rooms or dentist acquaintances.\u003c/p\u003e\n\u003cp\u003e\u0026quot;I\u0026apos;m trying to make an appointment at the state hospital, but there\u0026apos;s no room in the system. They do not even care when I go to the emergency room. I have to wait.\u0026quot; (F, 36)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I do not understand the appointment system; it just never works out. In the end, I had to go to a private place near our house. (F, 29)\u003c/p\u003e\n\u003cp\u003e\u0026quot;When my pain became so severe, I went straight to the emergency room. The doctor immediately prescribed an antibiotic, but it did not help. I still have to wait for the actual treatment.\u0026quot; (M, 40)\u003c/p\u003e\n\u003cp\u003e\u0026quot;When I could not make an appointment, I asked for help from a relative who was a dentist, and he arranged it. Otherwise, it would have been very difficult for me to reach him on my own.\u0026quot; (F, 51)\u003c/p\u003e\n\u003cp\u003e\u0026quot;It used to be easy, but now it is almost impossible to find time through the central appointment system. Every time I look, it says it is full.\u0026quot; (M, 33)\u003c/p\u003e\n\u003cp\u003eThe majority of participants (n=21) stated that they obtained information about dental treatments, mainly from their close circle, personal experiences or social media; the number of those who received information directly from health professionals was quite limited.\u003c/p\u003e\n\u003cp\u003e\u0026quot;Frankly, everything I learned about teeth, I heard from my mother and friends. Nobody goes to the doctor and asks each one individually anyway.\u0026quot; (F, 35)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I usually watch videos shared by dentists online. From there, I more or less understand what needs to be done.\u0026quot; (M, 24)\u003c/p\u003e\n\u003cp\u003e\u0026quot;When my tooth starts to hurt, I first try my own methods. Sometimes I use natural remedies I find online. If the pain becomes unbearable, I have to visit the dentist. I do not normally like going to the hospital.\u0026quot; (M, 29)\u003c/p\u003e\n\u003cp\u003e\u0026quot;I had treatment last year, and after my experience there, I understood some things. Frankly, I had no knowledge before that.\u0026quot; (M, 39)\u003c/p\u003e\n\u003cp\u003e\u0026quot;My cousin has been receiving dental treatment for years, and I learn a lot from him. He even tells me where to go with his guidance.\u0026quot; (M, 31)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eQualitative research is an approach that examines individuals\u0026apos; experiences, perceptions, and the ways they make sense of the world in which they live and aims for detailed analysis of phenomena rather than statistical generalization [20, 21]. The main goal is not to access numerical data, but to present participants\u0026apos; thoughts, experiences, and observations in a realistic and descriptive manner.\u003c/p\u003e\n\u003cp\u003eThis research method, which is generally used in the social sciences, makes a significant contribution to finding solutions to problems created by rapid changes and complex situations in the field of health by drawing on individuals\u0026apos; experiences [22, 23]. In this context, the study employed a purposive sampling method to select individuals who could provide detailed information on the subject, and in-depth interviews were used during the data collection process.\u003c/p\u003e\n\u003cp\u003eThe interviews were conducted around predetermined topics; the order of the questions was changed when necessary, and additional questions were asked to deepen the answers [24]. As in similar studies, the collected data were examined via an inductive approach and descriptive analysis; responses were coded and categorized under four main themes, and direct quotes were added to preserve the strength of the participants\u0026apos; statements [21].\u003c/p\u003e\n\u003cp\u003eThe findings indicate that knowledge and awareness of oral and dental health are generally low. Awareness of gum disease is quite limited compared with that of dental caries. This may be because cavities are more common in childhood and can cause pain [25]. It is thought that the participants lacked knowledge about preventive measures such as fissure sealants and fluoride application, which may be due to the low rate of dental visits during childhood. While tooth brushing is known to be important for oral health, there is uncertainty about the ideal brushing frequency, and flossing is generally not included in daily care routines. Furthermore, various difficulties are encountered in maintaining existing oral care habits regularly [12].