Oral health care assessment & planning
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 questions 2 - 6 indicates a dental referral is required.
- Do you have any of your own natural teeth?
- Have you had pain in your mouth while chewing?
- Have you lost any fillings, or do you need a dental visit for any other reason?
- Have you avoided laughing or smiling because of problems with your teeth, mouth or dentures?
- Have you had to interrupt meals because of problems with your teeth, mouth or dentures?
- Have you had difficulty relaxing because of problems with your teeth, mouth or dentures?
Oral Health Care Assessment and Planning - Supporting quality oral health care for patients
Oral health assessment
Oral health assessment is the first step in helping to maintain oral health.
This does not take the place of a comprehensive dental examination but is used to identify whether a person has oral health problems and is in need of 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, on a regular basis or when clinically indicated.
Oral health assessment tool (OHAT)
The oral health assessment tool (50KB PDF) 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, using the oral health care planning guidelines (897KB PDF).
The Oral Health Self-learning Quiz (1MB PDF) gives an overview of common oral health conditions and the oral health assessment demonstration (below) is an instructional video when assessing the eight categories of oral health.
Oral health assessment demonstration - instructional video assessing the eight categories of oral health
Referral pathways
SA Dental referral pathways for adults and children in South Australia.
Additional information
- The risk of poor oral health increases as people become less able to self-manage due to issues of functional dependence, physical frailty, medical co-morbidity, poly-pharmacy and cognitive impairment.
- Increasing numbers of 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.
- Oral disease impacts on other areas of health and quality of life.
- Oral Health Assessment is essential for the identification of issues and implementation of management strategies.
- Simple oral health strategies involving a multi-disciplinary approach can assist with promoting and maintaining good oral health.
Continence
Poor oral health affects food selection in particular the ability to chew foods with high fibre content. This can affect continence management.
Delirium
Chronic infection from poor oral health can compromise the immune system and contribute to a systemic inflammatory response. This in conjunction with oral pain can exacerbate a change in behaviour especially for older people with dementia.
Dementia
Older people with dementia are particularly at risk of developing complex oral disease and conditions. Dementia compromises their ability to reliably report their experience of oral health problems and dental pain. In addition, older people with dementia can sometimes behave in ways that make it difficult to provide oral health care.
Depression
Poor oral health may cause pain and discomfort, bad breath, impact on people’s ability to speak, sleep well, socialise and feel happy with their appearance.
Medication
Polypharmacy can impact on oral health by causing dry mouth (xerostomia). Drug classes that especially contribute to dry mouth are those with anticholinergic effects such as ACE inhibitors and diuretics. For further information contact the Therapeutic Advice and Information Service.
Mobility
As a consequence of poor oral health, nutritional status may suffer and have an impact on maintaining weight, muscle mass and strength.
Nutrition
Tooth loss, poorly fitting dentures and oral infections affect appetite, food enjoyment and ability to chew which impacts on food intake and food selection.
Skin integrity
As a consequence of poor oral health, nutritional status may suffer and have an impact on skin integrity and wound healing.
Oral health is linked to general health, and oral conditions involving teeth, gums and dentures can significantly affect overall well-being and the ability to age positively.
For example:
- Oral pain and difficulty with eating can affect nutritional intake and body weight and therefore skin integrity, strength and mobility, and continence.
- Oral pain may also affect mood and behaviour, especially for people with cognitive impairment who find it difficult to self report their pain and discomfort.
- Poor oral health is linked to increased risk of cardiovascular disease, stroke and aspiration pneumonia. Aspiration pneumonia is a major cause of morbidity and mortality for hospitalised and institutionalised frail older people.
- Chronic oral infection can complicate the medical management of general illnesses such as diabetes, chronic heart failure and respiratory diseases.
- Poor oral health results in bad breath and affects people’s ability to speak, socialise and feel happy with their appearance.
- Medications taken by older people or people with mental health conditions often cause dry mouth (xerostomia) which affects speaking, eating and also increases the levels of oral bacteria and infection.
Check for and report or 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 a registered nurse or doctor perform an Oral Health Assessment using the Oral Health Assessment Tool (OHAT) 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.
Management principals should be based on a Model of Oral Health Care which integrates four key oral health processes into general care
- oral health assessment
- oral health care planning
- assistance with daily oral hygiene
- referral for dental treatment.
For healthy teeth and gums follow these simple steps
- use a soft toothbrush
- clean your teeth or dentures twice a day
- use a fluoride toothpaste
- drink water when you are thirsty
- sip water if your mouth is dry
- eat a healthy diet
- avoid sweets and sugary drinks between meals
- visit your dentist for a regular check-up.
Oral health assessment and dental referral
Training modules developed for non-dental healthcare professionals and/or healthcare workers to integrate oral health assessment and dental referral into routine general health assessments.
