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Oral health assessment by lay staff for older adults

Summary

The aim of this protocol is to enable non-dental professionals to assess oral health status for research or health screening purposes. Aspects assessed are lips, tongue, soft and hard tissue, natural and artificial teeth, oral cleanliness, plaque, swallowing, and the impact of oral health on quality of life.

Abstract

Oral health is an often underestimated contribution to overall health. However, the literature underscores the myriad systemic diseases affected by oral health, including type II diabetes, heart disease, and atherosclerosis. Therefore, oral health assessments called oral screenings play an important role in assessing disease risk, treating disease, and even improving disease through oral treatment. Here we introduce one way to quickly and consistently assess oral health over time. The protocol is simple enough for non-oral health professionals such as students, family members, and caregivers. Useful for all ages of patients, the method is especially important for the elderly, who are often at risk for inflammation and chronic diseases. The components of the method include existing oral health rating scales and inventories that are combined into a comprehensive oral health assessment. Thus, oral characteristics assessed include intraoral and extraoral structures, soft and hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact this oral health condition has on the patient's quality of life. The advantages of this method include the inclusion of actions and perceptions from both the observer and the patient, as well as the ability to track changes in oral health over time. The results obtained are quantitative sums of questionnaires and oral screening elements that can be combined for an Oral Health Status Score. The results of the sequential oral screenings can be used to track oral health progression over time and guide oral and general health care recommendations.

Introduction

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Oral health affects overall health. Oral exercise is used to move food and debris out of the mouth instantly and, along with the protective functions of saliva, are the body's natural defense mechanism against oral infection and tooth decay1. Lack of oral health leaves individuals very susceptible to buildup of oral pathogens, inflammation, and infection that can spread to the body. For example, people with type II diabetes are at greater risk of developing periodontal disease, an inflammatory gum disease. Patients with periodontal disease are also more likely to develop type II diabetes, as periodontal disease can affect glycemic control2,3. Poor oral health is linked to many additional systemic or body-wide diseases, including heart disease, stroke, and osteoporosis4,5,6.

The need to screen patients for oral health status is therefore important not only in diagnosing oral disease, but also in assessing systemic disease risk. This is especially important in the elderly, who are more likely to develop chronic inflammatory diseases6. In addition, poor oral health causes social isolation, dehydration, and malnutrition. Patients with weaknesses such as dementia, stroke, and Parkinson's disease (PD) often develop dysphagia or have difficulty swallowing7. Not only does this life-threatening condition cause unsightly abstinence, it can also result in oral bacteria being accidentally swallowed into the lungs. Aspiration pneumonia is a common outcome and leading cause of death in the elderly8.

Our goal is to provide an oral screening protocol that non-dental professionals can use for research or health purposes. We describe a compilation of existing oral screening tools that together provide a comprehensive and useful assessment of oral health. We chose these tools to enable dental students to collect data in research studies and gain patient experiences. Legal restrictions limit the techniques that students (i.e., undergraduate, unlicensed interns) can perform; This compilation is designed to be performed by any pre-trained or calibrated student. In addition, nurses, caregivers, and family members can also use these protocols with oral health monitoring for older adults. These tools include the General Oral Health Assessment Index (GOHAI)9who have favourited Radboud Oral Motor Inventory (ROMP) underscale ingestion10who have favourited Brief Oral Health Status Examination (BOHSE)11and the Simplified Oral Hygiene Index (OHI-S)12. Oral characteristics assessed include intra-oral and extra-oral structures, soft s / hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact of this oral health status on the patient's quality of life. Anyone can complete this oral screening legally and safely, even those without dental training or dental tools. The brief nature of oral screening allows caregivers and researchers to easily track changes in oral health over time.

Aside from the fact that almost anyone can learn to manage this oral screening, a benefit of this method is that it includes both screener and self-reporting components. In this way, specific oral health measures can be matched with the functional and emotional perception of the patient.