\u003c/p\u003e\n\u003cp\u003eIndividuals with mental disorders face various barriers to accessing oral and dental health services. Psychiatric illnesses such as schizophrenia, depression, or anxiety disorders make it difficult for individuals to maintain regular oral care behaviors, whereas psychosocial factors such as fear of the dentist, low pain tolerance, past negative dental experiences, and a sense of loss of self-control during treatment can also lead to avoidance of dental treatment [26]. The participants stated that they knew the importance of brushing their teeth, but they were unable to maintain this behavior for reasons such as \u0026quot;not wanting to,\u0026quot; \u0026quot;forgetting,\u0026quot; or \u0026quot;not being able to take action. \u0026quot;One reason is that antipsychotic and antidepressant medications frequently used in these individuals reduce salivary flow, causing dry mouth, which can pave the way for both dental caries and periodontal problems [27-29]. The increased prevalence of tooth loss, edentulism, and related functional impairments in these patients leads to negative consequences not only for oral health but also for overall health and quality of life. Therefore, when planning oral health interventions for individuals with mental disorders, it is important to address both psychiatric and dental needs holistically [30].\u003c/p\u003e\n\u003cp\u003eToday, individuals frequently obtain information about oral and dental health through the internet and media [31, 32]. However, participants believe that this information does not always provide them with solutions. This suggests that access to digital information has increased, but uncertainties regarding health literacy and trust persist. Increasing digital health literacy and guiding individuals to reliable sources are considered crucial. The development of specialized, simplified, and visually- focused content for these individuals would be beneficial. Furthermore, while trust in institutions is a determining factor in seeking treatment, challenges such as overcrowding and long waiting times in public institutions lead some individuals to seek private services. These findings point to the need for improvement at both the individual and systemic levels.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study qualitatively examined the knowledge, attitudes, and behaviors of outpatients with schizophrenia regarding oral and dental health, shedding light on significant gaps in this area. The study findings revealed that participants\u0026apos; knowledge of oral health was inadequate and that their awareness, particularly regarding tooth decay and periodontal disease, was quite low. Daily oral care habits were irregular, flossing was uncommon, and brushing habits were frequently forgotten. The participants cited a lack of education and inadequate reminder mechanisms regarding oral and dental health as the most significant barriers to oral care. The study\u0026apos;s data demonstrate that oral and dental health is not a choice but rather a behavior shaped by accessibility and education.\u003c/p\u003e\n\u003cp\u003eThe study also revealed that participants largely access oral health information through their families or close friends, the media, and the internet, but they have limited trust in these sources. Social recommendations and trust in the institution were found to be decisive factors in choosing a dentist and choosing a healthcare provider. Difficulties accessing public oral and dental health services also influence patient behavior.\u003c/p\u003e\n\u003cp\u003eThese findings demonstrate the need to develop targeted, sustainable, and accessible oral health education programs for individuals with mental health disorders. Furthermore, integrating reminder strategies into daily life can create lasting changes in these individuals\u0026apos; oral health behaviors. Access to healthcare, quality of care, and strengthening the patient‒physician relationship are among the key elements that enhance the success of this process.