Oral health screening: feasibility and reliability of the oral health assessment tool as used by speech pathologists

Background: The aim of this study was to investigate the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech pathologists, to become part of a comprehensive clinical swallowing examination. Methods: A multicentre study in 132 elderly subjects was conducted by speech pathologists. The inter-rater, test–retest and intra-rater reliabilities of the OHAT were assessed in R statistics, version 3.0.1. Intraclass correlation coefficients (ICCs) were used for the total OHAT, and Kappa statistics were used for the individual categories. Results: Total OHAT scores showed good inter-rater (ICC = 0.96), intra-rater (ICC ≥ 0.95) and test–retest (ICC ≥ 0.78) agreement. The inter-rater Kappa statistics were almost perfect (κ ≥ 0.83) for seven of the eight individual categories of the OHAT and perfect for ‘dental pain’ (κ = 1.00). The test–retest Kappa statistics indicated excellent agreement for ‘natural teeth’ and ‘dentures’ (κ ≥ 0.86). The intra-rater per cent agreement was excellent for all categories except ‘gums and tissues’. Conclusions: This is the first study to examine the feasibility and reliability of the OHAT as used by speech pathologists. As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. However, future research investigating actual referral strategies and adaptation of care strategies following assessment with OHAT is needed.Key words: Dental care, elderly, feasibility, oral health screening, reliability     

太原市养老机构老年人口腔健康状况的调查分析

目的了解太原市养老机构老年人的口腔保健意识及其健康状况,以针对性地开展口腔疾病的防治,提高养老机构老年人的生活质量。方法随机抽取太原市6个行政区48所养老机构内的359名老人,分别对口腔保健意识、态度及行为设计问卷调查,并进行口腔检查,所得数据通过SPSS 20.0软件进行统计分析。结果太原市养老机构老年人口腔保健意识欠缺,保健行为不规范,口腔健康状况除受刷牙习惯及口腔不良习惯的显著影响,尚与年龄、受教育程度等因素相关,55～64、65～74岁年龄组每日刷牙、曾有过口腔就诊经历的比例均低于第四次全国口腔流行病学调查数据,而无牙颌比率、缺牙未修复比率均高于同年龄组全国平均水平。结论太原市养老机构内老年人自我口腔保健意识及口腔健康状况较差,应有计划、有目的地对其开展口腔卫生宣教,帮助其养成良好的口腔卫生行为习惯,养老机构应定期开展口腔卫生检查诊疗服务,以改善老年人口腔健康状况,提高生活质量。     

Oral health problems in elderly rehabilitation patients

Abstract:  A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8–27.8; P  < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.     

Long‐term effects of using oral care aides at a nursing home for elderly dependent residents—a pilot study

The oral health status of elderly dependent residents is reported to be poor, as well as difficult to describe. Analysis of oral microbial flora has been suggested as a suitable measurement method. Oral care aides have been shown to have a positive influence on oral health care in nursing. The outcome of an intervention with oral care aides was followed during a two‐year period by recording: (a) the proportion of opportunistic microorganisms and bacteria associated with caries (b) whether oral hygiene assistance were given to the residents or not, and (c) individual experiences concerning oral health care among the staff involved. The oral flora and the amount of oral hygiene assistance improved throughout the entire study period, but staff interviews revealed that it took two years for good cooperation and prophylactic routines to be established. An unexpected finding was the positive correlation (p = .0005) between a high proportion of the opportunistic microorganisms and death within one year.     

Development of a systematic oral care program for frail elderly persons

The purpose of this study was to develop, implement and evaluate a systematic oral care program for community-dwelling-dependent or institutionalized elderly adults. The study group consisted of 20 dependent elderly adults of which 15 were living in the community and five were in a nursing home. After eight weeks of systematic oral care, the plaque and gingival indices were scored and compared with baseline measurements. Also at the end of the study, caregivers completed a questionnaire that assessed their perspective on the advantages, disadvantages, burden and fatigue in providing the systematic oral care program. The results of this study demonstrate that a systematic oral care program reduced plaque and gingival indices for the subjects as well as reducing the caregivers' burden and fatigue in providing daily oral care.     