Self-reporting components (patient opinions about their oral health)

General index for assessing oral health

The GOHAI is a self-reported measure of oral health quality of life in older adults9. The survey includes 12 questions that rate oral function, mouth pain and discomfort, and psychosocial impact (Table 1). The GOHAI questionnaire, which is used to assess oral health in over 200 scientific publications, has been found to be sensitive to dental care regulations13 proven and the subjective well-being after 10 years14predicted. In addition, a caregiver can complete the GOHAI if the patient is unable to communicate effectively15.

There are several questionnaires for measuring health-related quality of life; Among the most popular are the Oral Impacts on Daily Performances (OIDP)16, the Oral Health Impact Profile (OHIP)17,18and GOHAI. The OIDP measures eight daily activities in terms of frequency and severity, but is not specifically designed for older patients. The OHIP was originally designed as a 49-statement survey, but later on 14 statements (OHIP-14)19shortened. Several studies have compared the effectiveness of OHIP-14 and GOHAI. All conclude that both ratings are comparable, although some studies show that older people with high oral health needs are better able to identify with GOHAI and that GOHAI are more sensitive to objective scores of oral function20,21,22,23,24,25,26can be. That is why we opted for the GOHAI over the OHIP-14.

Swallowing partial scales from the Radboud Oral Motor Inventory

Dysphagia (difficulty swallowing) often affects the elderly population due to muscle atrophy. It can affect up to 35% of the elderly over 75 years of age, and it greatly increases the risk of malnutrition and aspiration pneumonia27. The percentage of affected patients increases to more than 50% if the patient has a neurological disease (e.g. Parkinson's, Alzheimer's, multiple sclerosis, stroke and others)28. Most objective measurements of dysphagia are too invasive for the elderly or require the expertise of a professional (i.e., a doctor or speech and language pathologist) and specialized equipment (i.e., endoscope or video fluoroscope). Therefore, using a validated self-assessment questionnaire is a good alternative when students need to collect data or nurses need to quickly assess dysphagia in a patient in order to refer them to a specialist.

There are more than two dozen self-assessment questionnaires for dysphagia, each specific to a particular type of patient29,30,31,32. The most comprehensive and popular is the SWAL-QOL questionnaire (Swallowing Quality-of-Life)33designed for many different types of patients, including those with neurodegenerative diseases. However, this questionnaire is quite long and consists of 44 questions.

A patient may be overwhelmed with answering a series of questionnaires and sitting for long sessions while the examiners collect data, especially if the patient has an age-related disorder. The ROMP was originally designed to address dysphagia, sialorrhea, and speech problems in patients with PD10to eat. The swallowing part of the ROMP consists of 7 questions with a 5-point answer option likert (Table 2). It can be given in a short time and even in the frail elderly. Therefore this compilation contains the swallow part of the ROMP. For research purposes, researchers can evaluate other swallow rating surveys to ensure that the best option is used for their research objectives32.

Screener Components (Screener Assessment of Patients Oral Health)

Short oral health check and simplified oral hygiene index

Oral health has improved over the years as more elderly people keep their teeth and so has continued for decades34,35years of need medical care. However, some parts of this population are still with poor oral health. In particular, the elderly who live in long-term care facilities and are humans ill with age-related diseases, including tooth decay (i.e., cavities), gingivitis, plaque accumulation, denture problems, and mucosal lesions36,37,38,39. Ideally, the elderly have a dentist visit and long-term care facility at least twice a year, but most of the time they do not. The last two components of our oral health assessment use oral cavity observation but without dental expertise or professional dental tools.