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFSAY and EED, collected and analyzed the data, and drafted the initial version of the manuscript. DİH, contributed to participant recruitment and clinical evaluation, and supervised the psychiatric aspects of the research. EU, contributed to the methodological design of the qualitative study, conducted the transcription of interviews, and assisted with thematic data analysis. MT, provided supervision throughout the study process, critically revised the manuscript, and approved the final version. AD, conceived and designed the study, contributed to the overall study design, provided academic supervision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the study, ethical committee approval was obtained from Ege University Faculty of Dentistry Scientific Research and Publication Ethics Committee dated 01.09.2025, with the permission number 12/04.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e Glick M, Williams DM, Kleinman DV, et al. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. \u003cem\u003eJ Am Dent Assoc\u003c/em\u003e. 2016;147(12):915\u0026ndash;917.\u003c/li\u003e\n\u003cli\u003e Scrine C, Durey A, Slack-Smith L. Enhancing oral health for better mental health: exploring the views of mental health professionals. \u003cem\u003eInt J Ment Health Nurs\u003c/em\u003e. 2018;27(1):178\u0026ndash;186.\u003c/li\u003e\n\u003cli\u003e McCreadie RG, Stevens H, Henderson J, Hall D, McCaul R, Filik R, et al. The dental health of people with schizophrenia. \u003cem\u003eActa Psychiatr Scand\u003c/em\u003e. 2004;110(4):306\u0026ndash;310.\u003c/li\u003e\n\u003cli\u003e Arnaiz A, Zum\u0026aacute;rraga M, D\u0026iacute;ez-Altuna I, et al. Oral health and the symptoms of schizophrenia. \u003cem\u003ePsychiatry Res\u003c/em\u003e. 2011;188(1):24\u0026ndash;28.\u003c/li\u003e\n\u003cli\u003e Gurbuz O, Alatas G, Kurt E, et al. Periodontal health and treatment needs among hospitalized chronic psychiatric patients in Istanbul, Turkey. \u003cem\u003eCommunity Dent Health\u003c/em\u003e. 2011;28(1):69\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003e Gurbuz O, Altınbas K, Kurt E. Oral health in psychiatric patients. \u003cem\u003eCurr Approaches Psychiatry\u003c/em\u003e. 2011;3(4):628\u0026ndash;646.\u003c/li\u003e\n\u003cli\u003e Kisely S. No mental health without oral health. \u003cem\u003eCan J Psychiatry\u003c/em\u003e. 2016;61(5):277\u0026ndash;282.\u003c/li\u003e\n\u003cli\u003e Kenny A, Dickson-Swift V, Gussy M, et al. Oral health interventions for people living with mental disorders: protocol for a realist systematic review. \u003cem\u003eInt J Ment Health Syst\u003c/em\u003e. 2020;14:24.\u003c/li\u003e\n\u003cli\u003e World Health Organization (WHO). \u003cem\u003eInternational Statistical Classification of Diseases and Related Health Problems.\u003c/em\u003e 11th ed. Geneva: WHO; 2022.\u003c/li\u003e\n\u003cli\u003e Matevosyan NR. Oral health of adults with serious mental illnesses: a review. \u003cem\u003eCommunity Ment Health J\u003c/em\u003e. 2010;46(6):553\u0026ndash;562.\u003c/li\u003e\n\u003cli\u003e Bardow A, Nyvad B, Nauntofte B. Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ. \u003cem\u003eArch Oral Biol\u003c/em\u003e. 2001;46(5):413\u0026ndash;423.\u003c/li\u003e\n\u003cli\u003e Lewis S, Jagger RG, Treasure E. The oral health of psychiatric in-patients in South Wales. \u003cem\u003eSpec Care Dentist\u003c/em\u003e. 2001;21(5):182\u0026ndash;186.\u003c/li\u003e\n\u003cli\u003e Ramon T, Grinshpoon A, Zusman SP, Weizman A. Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel. \u003cem\u003eEur Psychiatry\u003c/em\u003e. 2003;18(3):101\u0026ndash;105.\u003c/li\u003e\n\u003cli\u003e Arnaiz A, Zumarraga M, Diez-Altuna I, Uriarte JJ, Moro J, Perez-Ansorena MA. Oral health and the symptoms of schizophrenia. \u003cem\u003ePsychiatry Res\u003c/em\u003e. 2011;188(1):24\u0026ndash;28. doi:10.1016/j.psychres.2010.09.012\u003c/li\u003e\n\u003cli\u003e Lopes AG, Ju X, Jamieson L, et al. Oral health-related quality of life among Brazilian adults with mental disorders. \u003cem\u003eEur J Oral Sci\u003c/em\u003e. 2021;129(1):e12774.\u003c/li\u003e\n\u003cli\u003e Soares GH, Bado FMR, Lopes AG, et al. Structure and replicability of oral health related quality of life networks across patients with schizophrenia and the general community. \u003cem\u003eCommunity Dent Oral Epidemiol\u003c/em\u003e. 2023;51(1):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003e Yağar F, D\u0026ouml;kme S. Niteliksel araştırmaların planlanması: araştırma soruları, \u0026ouml;rneklem se\u0026ccedil;imi, ge\u0026ccedil;erlik ve g\u0026uuml;venirlik. \u003cem\u003eGazi Sağlık Bil Derg\u003c/em\u003e. 2018;3(3):1\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003e Creswell JW, Poth CN. \u003cem\u003eQualitative Inquiry and Research Design: Choosing Among Five Approaches.