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OBJECTIVES: Translating the Oral Health Assessment Tool (OHAT) into Dutch and assessing the inter-rater reliability among community nurses. METHODS: The original version of the OHAT was translated following the five stages of the 'Guidelines for the Process of Cross-Cultural Adaptation'. After a forward and backward translation, consensus on the pre-final version was obtained in an expert panel discussion. This version was pre-tested on its comprehensibility among 31 nurses and hereafter finalized. Then, inter-rater reliability of the OHAT-NL was determined by two trained nurses during oral assessments of 37 care-dependent community-dwelling older people. Intraclass correlation coefficient (ICC) and the Cohen's kappa statistic for individual items were estimated. RESULTS: Feedback from nurses in the pre-test did lead to minor changes of the OHAT-NL. Inter-rater reliability was good (ICC 0.79; 95% CI 0.63-0.89) on the total score. Agreement on item level ranged from fair to very good, the kappa ranged from 0.36-0.89. CONCLUSIONS: OHAT is now available in Dutch having good inter-rater reliability among trained community nurses. Future research can further validate the OHAT-NL and develop intervention according to total OHAT-NL scores.

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OBJECTIVE: To assess the associations between oral health status and short-term functional outcomes in hospitalized patients aged over 65 years with acute ischemic stroke. MATERIALS AND METHODS: This retrospective observational analysis included older adult patients (age, ≥ 65 years) admitted for acute ischemic stroke. The oral health status at admission was evaluated using the Oral Health Assessment Tool (OHAT). Patients were categorized into the normal oral health (OHAT score, 0-2) or poor oral health (OHAT score, ≥ 3) group. Stroke severity, Functional Oral Intake Scale (FOIS), and medical history were compared. Multivariate analysis was used to determine the association between the OHAT score and modified Rankin Scale (mRS) score at discharge, FOIS score at discharge, and length of hospital stay. RESULTS: The study comprised 129 patients (mean age: 78.8 ± 7.7 years). The poor oral health group (n = 22) had a higher stroke severity and lower FOIS scores than the normal oral health group (n = 107). The poor oral health group exhibited significantly higher rates of moderate to severe disability at discharge (odds ratio = 9.18, 95% confidence interval [CI]: 1.74-48.30, P = 0.009), lower FOIS scores at discharge (ß = -0.96, 95% CI: -1.71 to -0.20, P = 0.014), and longer hospital stays (ß = 10.70, 95% CI: 0.80-20.61, P = 0.034) than the other group. CONCLUSION: In older patients with acute ischemic stroke, poor oral health status at admission was associated with worse short-term functional outcomes, including increased disability, dysphagia, and longer hospital stay. CLINICAL RELEVANCE: Assessing and addressing the oral health status of this population can potentially improve short-term functional outcomes and enhance comprehensive stroke care.

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BACKGROUND/AIM: We investigated the influence of the preoperative Oral Health Assessment Tool (OHAT) score on the outcomes of patients with esophageal cancer after curative surgery. PATIENTS AND METHODS: This study included 90 patients with esophageal cancer who underwent curative surgery and who were screened with the OHAT between 2008 and 2021. The OHAT consists of eight categories with three possible scores. The risk factors for 5-year overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Patients were divided into healthy (n=42) and unhealthy (n=48) groups. The OHAT score was identified as a significant risk factor for postoperative pneumonia (11.9% vs. 43.8%, p=0.001) and postoperative hospital stay (20.5 days vs. 50.1 days, p=0.042). The 5-year OS rate after surgery was 71.2% in the healthy group and 43.2% in the unhealthy group, which was a significant difference (p=0.015). A multivariate analysis showed that a high OHAT score was a significant independent factor for 5-year OS (p=0.034). CONCLUSION: The OHAT score was a useful prognostic marker in patients who underwent curative surgery for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

