In previous blogs (Dental Elf – 30^th Jun 2017, Dental Elf – 10^th Oct 2018) the topic of oral health care for dependent older adults has been explored. Some studies have highlighted that older adults who depend on third parties for oral care experiences with their teeth, dentures, and oral soft tissues. While other studies have reported that around 1 in 4 dependent adults suffer with orofacial pain. Consequently, caregivers have expressed a need for a tool to assist the establishment of appropriate oral care plans with the result that several measurement tools have been specifically developed for the purpose of providing care givers an oral health measurement instrument that could help them establish oral care plans.

The aim of this review was to identify the best available measurement tool for assessing oral health and orofacial pain in dependent adults, which can be used by the non-dental caregivers.

Methods

Seven electronic databases were searched from inception to the 9th of October 2017 and were later updated on the 1st of August 2019 and 25th of February 2022: MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Health Technology Assessment (HTA), Open Access Theses and Dissertations (OATD) and OpenGrey. The search strategies focused on three key elements: the constructs of oral health and orofacial pain, dependent adults and measurement properties. Two authors independently investigated with a third author when required.

Studies describing development or evaluation of a tool to assess oral health or orofacial pain in dependent adult in patients aged 18+ who need or receive support and published in English were considered. The primary outcomes were to evaluate the quality of the methods used to assess each tool and to come to an overall evidence-supported rating. The secondary outcomes included the ease of use and feasibility of each tool. Data extraction and study quality assessment was undertaken independently by two authors. The COSMIN risk of bias checklist was used.

Results

• 19 studies that met the inclusion criteria, 14 of which were related to oral health and 5 dedicated to orofacial pain.
• 9 measurement tools in total were identified.
• None of the measurement tools investigated were shown to have been adequately and comprehensively tested to establish strong evidence in relation to their measurement properties, feasibility and interpretability.
• Measurement tools OHAT¹, THROAT² and OHSTNP³ for oral health and OPST-NVI⁴ for oro-facial pain were all found to have sufficient reliability.

Conclusions

The authors concluded: –

…there are nine oral health and three orofacial pain measurement instruments for dependent adults. However, none of these measurement instruments were shown to have been adequately and comprehensively tested to establish strong evidence in relation to their measurement properties, feasibility and interpretability. Nevertheless, some of the included measurement instruments in this review demonstrated sufficient performances in reliability (i.e. OHAT and THROAT) and construct validity (i.e. OPS-NVI). Thus, these instruments have the potential for future use once other measurement properties, interpretability and feasibility have been sufficiently tested and evaluated.

Comments

This paper is a robust systematic review with sound methodology however is restricted by the low quality of source data.The authors were hopeful that OHAT, THROAT and OPST-NVI could be useful in the future as measurement tools should they be further investigated and evaluated. Issues with extensive training time, required resources, or small sample sizes restricted the authors from recommending them.

Various assessment tools and training resources for non-dental care givers are available and well established across the UK including Caring for Smiles⁵, Mouth Matters⁶ and Open Wide⁷. The theoretical benefit of using assessment tools to measure oral health in dependent adults is clear, however there is little evidence to demonstrate that such measures bring about improved oral health outcomes in this population.

Links

Primary Paper

BaHammam FA, McCracken GI, Wassall R, Durham J, Abdulmohsen B. Measurement properties, interpretability and feasibility of instruments measuring oral health and orofacial pain in dependent adults: a systematic review. BMC Oral Health. 2022 May 25;22(1):208. doi: 10.1186/s12903-022-02235-w. PMID: 35614421; PMCID: PMC9131695.

Review protocol in PROSPERO

Other references

Dental Elf – 30^th Jun 2017

Oral care in nursing homes

 Dental Elf – 10^th Oct 2018

Oral care for nursing home residents

 

1.  NICE Oral Health Assessment Tool (OHAT)
2. THROAT: Dickinson, H., Watkins, C. & Leathley, M. (2001). The Development of the THROAT: The Holistic and Reliable Oral Assessment Tool. Clinical Effectiveness in Nursing. 5, 106-110.
3. OHSTNP: Tsukada S, Ito K, Stegaroiu R, Shibata S, Ohuchi A. An oral health and function screening tool for nursing personnel of long-term care facilities to identify the need for dentist referral without preliminary training. Gerodontology. 2017 Jun;34(2):232-239. doi: 10.1111/ger.12255. Epub 2017 Jan 8. PMID: 28066920.
4. OPST-NVI: Corbett A., Achterberg W., Husebo B., et al. An international road map to improve pain assessment in people with impaired cognition: the development of the Pain Assessment in Impaired Cognition (PAIC) meta-tool. BMC Neurology. 2014;14:p. 229. doi: 10.1186/s12883-014-0229-5.
5. Caring for smiles:
6. Mouth matters:
7. Open wide: