Oral health assessment is the first process in helping to improve an older person's oral health.

This does not take the place of a comprehensive dental examination but is used to identify whether an older person has oral health problems and needs a dental referral.

An oral health assessment does not take very long to do. It can be easily done at the same time as other general health assessments. An initial base-line assessment of the mouth should take place during a patient’s initial admission assessments and no later than 24 hours following admission. For planned admissions, an oral health assessment should be included in general pre-admission assessments. Oral health should be re-assessed as the need arises.

When assisting with an older person’s oral hygiene check for and report/follow up on signs of the following oral health conditions:

• soreness and cracks at corners of the mouth
• sore, swollen or inflamed or coated areas on the tongue
• red swollen mouth
• bad breath
• dry oral tissues
• saliva which is thick, stringy or rope-like
• swollen red gums that bleed easily when brushed
• loose or broken teeth or exposed tooth roots
• oral pain or tooth sensitivity
• difficulty eating and or speaking
• changed behaviour and refusing to open mouth
• poor oral cleanliness and food left in the mouth
• chipped or broken teeth on the denture
• chipped or broken acrylic areas on the denture
• bent or broken mental wires or clips on a partial denture
• check for a name on the denture

• It is recommended that an appropriate health professional such as registered nurse or doctor perform an oral health assessment (below) using the Oral Health Assessment Tool (OHAT) (7MB PDF) on admission and repeat as required.
• A ‘healthy’ or ‘changes’ assessment can be managed using the Oral Health Care Planning Guidelines.
• An ‘unhealthy’ assessment indicates a referral to a dental professional is recommended. As most referrals are likely to be of a non-urgent nature, this information should be included in discharge planning advice and correspondence.

1. The risk of poor oral health increases when older people become less able to self-manage due to issues of functional dependence, physical frailty, medical co-morbidity, polypharmacy and cognitive impairment.
2. Increasing numbers of older people are retaining at least some of their natural teeth. As their ability to self-manage oral hygiene decreases, their risk of oral disease and infection increases.
3. Oral disease impacts other areas of health and quality of life.
4. Oral Health Assessment (below) on admission to the hospital is essential for the identification of issues and implementation of management strategies.
5. Simple oral health strategies involving a multi-disciplinary approach can assist with promoting and maintaining good oral health.

Oral health assessment tool (OHAT)

A clinical assessment of oral health status is recommended for frail older people.

The Oral Health Assessment Tool (50KB PDF) is recommended for older people who are unable to reliably self-report and when a clinical assessment is required. It consists of a visual inspection using eight categories of oral health:

• lips
• tongue
• gums and oral tissue
• saliva
• natural teeth
• dentures
• oral cleanliness
• dental pain.

The eight oral health categories are assessed as healthy, changes or unhealthy. A healthy or changes assessment can be managed by oral health care planning. An unhealthy assessment indicates the need for a dental referral

The Oral Health Assessment Toolkit for Older People (7MB PDF) is to be used in conjunction with the Oral Health Self-learning Quiz (1MB PDF) and the oral health assessment demonstration (below). It gives an overview of the common oral health conditions experienced by older people, provides helpful hints on oral health assessment preparation, how to manage changed behaviours, offers advice on medication considerations, and shows how to remove/reinsert dentures.

Six question oral health assessment tool

The six-question oral health assessment tool has been developed to help non-dental health workers identify adults who are experiencing or who are at risk of poor oral health. The six simple questions are predictive of a person’s need for dental treatment.

A ‘yes’ to any of the questions 2-6 indicates a dental referral is required.

1. Do you have any of your own natural teeth?
2. Have you had pain in your mouth while chewing?
3. Have you lost any fillings, or do you need a dental visit for any other reason?
4. Have you avoided laughing or smiling because of problems with your teeth, mouth or dentures?
5. Have you had to interrupt meals because of problems with your teeth, mouth or dentures?
6. Have you had difficulty relaxing because of problems with your teeth, mouth or dentures?