老年口腔健康评价指数(GOHAI)中文版的信度考评

目的:考评老年口腔健康评价指数GOHAI中文版的信度。方法:按照国际生存质量评价(IQOLA)项目的标准程序,对GOHAI进行翻译、回译和文化调适,建立GOHAI中文版;使用GOHAI中文版和一般项目表对随机抽取的60岁及以上老年人进行口腔健康生存质量调查,调查结果经统计分析,考评量表的内部一致性信度和重测信度。结果:共有343位老年人接受调查。有效问卷312份,数据缺失问卷28份。GO-HAI中文版内部一致性Cronbach′sα系数为0.81,分半信度系数0.80,条目-量表相关系数在0.25~0.71之间;重测相关系数为0.866(P<0.01)。结论:GOHAI中文版具有良好的信度。     

Effect of an oral health assessment education program on nurses' knowledge and patient care practices in skilled nursing facilities

This pilot intervention study measured the impact of an oral health education intervention on nurses' knowledge and patient care practices in regard to oral assessments of institutionalized elders. Two 1-hour education sessions were completed over a 3-week period; a pretest and a posttest were administered immediately preceding the first session and immediately following the second session. Medical records were reviewed prior to and after the intervention to assess practices including completeness of oral health assessment and congruency with the Minimum Data Set 2.0 (MDS).
Nine nurses attended the education intervention. Retrospectively, 176 records were reviewed preintervention and 80 postintervention. There was no significant change in knowledge from the pre- to posttest ( p = .262). Completeness of all oral health assessment variables increased significantly ( p = .001) as did the congruency of data between the nursing assessment (NA) and MDS assessments ( p = .002).
Providing nurses with education on oral health assessments in skilled nursing facilities has a positive impact on completeness of data and congruency between the NA and the MDS.     

Preliminary study on the effect of oral care on recovery from surgery in elderly patients

This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.     

Validation of the Korean version of the oral health impact profile among the Korean elderly

OBJECTIVES: This study aimed to validate a Korean version of the oral health impact profile (OHIP) and to develop a short-form of OHIP for the Korean elderly. METHODS: The original English version of OHIP was translated into Korean using a forward-backward method. Internal consistency was measured by Cronbach's alpha among 1098 subjects aged 56 or more. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) with a 3-month interval among 155 subjects aged 57 or more. The validity of the Korean version of OHIP (OHIP-K) was assessed by comparing OHIP scores with the perceived dental treatment needs and by identifying associations between OHIP scores and the number of natural teeth among 128 subjects aged 54 or more. The short-form of OHIP for the Korean elderly (OHIP-14K) was developed using linear regression models and was also validated and compared with the short-form of OHIP by Slade (OHIP-14S). RESULTS: The Cronbach's alpha value for OHIP-K was 0.97. The ICC for OHIP-K was 0.64. Adults with perceived dental treatment needs had a higher OHIP score than adults without any such needs (P < 0.001). The number of natural teeth was negatively associated with the OHIP score (r = -0.44, P < 0.001). OHIP-14K and OHIP-14S shared seven identical items out of a total of 14 items. OHIP-14K results correlated with OHIP-K almost exactly (r(2) = 0.96), as did OHIP-14S (r(2) = 0.95). CONCLUSIONS: OHIP-K showed excellent reliability and validity. OHIP-14S may be a better choice for the evaluation of oral health-related quality of life among the Korean elderly for an international comparison.     

老年人龋病的防治重点——论老年人口腔健康标准之无龋洞

口腔健康是全身健康的重要组成部分,关注老年人口腔健康,对于维护老年人全身健康,提高其生活质量具有重要意义。那么什么情况下可以定义为老年人口腔健康呢?此前关于老年口腔健康,国内外尚未见全面的标准提出。刘洪臣于2019年结合世界卫生组织的口腔健康标准提出老年人口腔健康的10项指标,即1.牙齿清洁;2.无龋洞;3.无疼痛感;4.牙齿和牙龈颜色正常;5.无出血现象;6.牙齿排列整齐;7.不塞牙;8.无缺牙;9.咬合舒适;10.无口臭引起人们的广泛关注。本文将主要围绕十项标准中的无龋洞来讨论龋病对老年人健康的危害(面部及全身的影响)、老年人龋病的防治的重点以及探讨无龋洞的理念作为老年口腔健康标准的意义。     

Systemic diseases and their treatments in the elderly: impact on oral health

The lifespan of the US population is increasing, with the elderly desiring successful aging. This goal is jeopardized as multiple systemic conditions and their treatments become more prevalent with age, causing impaired systemic and oral health and influencing an older person's quality of life. To obtain successful aging, a compression of morbidity must be obtained through prevention and management of disease. This paper describes the most common systemic diseases causing morbidity and mortality in persons aged 65+ years: diseases of the heart, malignant neoplasms, cerebrovascular diseases, chronic obstructive pulmonary disease, pneumonia, influenza, diabetes mellitus, trauma, Alzheimer's disease, renal diseases, septicemia, and liver diseases. Disease prevalence and the impact of medications and other therapeutic measures used to treat these conditions are discussed. Oral sequelae are reviewed with guidelines for early detection of these deleterious consequences, considerations for oral treatment, and patient management. An understanding of the impact of systemic diseases and treatment on oral health is imperative for dental practitioners to appropriately treat and manage older patients with these conditions. With a focus on early detection and prevention, oral health care providers can improve the quality of life of this population and aid in the attainment of successful aging.     

