Guidelines for a Palliative Approach in Residential Aged Care

6.9.1 Assessment
A thorough oral assessment is required to provide the basis for sound management of oral care
and to facilitate prevention or minimisation of oral complications [221] (Level IV). Although
a number of assessment tools have been devised, there are concerns that many of these lack
reliability and validity, limiting their clinical utility [221] (Level IV). However, the
D-E-N-T-A-L screening tool was found to have reasonable validity and reliability for assessing
severe periodontal and denture needs, though it was not sensitive to identifying persons with
severe need for denture-related care [222] (Level IV).
The D-E-N-T-A-L is a self-report questionnaire that looks at the older person’s perception
of dental treatment needs. [223] It is not an assessment tool; rather it helps to determine the
individual’s need for referral for further evaluation. The older person completes the assessment
by responding ‘yes’ or ‘no’ to the following areas of concern:
Table 14: The D-E-N-T-A-L self-report questionnaire [223]
Assessment item
Point value
Dry mouth 2
Eating difficulty 1
No recent dental care (within 2 years) 1
Tooth or mouth pain 2
Alternation or change in food selection 1
Lesions, sores or lumps in the mouth 2
SCORE
For each ‘yes’ the point value is given (‘no’ = 0). Positive items are then calculated, which
provides a score. A score greater than 2 points indicates that a dental problem exists that might
affect the resident’s wellbeing. [223] The D-E-N-T-A-L is appropriate for use with older persons
with no cognitive impairment; however, further research is required before the tool can be
used for people with advanced dementia. Similarly, further testing is required to determine the
validity and reliability if the tool is completed by anyone other than the older person.
One further tool that has reasonable reliability and validity [222] (Level IV) is the single-item selfreport
Geriatric Oral Health Assessment Index to dental care (GOHAI). [224] The GOHAI uses
a single question: “How would you describe the health of your teeth and gums? Would you say
it is excellent, very good, good, fair or poor?” [224] The responses are then scored from
1 to 5, 1 for ‘excellent’ through to 5 for ‘poor’. This single question was better than the
D-E-N-T-A-L at identifying people with a severe need for denture related care, severe dental
need or severe periodontal need [222] (Level IV). Scores of 4 or 5 were found to be the most
accurate for identifying dental care needs and a suitable cut-off point for ensuring that referrals
for dental evaluation and treatment were made [222] (Level IV).
The GOHAI could be an appropriate screening tool to include in a resident’s assessment,
given its brevity. However, as with the D-E-N-T-A-L, the GOHAIs appropriateness for older
persons with advanced dementia has not been determined and further research is required. In
the interim, the most appropriate screening tool for use with residents is the GOHAI, due to
102 Guidelines for a Palliative Approach in Residential Aged Care