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OBJECTIVES: To investigate the changes in oral health status with dental intervention during the acute and subacute stages of stroke and their associations with oral intake status. BACKGROUND: Oral health may deteriorate easily in patients following a stroke. However, data are scarce on the changes in oral health with dental intervention throughout the acute and subacute stages of stroke recovery. MATERIAL AND METHODS: We prospectively recruited 98 stroke patients who were admitted to an acute hospital and referred to a dental team and then could be followed at a subacute rehabilitation unit in the same hospital. Provided dental intervention, including oral health care and other general dental treatments, was recorded. Oral health was assessed with Oral Health Assessment Tool (OHAT), and the changes in OHAT score during the acute and subacute stages were statistically tested. Oral feeding status was examined using Functional Oral Intake Scale (FOIS). The cohort was divided into the non-oral feeding, dysphagia and regular diet groups based on FOIS score. Differences in OHAT among the oral intake groups were statistically tested. RESULTS: Gross OHAT score did not differ among the oral intake groups at the time of admission (mean ± standard deviation score: 6.5 ± 2.8 for non-oral diet, 5.6 ± 2.4 for dysphagia diet and 5.3 ± 2.1 for regular diet), but improved more in the regular diet group (2.4 ± 1.5) than in the other groups (5.8 ± 3.0 for non-oral diet and 4.0 ± 2.1 for dysphagia diet) at the last evaluation. Oral hygiene scores improved significantly in the acute stage, while scores for dentures and natural teeth ameliorated significantly in the subacute stage. CONCLUSION: Our findings suggest that appropriate dental intervention in the acute and subacute stages of stroke may contribute to improved oral health and oral food intake.

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Objective: Although the oral environment significantly affects the risk of pneumonia, there have been few studies regarding its relation with swallowing. There is no doubt that there is a significant link between the oral environment and the development of pneumonia; however, there have been few comparative studies of swallowing using video endoscopy (VE) and video fluorography (VF) as indicators to determine the actual availability of oral intake and the choice of food form. This study was performed to examine whether the oral environment or swallowing function contributes more to the development of pneumonia in the elderly. Methods: The study population consisted of 24 patients (7 men and 17 women; age range: 64-97 years; average age: 86 years) assessed using the Oral Health Assessment Tool (OHAT), VE and VF at Fukuoka Dental College Hospital. The most common disease was pneumonia (17 patients), followed by cerebral infarction (5 patients), pyelonephritis (4 patients), bronchitis (2 patients), Parkinson's disease (2 patients), scleroderma (1 patient), diabetes (1 patient), eosophageal cancer (1 patient) and Parkinson's syndrome> (1 patient). Some patients had multiple diseases. Oral intake was possible in 20 patients (80%), whereas tube feeding and gastric banding were required in 4 patients. Results: The OHAT score was not correlated with either the VE or VF score. Furthermore, the OHAT score was not significantly different between the multiple- and no/single-pneumonia episode groups. The group with multiple episodes of pneumonia had lower VE and VF scores than those with no or only a single episode of pneumonia. Conclusion: Oral assessment, VE and VF are necessary to evaluate swallowing in patients with suspected dysphagia. Swallowing function, especially as assessed by VE and VF, is more important than examination of the oral environment for evaluating risk of recurrent aspiration pneumonia in the elderly. In addition, multiple factors contribute to recurrent pneumonia in patients with a good oral environment, including subclinical aspiration, pharyngeal clearance and delayed activation of the gag reflex.

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BACKGROUND: Dysphagia is one of the common complications caused by stroke, leading to poor oral health. Oral health is often neglected after stroke by clinical care providers and the patients. Identifying the status of oral health in hospitalised stroke patients with swallowing disorders will facilitate the attention of clinical care providers. AIM: To investigate the differences in the oral health status between hospitalised post-stroke patients with dysphagia and non-dysphagia. DESIGN: A cross-sectional study. METHODS: A purposive sampling method was used to recruit participants. Participants included hospitalised post-stroke patients with dysphagia and without dysphagia. Stroke patients were recruited from the Department of Neurology, Guizhou Provincial People's Hospital in China. A total of 120 stroke patients completed the survey. The data collected included their demographics, the scores on the Oral Health Assessment Tool (OHAT), Geriatric Oral Health Assessment Index (GOHAI), and the Eating Assessment Tool-10 (EAT-10). The study was compliant with the STROBE checklist. RESULTS: The average age of the dysphagia group was 67 (64~76) vs the participants without dysphagia group 67 (65~76), (p = .610). The mean standard deviation (SD) OHAT score of participants with dysphagia was 5.28 (2.33) compared to participants without dysphagia 8.89 (3.07), (p < .05). This result indicates post-stroke dysphagia (PSD) patients had worse oral health than stroke patients without dysphagia. Binary logistic regression analysis showed that oral health status was the independent influencing factor of swallowing function (p < .01). CONCLUSION: The participants with dysphagia had worse oral health status compared to those without dysphagia, illustrating the critical importance of improving attention to oral health management in patients with post-stroke swallowing disorders. RELEVANCE TO CLINICAL PRACTICE: Oral health was often omitted when comparing to other functional impairments resulting from stroke. Health caregivers of post-stroke patients with dysphagia should be aware of the importance of evaluating patient's oral condition and implementing oral care.