Few oral health assessments are designed for a layperson or inexperienced person to assess oral health. The Daily Oral Hygiene Activities Index (ADOH) is a rating of the physical ability to perform oral hygiene and rates an elderly person with complete flossing, brushing, topical fluoride application, and oral rinses40. While this tool is a good option for tracking the progressive loss of oral hygiene capacity in the elderly, it does not assess oral status and is involved and time consuming. The Oral Health Screening Tool for Nursing Personnel (OHSTNP) was recently published and validated41. This oral screening tool has 12 elements including many very similar to the BOHSE. Screening includes assessing basic nutrition and oral function during feeding and swallowing. But no other studies confirm its validity. The Oral Health Assessment Tool (OHAT) is an 8-element tool, derived from the BOHSE, widely used to assess oral health in long-term care residents, including those with dementia42. Therefore we close the BOHSE (Table 3) as it is established, reliable, validated and used by lay staff11,42,43can be used. To include the measurement of plaque accumulation, we used the OHI-S (Table 4) added with a change to help nurses, caregivers, and health students easily calculate the rubble index without the dental license restrictions12,44disturb.

Together, these four oral health ratings form a short and simple assessment tool that nurses and caregivers can use to quickly assess oral health status in the elderly at home, in long-term care, or even in the hospital, before referring to a dental clinic. Professional. This compilation is also useful for engaging health students in research and patient interaction, particularly to help prospective dentists care for the growing elderly population.

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Protocol

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The Institutional Review Board (IRB) at the University of Texas Health Science Center in Houston has approved all of the methods described here.

1. General recommendations

  1. If time permits, complete the questionnaires and oral health assessment on the following days or with a break between them as this will reduce the patient's fatigue and resilience.
  2. Begin with the questionnaires to create a relationship and trust between the screener and the patient, making the transition to oral screening easier when the screener is in close proximity to the patient's face and mouth.
  3. Always let the patient rest between questions when asked. There is no need to elaborate the questionnaire elements, so hold the conversation cautiously on the topic if necessary.
  4. For research purposes, randomize the order of the questionnaires and include information about the last time the patient food or drink (other than water) and the last time the patient performed oral hygiene (i.e. brushing teeth, oral rinsing, etc.) as needed.
  5. Use the correct infection control techniques. Pay attention to the sequence of physical contact the oral screener has with the patient and surrounding objects. For example, do not use examination gloves (or bare hands) to touch the patient's mouth, use a pen to write the results on paper, and then return to the patient's mouth.
  6. Recruit a second observer to write and write the results of the oral screening on the paper questionnaires.
    NOTE: This allows for faster oral screening and also acts as an infection control, limiting physical contact of the oral screener to the patient only.
  7. Include all patients over the age of 50.
    NOTE: Because the scoring is for use in assessing oral health for potential referral to a dentist, the method can be used on all patients including those who have dentures, are edentulous, bedridden, dumb, or cognitively impaired. In the latter cases, ask the supervisor for answers to the questions about voluntary disclosure.

2. Training

  1. Read the original research on the four oral health assessment tools included here. Pay particular attention to the Introduction and Discussion sections of the posts as they describe why and for what populations each tool was created.
  2. Watch the video for this publication to see oral health screening in action.
  3. Practice screening friends and family for oral condition with Table 1, Table 2, Table 3, Table 4and the protocol described here. Repeat until an individual's oral screening can be repeated in less than 30 minutes.

3.General Oral Health Assessment Index (GOHAI)9

  1. Ask the patient to sit comfortably to answer questions. Tell the patient to take the last 3 months into account when answering. If the patient is unable to answer the questions due to a disability, have a caregiver answer the questions and make a note of this.
  2. Ask questions Table 1 successively. Mark the patient's answers on a piece of paper or a digital copy of this GOHAI questionnaire. At the end of the 12 questions, thank the patient and ask if he / she has any comments to add.
  3. Rate the GOHAI in two ways, either the additive or simple counting methods.
    NOTE: Additive score: For the 3 questions that were formulated positively (questions 3, 5 and 7), reverse the codes (1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always to 1 = always , 2 = often, 3 = sometimes, 4 = rarely, 5 = never). Adds the answer codes for the 12 answers. For this method, GOHAI scores range from 12 to 60. The single number GOHAI score is used to ensure that patients have not been confused with a 5-point scale.Points 0 points for "never" and "seldom" and 1 point for "sometimes", "often" and "always". The total GOHAI values ​​range from 0 to 12. In both cases, higher values ​​represent a poorer oral health quality of life.