The delivery of oral care services to elderly people living in a noninstitutionalized setting

Advances in medical science are enabling people to survive more illness and disability. As people live longer, their mobility and/or ability for self-care often are reduced by physical or mental disability and other chronic diseases. It may become unreasonable or impractical for them to access mainstream dental services. Increasing numbers of dentate elderly people with expectations of oral health higher than earlier cohorts of elderly people are likely to bring increasing demands to the dental profession for their continuing care. Thus, the oral care for disabled elderly people in noninstitutionalized settings may pose a challenge. The oral care options available to this group of people include the dental surgery/operatory, a mobile dental service, home-based or domiciliary dental care, a mix-and-match combination of surgery-based and domiciliary care, and cyberspace. Noninstitutionalized, disabled elderly people may have to rely on domiciliary care services for their oral health care. This paper explores the training implications, the necessary knowledge and skills base, the benefits and limitations to both the service provider and user, the equipment available, and the cost/funding of domiciliary dentistry. Domiciliary dental care services need to be developed by improving pre- and postdoctoral training programs and by establishing realistic remuneration for dental teams providing this care so that noninstitutionalized, disabled elderly people can access oral health care.     

Using an oral health‐related quality of life measure in three cultural settings

Aim : To assess the application of the Oral Impacts on Daily Performances (OIDP) index for use in three different language and cultural settings; Objectives : To develop a Spanish and Afrikaans version of the OlDP for use in the USA and South Africa and to assess its reliability and validity in three counties: UK, USA and South Africa. Design : Co‐ordinated pilot studies using the OlDP questionnaire and clinical examination using WHO criteria in the three countries using cross‐sectional convenience samples of children. Settings: Two populations in each country: relatively well‐off and more socially disadvantaged in three age groups 40 years+, 15–16 and 11–12 year‐olds. Results : 525 volunteers participated in the study; 154 in Texas, 177 in Bristol and 194 in Cape Town, the majority being females. The prevalence of oral impacts on daily performances varied between the three sites, with the sample in Bristol showing lower prevalence of 28.8% reporting at least one oral impact in the past six months. Difficulty eating was a common impact in all three sites, reported by 22.7% of the Texas sample, 18.6% of the Bristol sample and 33.0% of the Cape Town sample. Criterion and construct validity: the OlDP performed consistently well in all three sites. The combined dental caries status of the two lower age groups (12‐ and 16‐year‐olds) varied by site: Texas had the highest overall mean DMFT of 4.31, then Bristol with 3.07 and Cape Town the lowest at 2.89. Conclusions : The OlDP index had excellent psychometric properties in the Cape Town and Texas samples and had an overall good performance in the Bristol sample. Potentially the index can be used for oral health needs assessment and planning services. Further studies using larger samples might provide information relevant to the revision of existing oral health care systems.     

Clinical assessment of oral malodor intensity expressed as absolute value using an electronic nose

Objectives:  In our previous study, scores determined via a multiple linear regression method (EN-MLR) involving an electronic nose provided objective halitosis-related measurements; however, this model afforded only relative expression exclusively. The objective of this investigation was to assess clinically oral malodor intensity expressed as an absolute value using an electronic nose.
Subjects and methods:  Sixty-six subjects were evaluated based on results of an actual organoleptic test (OLT), measurements of volatile sulfur compound (VSC) concentrations, a score representing malodor intensity (EN-MI) as the absolute value and EN-MLR measured with an electronic nose system. Oral health parameters were also examined.
Results:  The OLT score served as a benchmark. The area under the receiver-operating characteristic (ROC) plots of EN-MI score (0.975) was significantly larger than that of log VSC (0.896) ( P  = 0.036); however, the area did not differ significantly from that of EN-MLR score (0.932). Percentage of teeth with pocket depth ≥4 mm, tongue coating score and plaque control record displayed meaningful association with EN-MI score in multiple logistic regression analyses.
Conclusion:  Oral malodor intensity expressed as an absolute value employing an electronic nose may be a suitable method for clinical evaluation of oral malodor.     