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BACKGROUND: The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. METHODS: This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants' empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). RESULTS: The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. CONCLUSIONS: The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals' empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687 . Registered 4 September 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586.

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In acute stroke patients, it is important to maintain tongue hygiene and tongue function for prognosis management. However, the direct relationship between these factors is unclear, since these are often assessed by multiple observables. In this study, we used structural equation modeling (SEM) analysis, a tool to analyze the relationship between concepts that cannot be measured directly, to analyze the relationship between tongue hygiene and tongue function. The subjects were 73 patients with acute stroke admitted to a university hospital who underwent dental intervention. Age, sex, nutritional intake method, clinical severity classification of dysphagia, number of current teeth, number of functional teeth, oral health, tongue movement, tongue coating, number of microorganisms on the tongue surface, tongue surface moisture level, and tongue pressure were measured at the first visit. SEM analysis showed that the relationship between tongue function and tongue hygiene was 0.05 between tongue function and swallowing function was 0.90, and that between tongue hygiene and swallowing function was 0.09. We found no statistical relationship between tongue function and tongue hygiene in acute stroke patients. However, it was reconfirmed that tongue function is strongly related to feeding and swallowing functions.

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BACKGROUND: In end-of-life patients with advanced cancers, oral examination, oral care, and oral re-examination are crucial. Although oral symptoms are among the major complaints of end-of-life patients, few studies have focused on oral care in these patients. In this study, the association between oral symptoms and oral dryness among end-of-life patients was examined, and improvement of oral conditions after oral care interventions by a professional dentist was quantified. METHODS: This prospective intervention study included 27 terminally ill patients with advanced cancers in a hospice ward. Professional oral care was administered every morning, and the improvement of oral conditions was assessed by comparing oral conditions before and after the intervention. Oral assessment was performed using the Oral Health Assessment Tool (OHAT) and Oral Assessment Guide. Oral dryness was evaluated through Clinical Diagnosis Classification of oral dryness and an oral moisture device. Oral cleanliness was evaluated using a bacterial counter, and tongue smears were collected for Candida examination; furthermore, oral function was recorded. RESULTS: The presence of oral mucositis was closely associated with severe oral dryness (odds ratio [OR] = 14.93; 95% confidence interval [CI]: 1.95-114.38). The level of oral debris retention was significantly related to the degree of oral dryness (OR = 15.97; 95% CI: 2.06-123.72). The group with higher scores (OHAT > 8), which represent poor oral conditions, showed severe oral dryness (OR = 17.97; 95% CI: 1.45-223.46). Total OHAT scores (median: 7 vs 2) and those of other subgroups (lip, tongue, gums and tissues, saliva, and oral cleanliness showed a significant decrease after the intervention. Furthermore, the occurrence of mucositis (47.1% vs 0%), candidiasis rate (68.8% vs 43.8%), oral dryness self-sensation (63.6% vs 9.1%), and severe oral debris (52.9% vs 11.8%) decreased significantly. CONCLUSIONS: Proper oral care can improve oral health and hygiene, reduce the rate of mucositis, reduce the sensation of oral dryness, increase oral moisture, and reduce the chances of oral infections among end-of-life patients. Daily oral care is necessary and can alleviate oral discomfort, increase food intake, and increase the chances of communication between end-of-life patients and their families.

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BACKGROUND: Limited assessment tools for estimating the oral health of nursing home residents are available in the German language. AIMS: To develop a German version of the Oral Health Assessment Tool (OHAT) and to evaluate test-retest and inter-examiner reliability in use for the assessment of nursing home residents' oral health by caregivers before and after dental training. METHODS: The original English version of the OHAT was translated into German by a forward-backward translation process. Reliability assessments were conducted in a nursing home (n = 18) by independent application of the OHAT by two trained dentists and four professional caregivers. After receiving dental training, the caregivers repeated the OHAT with the same participants. Reliability analyses of single items were performed using Cohen's kappa statistics. Intra-class correlations were compiled to assess reliability of the total scores. T tests were used to compare percentage agreement, and under- and overestimation of findings between a reference dentist and the caregivers before and after the training unit. RESULTS: Specificity and sensitivity of the German OHAT were 87% and 86%. Test-retest reliability of the total OHAT score as estimated by the dentists was excellent (ICC 0.910; 95% CI 0.776-0.965). Before training, mean κ values between the reference dentist and caregivers ranged between 0.155 and 0.912, whereas the inter-examiner reliability of most items was only fair. After training, overall agreement between the dentist and the caregivers improved significantly from 62.1 to 83.1% (p < 0.001), as well as satisfying inter-examiner agreement for the single items. CONCLUSIONS: The German version of the OHAT is a reliable and valid tool for the assessment of oral health conditions of nursing home residents. When used by caregivers, instruction on the tool and practical training are mandatory to ensure reliable estimations. However, further studies with a larger sample size are encouraged to verify the outcomes of this study.