4. Swallowing the Radboud Oral Motor Inventory (ROMP)10

  1. Tell the patient to consider the last 3 months when answering the next 7 questions. If the patient is unable to answer the questions due to a disability, have a caregiver answer the questions and make a note of this.
  2. Ask questions Table 2 successively. Mark the patient's answers on paper or a digital copy of this swallowing sub-scale of the ROMP. Thank the patient and ask if he / she has any comments to add.
  3. Sum the results of each swallowing question for a total swallowing score.
    NOTE: ROMP swallowing values ​​are between 7 and 35; higher values ​​represent impaired swallowing ability. The simple counting method can also be used with this questionnaire (see step 3.3 for more information).

5.Short oral health examination (BOHSE)11

  1. Mark a paper copy of the BOHSE for oral screening and marks on it during the examination of each oral and dental area (Table 3). Recruit a second observer to act as a scribe to expedite the investigation and prevent infection.
  2. Ask the patient to sit comfortably and await observation of their neck, mouth, and teeth. Tell the patient not to feel any discomfort and if they do, communicate it by raising their hand.
  3. Stand in front of the seated patient. Goblet fingers and gently palpate the submandibular and submental lymph nodes just anterior to the angle of the jaw. Ask the patient if he / she is being tender. Select the BOHSE Lymph Node Score (0x2) that applies.
    NOTE: Lymph nodes are small lumps under the skin (about 1 cm in diameter) but cannot be felt if they are healthy. Infected lymph nodes are tender, soft, touching and flexible. Cancerous lymph nodes are hard, non-painful, and immobile.
  4. Tell the patient that next is to watch their lips. Watch the lips and corners of the mouth for their color, dryness, and other abnormalities (such as ulcers, bleeding, crispy scars, wounds with rounded edges, or discoloration on the edge of the lips that meet the skin of the face). Ask the patient how long they have observed any abnormalities. Select the BOHSE Lips Score (0x2) that applies.
  5. Tell the patient that there is observation in their mouth next. Ask the patient to open their mouth and stick their tongue out. Monitor the status of the tongue for color, dryness, and other abnormalities such as ulcers and bleeding.
  6. Touch the tongue (with examination gloves) and evaluate the texture. Ask the patient how long they have observed any abnormalities. Select the BOHSE score for the tongue (0x2) that applies.
    NOTE: If the patient cannot stick the tongue out as long as necessary, grasp the tongue with your thumb and forefinger and gently hold the tongue outside of the oral cavity.
  7. In his mouth, watch the inside of the cheeks and the bottom and top of the mouth for their color, dryness, and other abnormalities such as ulcers and bleeding. Use a tongue printer as needed to stretch the cheeks and a penlight for better observation. Ask the patient how long they have been observing any abnormalities. Select the BOHSE score for tissue in the cheek, floor and roof of the mouth (0x2) that applies.
  8. Examine the patient's gums by using a tongue depressor to gently squeeze their gums and assess for strength and color. Ask the patient if he / she has loose teeth or pain around his / her teeth. Select the BOHSE Gum Score (0x2) that applies.
    NOTE: The gums should not have any redness, bleeding, food debris, or plaque on the triangle between the teeth.
  9. Tell the patient that the next thing they will do is look at their saliva and touch their tongue with a tongue depressor. Note the dryness of the tissues of the mouth and the flow of saliva (i.e. from saliva pooling in the floor of the mouth). Ask the patient if their mouth feels dry when they eat or if they have difficulty swallowing food without drinking water. Select the BOHSE score for saliva (0x2) that applies.
  10. Next, tell the patient to inspect the teeth. Count all natural (original) teeth and write the number at the bottom of the BOHSE table. Look for crumbled, cracked, or chipped teeth while looking at the natural teeth. Select the BOHSE Natural Teeth Score (0x2) that applies.
    NOTE: Decayed teeth may have discoloration or cracking of the tooth surface, widening of the cracks of the tooth, and there may be small holes in the white enamel or even brown or black visible stains.
  11. Check out the condition of artificial teeth (i.e. dentures, implants, or crowns). Look for chips and wear and tear. Ask the patient: whether he has partial dentures or dentures or implants, whether he has lost artificial teeth or other oral devices in the past and how often and for what purposes the artificial teeth are worn. Select the BOHSE Artificial Teeth Score (0x2) that applies.
  12. Count the pairs of teeth in the chewing position.
    NOTE: These are jaw-shaped (upper) and lower-jaw-shaped (lower) teeth that come into contact when the jaw closes, thus biting. The pairs of teeth can be natural or artificial. For example, teeth 8 and 25 (illustration 1) a pair; If either of them is missing, don't count as a couple.
  13. Assess overall marginal cleanliness by observing the entire oral cavity and teeth for food particles (leftovers) and tartar (called calculus). Choose BOHSE oral cleanliness score, which applies (0x2). Thank the patient for their willingness to participate and ask if he / she can add any comments.
    NOTE: Dental calculus is a crispy buildup on the gum line of the tooth that can trap stains on the teeth and cause yellow discoloration.
  14. Sum the scores of each BOHSE item for a total BOHSE score.
    NOTE: THE BOHSE scores range from 0 to 20; higher numbers represent poor oral health. If an item score is a 2, see the patient to see a dentist.