Effects of an oral health program on the occurrence of oral candidosis in a long-term care facility

OBJECTIVES: The aim was to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. Half of the residents were included in an experimental group which benefited from a preventive oral hygiene program including instruction of the carers and implementation of a recall program for professional oral hygiene care. METHODS: Intraoral examinations and yeast cultures from the oral mucosa and the fitting denture surface were carried out at baseline and 18 months later. The outgrowth of yeast was estimated on Oricult-N dip slides using the scale: no growth; 1-20 colonies; 21-100 colonies; >100 colonies. RESULTS: At baseline (n = 237) and at 18 months (n = 159) the experimental and the control groups were similar with regard to the residents' distribution by age, sex, dental and prosthetic status and prevalence of denture stomatitis. The 78 residents lost had the same baseline characteristics as the survivors, except for being older. In the experimental group the severity of the inflammation of the palate decreased (P = 0.005) as well as the prevalence of glossitis (P = 0.005). At baseline high yeast scores from the mucosa (>20) were observed in about 50% of the residents in the experimental as well as the control group. At 18 months this figure was 23.4% for the experimental and 48.7% for the control group (P = 0.001). There was also a reduction of the number of residents with positive cultures and the denture yeast scores at 18 months in the experimental group (P = 0.05). CONCLUSIONS: This study has shown that the preventive program was effective in reducing the colonization of the oral mucosa and dentures by Candida and thereby improving the health of the oral mucosa.     

Long-term effect of an oral healthcare programme on oral hygiene in a nursing home

This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.     

Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care

Abstract:  Objectives:  Respiratory infection is a major cause of death in the elderly. We have evaluated the role of professional oral health care (POHC) by dental hygienists in reducing respiratory infections in elderly persons requiring nursing care. Methods:  Two populations of elderly persons, one receiving POHC and one not, were examined to determine numbers of microorganisms, potent pathogens of respiratory infection, enzymatic activity in saliva, fevers, prevalence of fatal aspiration pneumonia and prevalence of influenza. Results:  In the first population, we found a high prevalence of potent respiratory pathogens such as Staphylococcus species, Pseudomonas aeruginosa and Candida albicans. Patients who received POHC showed a lower prevalence for these pathogens than those who did not. The ratio of fatal aspiration pneumonia in POHC patients was significantly lower than that in patients without POHC (non-POHC) over a 24-month period ( P  < 0.05). The prevalence of a fever of 37.8°C or more in POHC patients was significantly lower than that in the non-POHC group ( P  < 0.05). In the second study population, we investigated the effects of POHC on infection with influenza over a 6-month period. In the POHC group, neuraminidase and trypsin-like protease activities decreased, and one of 98 patients was diagnosed with influenza; whereas, in the non-POHC group, nine of 92 patients were diagnosed with influenza. The relative risk of developing influenza while under POHC was 0.1 (95% CI 0.01–0.81, P  = 0.008). Conclusion:  These results suggest that POHC by dental hygienists is effective in preventing respiratory infections in elderly persons requiring nursing care.     

The military oral health care system as a model for eliminating disparities in oral health

BACKGROUND: Healthy People (HP) 2010 is a national health promotion and disease prevention initiative of the U.S. Department of Health and Human Services. The HP 2010 report highlighted a range of racial/ethnic disparities in dental health. A substantial portion of these disparities appear to be explained by differences in access to care. Members of the U.S. military have universal access to care that also has a compulsory component. The authors conducted a study to investigate the extent to which disparities in progress toward achievement of HP 2010 objectives were lower among the military population and to compare the oral health of the military population with that of the civilian population. METHODS: The participants in this study were non-Hispanic white and non-Hispanic black males aged 18 to 44 years. They were drawn from the Tri-Service Comprehensive Oral Health Survey (10,869 including 899 recruits who participated in the TSCOHS Recruit Study) and the Third National Health and Nutrition Examination Survey (4,779). RESULTS: We found no disparities between black and white adults in untreated caries and recent dental visit rates in the military population. Disparities in missing teeth were much lower among military personnel than among civilians. CONCLUSIONS: A universal access-to-care system that incorporated an aspect of compulsory treatment displayed little to no racial disparity in relevant oral health outcomes. This demonstrates that it is possible for large, diverse populations to have much lower levels of disparities in oral health even when universal access to care is not provided until the patient is 18 or 19 years of age.