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AIMS AND OBJECTIVES: To analyse oral care delivery in one hospital through exploring experiences from both nurses' and patients' perspectives and examining patients' oral health. BACKGROUND: Oral health problems are associated with undernutrition and other general health outcomes. Although oral care belongs to the essentials of nursing, it is often neglected. Improving oral health may require behaviour change of both nurses and patients. Defining tailored strategies need a clear view on the context. DESIGN: A context analysis in one hospital using a convergent parallel mixed-methods design was reported following the EQUATOR guidelines using two checklists: COnsolidated criteria for REporting Qualitative research (qualitative research) and STROBE (observational research). METHODS: Semi-structured interviews were conducted with 19 nurses and 11 patients. The topic list was based on the Integrated Change Model. Prospective oral examination was performed among 91 surgical patients using the Oral Health Assessment Tool (OHAT). RESULTS: Nurses acknowledged that they did not prioritise oral care in daily practice. Furthermore, they lacked knowledge and skills to identify and provide care for oral problems. Nurses mentioned helpful resources to perform oral care, like standardised language and instruments. However, they had no access to or were unaware of them. Patients admitted that they did not prioritise oral care due to their sickness during hospitalisation, were unaware of the importance of oral care, but felt responsible for their oral care. The most prominent oral problems identified with the OHAT were unclean mouths (n = 75, 82%), unhealthy gum and tissues (n = 55, 60%) and dry mouth (n = 42, 46%). CONCLUSIONS: This context analysis identified inadequate oral care due to lack of positive attitude and knowledge in both nurses and patients, skills for nurses, and resources. RELEVANCE TO CLINICAL PRACTICE: The behavioural factors indicate strategies for development of a multicomponent intervention to improve oral care in this hospital, nutritional status and general health outcomes.

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AIM: The relationship between oral health-related quality of life (OHRQoL) and sarcopenia is unknown. The purpose of the present study was to clarify the prevalence of sarcopenia in older dental clinic outpatients and its relationship with OHRQoL and oral health status. METHODS: This cross-sectional study used data from consecutive dental clinic outpatients aged ≥65 years. The Oral Health Impact Profile-14 was used for the evaluation of OHRQoL, and the Oral Health Assessment Tool was used to assess oral health status. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. Uni- and multivariable analyses were carried out to investigate the relationship between sarcopenia and Oral Health Impact Profile-14 and Oral Health Assessment Tool scores. RESULTS: This study involved 279 patients (173 women, 106 men) with a mean age of 76 ± 7.5 years. The sarcopenia prevalence rate was 30.2%, and patients with sarcopenia had significantly poorer OHRQoL and oral health status than did patients without sarcopenia. Furthermore, sarcopenia was independently associated with Oral Health Impact Profile-14 and Oral Health Assessment Tool scores even after adjusting for confounding factors, such as age, sex, nutritional status, activities of daily living, dysphagia, comorbidities, polypharmacy and clinical dental findings. CONCLUSIONS: Sarcopenia was associated with OHRQoL and oral health status in older dental clinic outpatients. The prevalence of sarcopenia in older outpatients visiting the dental clinic was relatively high. Rehabilitation nutrition together with dental care might be necessary for sarcopenia treatment and prevention. Geriatr Gerontol Int 2018; 18: 915-921.

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The initiatives to improve the quality are widely developed in the healthcare sector. So, an evaluation of the professional practices (EPP) concerning oral diseases in elderly was organized in the long term care unit of the teaching hospital of Toulouse. In the dynamic of this EPP, a pilot study consisted in estimating a new kit of oral hygiene. This hygiene kit was chosen according to defined criteria adapted to the elderly. The results show a clear improvement of the oral health measured with a specific index (Oral health assessment tool).

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