6.Simplified oral hygiene index (OHI-S)12

  1. Ask the patient to sit comfortably. Tell the patient that a dye will be applied to their teeth so they can see buildup of plaque. Explain that if he / she isn't brushing his / her teeth, the dye can stay in the mouth for a few hours, but it will slowly fade.
  2. Hold the plastic blister with the plaque that exposes the dye smear. Find the cotton tip with the pink line around it. Remove the other half of the plaque that is exposing dye smears from their plastic blister, leaving the end with the pink line in the plastic. Find the cotton tip with the pink line around it. With the thumb and forefinger of each hand grasping either side of the pink line, break the cotton tip off the shaft by giving the pink line a sharp snap with both hands. Confirm that the pink dye stored in the hollow shaft of the swab drains quickly onto the other cotton tip.
    NOTE: The pink dye stains clothing, skin, and gums, so be careful not to touch the tip of the swab only on the teeth. The dye sticks to dental plaque and can stay in your mouth for hours unless it's brushed or wiped away.
  3. The six in figure 1 Wipe the tooth surfaces shown in red with pink dye: the labial surfaces (outside) of the upper right (tooth 8) and lower left (tooth 24) central incisors, the lingual surfaces (tongue side) of the selected lower molars (teeth 19 and 30) and the buccal ones Surfaces (cheek side) of the selected upper molars (teeth 3 and 14). In the absence of the specified upper or lower center canister, replace the central incisor (tooth 9 or 25, respectively) on the opposite side of the midline. Replace the upper (teeth 1, 2, 15 or 16) and lower molars (teeth 17, 18, 31 or 32) as needed. Carefully rinse with water and evaluate the debris index based on the criteria in Figure 2 under the Debris Index Before Tooth Brushing section.
  4. Provide oral hygiene instructions if the dirt index is high.
  5. Calculate the debris index by adding the debris values ​​for buccal, lingual, and labial, then divide the sum by the number of surfaces examined.

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Representative Results

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This set of oral health assessment tools has been assessed in various elderly populations. One patient with dementia (D-06) was selected to demonstrate how an elderly person's results could be interpreted by a caregiver. All patients have signed a consent form prior to enrollment and the studies are IRB approved.

