Table 2 Characteristics of oral health assessment instruments

ADOH [35]

To assess the physical ability to manipulate the aids used in oral self-care and to measure the return to function in response to care intervention and rehabilitative services.

Panel of expertise from geriatric dentistry.

Conceptualised from the classification scheme used in medicine i.e. Activities of Daily Living.

The sequence of interviewing instructions is given in the assessment instrument to guide the examiner in monitoring the individual’s abilities in performing each task.

4 categories scored on 5-point scale from 0–4.

0: for performing each step without any help;

1: requires a device to enhance the performance; 2: expends 50% or more effort in task completion; 3: expends less than 50% effort in task completion; 4: for total assistance in performing task.

Total score of 16. Classifies an individual as independent, partly dependent and dependent.

BOHSE [34]

To evaluate the oral health status of both cognitively impaired and unimpaired residents by nursing staff.

Registered nurses, dentists, certified nursing assistants, and licensed vocational nurses.

Developed through a review of available oral assessment guides, consultation with dental faculty, and recommendations from American Dental Association.

Examination is carried out in the same order as given in instrument guide starting from inspection and palpation of lymph nodes to observing oral cleanliness. Tongue blades, light, disposable gloves, and gauze squares were used as per need.

10 categories scored on 3-point scale from 0 to 2.

0: indicating healthy end; 2: unhealthy end of the scale.

Total score of 20 which ranges from 0: very healthy to 20: very unhealthy.

A higher cumulative score reflects the presence of many oral health problems.

DHR [52]

To develop easy and quick dental hygiene assessment scale for institutional nurses.

Panel of dentists, dental hygienists, nurses, and geriatricians.

Literature review on existing instruments. Benefits and strengths from OHI-S, MPS, and ROAG were considered and DHR criteria were discussed with a panel of expertise.

Assessment is conducted using a pen torch light source. Entire tooth surfaces of upper jaw are examined first and then the lower jaw for the presence of plaque (yes/ no).

2 categories scored on 3-point scale from 0 to 2.

Total score of 4, where 0: teeth without plaque represent optimal; 1: visible plaque on one or more teeth represent increased risk; 2–4: visible plaque on more than half of the teeth represent risk of oral health diseases.

Lower and upper jaw are scored separately.

GOHAI [53]

To gather information for easy diagnosis and provide appropriate interventions by patient self-report measure.

Expertise from geriatric dentistry, community dentistry, public health dentistry, and nursing departments.

Developed on the basis of past oral health status measurements, review of literature on impacts of oral diseases, existing questionnaire on oral functional status and symptoms, and consultation with health care providers.

As it is a self-reported assessment, geriatric oral health assessment is conducted through an interview.

12 categories scored on 3-point scale from 1 to 3.

1: always, often; 2: sometimes, seldom; 3: never. High score represents good oral health and low score represents oral health problems.

MPS [36]

To evaluate the oral health and oral hygiene in hospitals and other institutions.

Group of experts from gerontology and dentistry faculty.

Not stated.

Examination is performed in normal daylight with the aid of an artificial light source. Intraoral examination is performed with the help of dental mirrors.

2 categories scored on 4- point scale from 1 to 4.

Total score of 8, where 2–4: acceptable; 5–6: unacceptable; 7–8: poor.

Mucosal and Plaque Score are calculated separately.

OAS [54]

To enhance the oral health of older adults who need nursing care.

Expertise comprising of dentists, dental hygienists, medical social workers, and medical doctors.

Oral assessment items were decided by the focus group of expertise after the literature review on assessment of oral health.

Oral examination is performed without using any special instrument.

9 categories scored on 3-point scale from A-C

A: poor oral condition which needs immediate improvement; B: an optimal level, yet improvement is needed; C: condition with minimum problems.

Grade A, B and C represent Score 2, 1 and 0.

High score indicates poor oral health, which requires professional interventions.

OHAT [43]

To assess the oral health status by carers in residential care facilities.

Group of expertise from geriatric dentistry, dementia care, nurses, dentists, dental hygienists, carers, and RACFs.

Developed by modifying BOHSE after review of literature on oral assessment tools and suggestions from the group of expertise from Australia and United States.

Not stated.

8 categories scored on 3-point scale from 0 to 2.

0: healthy; 1: oral changes; and 2: unhealthy.

Total score is calculated by summing scores from each category.

OHSTNP [31]

To assist nursing staff of long-term care in identifying dental referral needs.

Group of nurses, dentists, and caregivers.

Developed by combining and modifying OHAT and Oral Screening Sheet.

General inspection by using a penlight, tongue depressor, and dental mirrors.

12 categories scored on 3-point scale from 0 to 2.

0: good; 1: fair; and 2: poor.

Questions related to the need for referral and reason of assessment are added at the bottom of the screening tool.

RAI-MDS [55]

To collect minimum amount of data regarding resident’s strengths, needs, and potential risk to plan and monitor individualised care in long term care setting.

Clinicians and researchers from nursing, social work, medicine, physical, occupational and speech therapy, and nutrition disciplines.

Developed by extensive review and revision of the assessment instrument and developing multiple drafts of MDS consulting with experts and a basic testing of the instrument.

Nurses complete the assessment form through resident’s records, direct observation, and conversation with residents.

2 sections pertaining to oral health consisting of yes/no items.

All responses indicating potential oral problems requires automatic dental referral.

ROAG-J [56]

To assess the oral health status of elderly people in a daily nursing care.

Not stated.

Developed by revising ROAG, which in turn is revised from OAG.

Examination is performed following the manual provided in ROAG-J.

8 categories scored on 4-point scale from 0 to 3.

0 and 1: no intervention; 2: preventive care action by nurses; 3: requires dentist for treatment.