\u003c/em\u003e 4th ed. Thousand Oaks (CA): Sage Publications; 2018.\u003c/li\u003e\n\u003cli\u003e Cianetti S, Lombardo G, Lupatelli E, Pagano S, Abraha I, Montedori A, et al. Dental fear/anxiety among children and adolescents: a systematic review. \u003cem\u003eEur J Paediatr Dent\u003c/em\u003e. 2017;18(2):121\u0026ndash;130. doi:10.23804/ejpd.2017.18.02.07\u003c/li\u003e\n\u003cli\u003e Hoepfl MC. Choosing qualitative research: a primer for technology education researchers. \u003cem\u003eJ Technol Educ\u003c/em\u003e. 1997;9(1):49\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003e Yıldırım A, Şimşek H. \u003cem\u003eNitel araştırma y\u0026ouml;ntemleri.\u003c/em\u003e 10th ed. Ankara: Se\u0026ccedil;kin Yayıncılık; 2016. p.48. ISBN: 9789750239991.\u003c/li\u003e\n\u003cli\u003e S\u0026ouml;nmez S, İlg\u0026uuml;n G. Nitel araştırma y\u0026ouml;ntemlerinin sağlık hizmetleri bağlamında incelenmesi. \u003cem\u003eBalıkesir Univ J Soc Sci Inst\u003c/em\u003e. 2018;21(40):375\u0026ndash;400.\u003c/li\u003e\n\u003cli\u003e Sevencan F, \u0026Ccedil;ilingiroğlu N. Sağlık alanındaki araştırmalarda kullanılan niteliksel veri toplama y\u0026ouml;ntemleri. \u003cem\u003eToplum Hekimliği B\u0026uuml;lteni\u003c/em\u003e. 2007;26(1):1\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003e Karataş Z. Sosyal bilimlerde nitel araştırma y\u0026ouml;ntemleri. \u003cem\u003eSosyal Hizmet E-Dergi\u003c/em\u003e. 2015;1(1):62\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003e Buğdaycı R, Şaşmaz T, Uludoğan C, Kurt A, \u0026Ouml;ner S, Yapıcı G, et al. İlk\u0026ouml;ğretim birinci sınıf \u0026ouml;ğrencilerinde diş \u0026ccedil;\u0026uuml;r\u0026uuml;ğ\u0026uuml; sıklığı ve etkileyen fakt\u0026ouml;rler. \u003cem\u003eTurk J Public Health\u003c/em\u003e. 2019;17(3):228\u0026ndash;237.\u003c/li\u003e\n\u003cli\u003e Alqahtani F, Al Khalifah G, Oyebode O, Orji R. Apps for mental health: an evaluation of behavior change strategies and recommendations for future development. \u003cem\u003eFront Artif Intell\u003c/em\u003e. 2019;2:30.\u003c/li\u003e\n\u003cli\u003e Afroz T, Beyene J, Zaheer K, et al. Oral health care challenges in individuals with severe mental illness: a qualitative meta-synthesis. \u003cem\u003eFront Oral Health\u003c/em\u003e. 2025;6:1655450. doi:10.3389/froh.2025.1655450\u003c/li\u003e\n\u003cli\u003e Abou-Ayash S, Paolone G, Panetta F, et al. Oral adverse effects of antipsychotic medications: a case/noncase analysis of EudraVigilance data. \u003cem\u003eClin Oral Investig\u003c/em\u003e. 2024;28(5):2689\u0026ndash;2699. doi:10.1007/s00784-023-05449-1\u003c/li\u003e\n\u003cli\u003e Mishu MP, Riaz Faisal M, Macnamara A, Delgado E, Stansfield E, Gilbody S, et al. A qualitative study exploring the barriers and facilitators for maintaining oral health and using dental service in people with severe mental illness: perspectives from service users and service providers. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e. 2022;19(7):4344. doi:10.3390/ijerph19074344\u003c/li\u003e\n\u003cli\u003e Berm\u0026uacute;dez Bejarano E, Berm\u0026uacute;dez S\u0026aacute;nchez JA. Factors that influence the appearance of dental anxiety and fear in daily dental practice in patients with mental disorders. \u003cem\u003eAnn Psychiatry Treatm\u003c/em\u003e. 2024;8(1):27\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003e Tengilimoglu D, Sarp N, Yar CE, Bektaş M, Hidir MN, Korkmaz E. The consumers\u0026rsquo; social media use in choosing physicians and hospitals: the case study of the province of Izmir. \u003cem\u003eInt J Health Plann Manage\u003c/em\u003e. 2017;32(1):19\u0026ndash;35.\u003c/li\u003e\n\u003cli\u003e Alkadhi OH, Aleissa NK, Almoharib MK, Buquayyid SA. Influence of social media on patients for choosing dental clinics: a cross-sectional survey. \u003cem\u003eJ Clin Diagn Res\u003c/em\u003e. 2020;14(1):32\u0026ndash;34.