Use the four assessment tools to assess a patient
Patient D-06 completed the GOHAI questionnaire and scored 20 points (range from 12 to 60, higher numbers representing poor oral health quality of life) suggesting that the patient was feeling reasonably well (Table 5). Answers to questions one and two suggest that the patient may experience discomfort during meals. This discomfort can have various causes; the patient may have problems chewing and / or swallowing food, or the patient may feel pain while eating. The second questionnaire assesses the ability to swallow. Patient D-06 scored 12 points (range 7 to 35, higher numbers representing swallowing problems, Table 6). This result suggests that the patient is able to swallow properly and has no significant choking events. However, the answers to questions three and four underline the discomfort during meals. Based on the rest of the answers, swallowing difficulty can be ruled out rather than discomfort. Taken together, these two self-reported questionnaires identify oral discomfort and restrictions during meals; the patient may have chewing problems that should be addressed to prevent worsening.

Answering both questionnaires can result in a low overall score, which represents good oral health and swallowing ability. However, the examiner should always recognize individual high score answers and encourage the patient to see a dentist or other doctor for further assessment and treatment.

The second part of the compilation includes a screener that looks into the patient's mouth. The overall BOHSE score for patient D-06 was 4 (range 0 to 20, higher numbers representing oral health problems) (Table 7). This result suggests that the patient had fairly good oral health and no major problems were discovered. However, the patient had some redness around the gums, a few decayed teeth, and poor overall oral cleanliness, suggesting possible dental problems that may affect the patient's ability to eat comfortably. Finally, the overall OHI-S score was 2.17 (range 0 to 3, higher numbers representing more tooth debris, Table 8). This is a relatively high score and along with the BOHSE gums, teeth and oral cleanliness points suggests that this patient may need better oral hygiene and will benefit from a visit to the dentist.

Taken together, all four assessment tools in this compilation show that patient D-06 may not have serious oral health problems. However, some responses to questionnaires and scores from BOHSE and OHI-S give warning signs that should not be discarded. There are a wide range of oral health problems and not a single patient can show problems in all of them. With all four assessment tools, a caregiver may be able to identify a hidden problem, even at the mild stages of its development, and recommend a course of action such as improving oral hygiene or visiting a dentist.

Use of the four assessment tools for research purposes
For research purposes, researchers can use this compilation of Oral Health Assessment Tools to compare different populations, assess the deterioration in oral health associated with specific diseases, and evaluate the effectiveness of a treatment, including inquiries. As mentioned in the previous section, different populations may have differences in some, but not all, of assessment tools that suggest that different populations may have unique dental needs.

We first assessed the oral health of patients with mild (Montreal Cognitive Assessment [MoCA] scores of 11-26; n = 12) and severe (MoCA scores of 0-10; n = 13) cognitive impairment (CI) who were in long-term care Life. There were no differences in age or gender between the two groups. Our results show that patients with severe CI report a significantly poorer oral health quality of life through their GOHAI values(Figure 3A.; p = 0.015). However, no differences were found between the two groups in terms of ROMP ingestion (slight mean sE: 7.8 x 0.4; severe mean sE: 8.5 x 0.4; p = 0.3), BOHSE (slight mean value for SE: 3.3 x 0.3; severe mean value for SE: 4.4 x 0.9; p = 0.2) and OHI-S (slight mean value for SE: 1.8 x 0.2; severe mean value for SE: 1.7 x 0.2; p = 0.6) (data not shown). This patient population did not show high levels of ROMP swallowing, suggesting that this oral problem cannot affect them. Both groups showed relatively high values ​​for BOHSE and OHI-S, suggesting that both groups may experience poor oral hygiene.

Next, we rated oral health in the elderly (age> 50) with lower (n = 29) and higher education (n = 34). Students with a high school degree or less (

We then assessed the oral health of patients with PD and compared them to age and gender controls. As from previous investigations10expected, patients with PD had significantly worse ROMP values ​​(swallowing)(Figure 3D.; p < 0,01).="" patienten="" mit="" pd="" zeigten="" eine="" schlechtere="" mundgesundheit="" als="" kontrollen,="" wie="" sie="" mit="" bohse="" bewertet="" wurden="">Figure 3E.; p = 0.03), but the plaque index was not significantly different (p = 0.6; Data not displayed). These results show that patients with PD can have oral hygiene comparable to controls but have specific problems that were assessed in the BOHSE. In particular, they showed significantly worse condition of the lips, tongue, gums and saliva (p < 0,001,="">p = 0,02, p = 0.03 or p = 0.01; Data not shown). GOHAI was not assessed in this population.

We assessed the proposed instruments in different populations and found that some populations had significantly different scores in some, but not all, of the four assessments. Therefore, using these four tools together enables comprehensive screening of specific oral health problems that may not be unique to an oral health assessment.


Figure 1: Simplified oral hygiene index (OHI-S) staining p. The diagram shows a map of the teeth for reference when staining for OHI-S scoring. The human mouth has 32 teeth, which are labeled in the drawing. The preferred teeth for staining are colored red and alternate teeth (if the patient lacks the preferred teeth) are colored blue. Dark black bars next to each colored tooth indicate the side of the tooth to be stained. For example, tooth 3 should be colored on the buccal side (cheek side), tooth 19 should be colored on the lingual side (tongue side) and tooth 8 on the labial side (front side). Please click here to view a larger version of this image.


Figure 2: Simplified Oral Hygiene Index - Debris Index (OHI-S DI) scoring instructions. The drawing shows possible areas to be stained for individual teeth. The values ​​are determined depending on the surface area covered by the stain as shown. Please click here to view a larger version of this image.


Figure 3: Preparation of the oral health assessment in various elderly population groups. Different patient populations were assessed using the 4 screening tools: General Oral Health Assessment Index (GOHAI), Radboud Oral Motor Inventory (ROMP) Oral Part, Brief Oral Health Status Examination (BOHSE), and Simplified Oral Hygiene Index (OHI-S). (A.) Patients with mild (MoCA score 11-26; n = 12) and severe (MoCA score 11-26; n = 13) cognitive impairment (CI) completed the GOHAI questionnaire. Patients with a severe CI scored significantly higher, suggesting that they have poorer oral health quality in life than patients with a mild CI (p = 0,015). (B.) The oral health of older participants (age> 50 years) was rated with the BOHSE. Participants with a higher education or less (

Table 1: General Oral Health Rating Index (GOHAI) questionnaire. The GOHAI measures the oral health quality of life and is an ideal instrument for checking older people. Use this table to interview patients and rate responses. Please click here to view this table (right click to download).

Table 2: Radboud Oral Motor Inventory (ROMP) swallowing questionnaire. The ROMP was originally developed to measure swallowing, salivary dysfunction, and language problems in patients with PD. Because of this, the swallow part is a short and suitable questionnaire for the elderly, including frail elderly people who are in long-term care or who have other neurological problems. Use this table to interview patients and rate responses. Please click here to view this table (right click to download).

Table 3: Brief oral condition examination (BOHSE). The BOHSE is an assessment tool for measuring oral health by examining the patient's mouth. This oral health screening can be done by any layperson with a little training. Use this table to examine patients and evaluate the various parameters of oral health. Please click here to view this table (right click to download).

Table 4: Simplified Oral Hygiene Index (OHI-S) Debris Index (DI) only. The OHI-S is a simple evaluation tool for measuring dirt and calculus. This log contains only the rubble index. This change enables health students to collect data without violating the use of dental devices or violating government regulations about their interaction with patients. To calculate a patient's score, at least two of the six possible surfaces must be colored and examined. Dirt Index values ​​can range from 0 to 3, with higher numbers representing higher amounts of tooth debris. Use this table to examine patients and rate each tooth surface. Please click here to view this table (right click to download).