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schizophrenia, Oral health, Dental anxiety, Qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-8056250/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8056250/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e Oral health is a crucial but often neglected component of general health in individuals with schizophrenia. Cognitive impairment, medication side effects, poor motivation, and limited access to care contribute to inadequate oral hygiene and untreated dental problems in this population. This study aimed to explore, through a qualitative approach, the knowledge, perceptions, and experiences of outpatients with schizophrenia regarding oral and dental health, brushing habits, dental anxiety, and dental treatments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis qualitative study was conducted at the Community Mental Health Center of Ege University Faculty of Medicine. Thirty adult outpatients with schizophrenia were recruited through purposive sampling. Data were collected via semi-structured, face-to-face interviews lasting 7\u0026ndash;25 minutes, recorded and transcribed verbatim. Thematic and descriptive analyses were performed inductively. Four main themes emerged: knowledge and awareness of oral health, brushing habits, dental anxiety, and attitudes toward dental treatment.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e Participants\u0026rsquo; awareness of oral and dental health was generally low. Most had never received oral health education and attributed dental problems to hereditary or psychological factors rather than preventive behaviors. Only two participants reported regular toothbrushing, and floss use was rare. Dental anxiety was common, mainly due to past painful experiences, fear of extractions, or environmental triggers such as sounds and odors in clinics. Although most participants recognized the importance of oral hygiene, barriers such as forgetfulness, low motivation, and dry mouth limited regular care. Access to dental services was often hindered by long waiting times in public hospitals, and participants primarily relied on family, friends, or social media for oral health information rather than professionals.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOutpatients with schizophrenia demonstrated limited knowledge, irregular oral care routines, and substantial dental anxiety, highlighting the need for targeted and holistic oral health education programs. Integrating structured reminder systems and simplified educational tools into psychiatric care may help sustain behavioral changes. Improved service accessibility and enhanced dentist\u0026ndash;patient communication are essential to promote oral health equity in this vulnerable group.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003e This study was approved by the Ege University Scientific Research and Publication Ethics Committee (12/04, 01.09.2025)\u003c/p\u003e","manuscriptTitle":"A Qualitative Study on the Knowledge and Opinions of Outpatient Schizophrenia Patients Regarding Oral and Dental Health, Brushing Habits, Dental Anxiety, and Dental Treatments","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 09:02:39","doi":"10.21203/rs.3.rs-8056250/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-27T06:08:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-01T02:04:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-18T17:42:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235421650305826737601508941699854569413","date":"2025-12-17T19:33:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120444578658605276093372078046084183414","date":"2025-12-16T13:43:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-13T15:39:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181361264867775987619104261850752538107","date":"2025-12-13T15:36:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-13T08:16:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274951856454486179532490057649064421835","date":"2025-12-13T07:52:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T13:59:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-20T08:51:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T04:58:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-18T04:56:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-11-07T10:50:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"adabd96f-6710-4a18-a1d2-419d0958a291","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T13:39:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 09:02:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8056250","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8056250","identity":"rs-8056250","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}