Table 5: The General Index for Assessing Oral Health (GOHAI) rates a patient with dementia. Sample results from a patient with dementia. The overall GOHAI rating was 20 (range is 12-60, higher numbers representing poor oral health quality of life), suggesting that the patient was feeling reasonably comfortable. Answers to questions one and two suggest that the patient may experience discomfort during meals. Please click here to view this table (right click to download).

Table 6: Radboud Oral Motor Inventory (ROMP) swallowing questionnaire for a patient with dementia. Sample results from a patient with dementia. The total ROMP score was 12 (range 7 to 35, higher numbers representing swallowing problems), suggesting that the patient was fairly comfortable swallowing. Answers to questions three and four indicate that the patient may experience discomfort during meals, but this may not be related to difficulty swallowing. Please click here to view this table (right click to download).

Table 7: Brief Oral Health Status Examination (BOHSE) for a patient with dementia. Sample results from a patient with dementia. The overall BOHSE rating was 4 (range 0 to 20, higher numbers representing oral health problems), suggesting that the patient had fairly good oral health, despite redness around the gums, a few crumbled teeth, and poor oral cleanliness on them suggest that this patient needs to improve oral hygiene and see a dentist. Please click here to view this table (right click to download).

Table 8: Simplified oral hygiene index (OHI-S) for patients with dementia. Sample results from a patient with dementia. The total OHI-S score was 2.17 (range 0 to 3, higher numbers representing more tooth debris), which indicates a higher amount of tooth debris. Please click here to view this table (right click to download).

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Discussion

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Here we show a generally accessible and comprehensive methodology for assessing oral health. These tools include the GOHAI9, the gulp sub-scale of the ROMP10who have favourited BOHSE11and the OHI-S12. Oral specialists such as dentists, dental therapists, dental hygienists and dentists currently assess oral health almost exclusively. They have the benefit of training, tooth chairs, and tools for advanced disease and care, but many potential elderly patients fail or fail to go to the dentist due to financial or physical limitations. On the occasion, oral screenings are conducted outside of the dental office, assessments are conducted informally or with an established oral screening tool. Often these oral health assessments are not repeated on a regular basis, nor do they cover enough oral health aspects to relate the results to general health or to identify problems as they arise.

The aim of this protocol is to assess and, if desired, track the progress of oral health over time and guide recommendations for oral and general health care. We have selected four oral health assessment tools specifically for shielding elderly patients. Most of the time, older patients can have other disabilities and get tired more quickly. Therefore, short questionnaires were preferred to long ones. Two of the assessment tools chosen include a caregiver to objectively assess oral health. The protocols describe simple steps that any non-dental professional can learn. Therefore, this protocol can be used to assess oral health in the elderly in the community as well as in long-term care residents.

Health students are often limited in interacting with patients. This protocol is ideal for encouraging early career students to participate in research, collect data, and gain experience working with the elderly. This valuable experience informs students about the importance of careful data collection and patient management. In addition, it prepares them to practice evidence-based dentistry in the future. Ultimately, this experience can encourage future generations of students to work towards improving the oral health of the growing older population.

The limitations of this protocol are coupled with its advantages. As a research tool, this protocol lacks the ability to assess and quantify more accurate indicators of oral health deterioration such as periodontal disease and cavities. This compilation of Oral Health Assessment Tools can be used to encourage patients to express their discomfort, but a professional is needed to make a definitive diagnosis and recommend a course of treatment. However, we believe it can be a useful tool for non-dental professionals to screen patients for research or health purposes.

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Disclosures

The authors have nothing to reveal.

Acknowledgments

The American Parkinson's Disease Association funded this work.

Materials

SurnameCompanyCatalog NumberComments
Hurriview Plaque Indicating Snap-n-Go SwabsHenry Schein916553
Non-latex examination glovesVWR76246-462any vendor will do; optional if you use only tongue depressor to touch the mouth
Small flashlight or pen light (Energizer LED Pen Flashlight)VWR500033-336any vendor will do; unnecessary, but helpful
Sterile, individually wrapped tongue depressorVWR500011-108any vendor will do

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