Brief Oral Health Status Examination (BOHSE)

BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet

Test: Brief Oral Health Status Examination (BOHSE)

Year: 1995

Domain: Biological

Assessment Tool Category: Oral Health

Variations/Translations: Brief Oral Health Status Examination (BOHSE) was adapted to become the Oral Health Assessment Tool (OHAT) in 2007 for the Ontario LTC sector and again in 2008 for all primary care sectors in Ontario.

Setting: Long-term care and community settings

Method of Delivery: Observation, measurement and palpation of oral cavity, surrounding tissues and natural/artificial teeth. Examiners may or may not be certified health workers (eg. spouse).

Description: This is tool that assesses oral health in elderly individuals. It covers the patient's current oral health status, including factors which can contribute to the risk of oral disease and indicate the need for referral. The BOHSE assessment covers ten oral hygiene categories – lymph nodes, lips, tongue, cheek/roof of mouth, gums, saliva, natural teeth, artificial teeth, chewing position, and oral cleanliness. Using a pen light, tongue depressor, and gauze, the conditions of the oral cavity, surrounding tissues and natural/artificial teeth are examined and graded. The descriptors illustrate what to look for in a progressive manner from normal tissue to diseased tissue.

Scoring/Interpretation: The ten categories are rated by the examiner using a 3-point scale (0, 1, 2); 0 indicating the healthy end and 2 the unhealthy end of the scale. The final score is the sum of the scores from the 10 categories and ranges from 0 (very healthy) to 20 (very unhealthy). The tool reflects health status from the total score reported. A higher score indicates that many problems have been identified. Although the cumulative score is important, individuals who scored on items that are underlined should be referred for a dental evaluation and exam immediately.

Time to Administer: Approximately 5-10 minutes with a reported average of 7.8 minutes

Availability: The tool is available for free at www.hartfordign.org

Software: N/A

Website: N/A

Quantitative/Qualitative: Mixed Methods (qualitative observation with quantitative assessment)

Validity (Quantitative): Validity analyses of the OHAT categories and examination findings showed complete agreement for the lips category, with the natural teeth, dentures, and tongue categories having high significant correlations and percent agreements. The gums category had significant moderate correlation and percent agreement. Non-significant and low correlations and percent agreements were evident for the saliva, oral cleanliness and dental pain categories.

Reliability (Quantitative): Intra-carer reliability for OHAT categories: percent agreement ranged from 74.4 per cent for oral cleanliness, to 93.9 per cent for dental pain; Kappa statistics were in moderate range (0.51-0.60) for lips, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p<0.05). Inter-carer reliability for OHAT categories: percent agreement ranged from 72.6 per cent for oral cleanliness to 92.6 per cent for dental pain; Kappa statistics were in moderate range (0.48-0.60) for lips, tongue, gums, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p<0.05). Intraclass correlation coefficients for OHAT total scores were 0.78 for intra-carer and 0.74 for inter-carer reliability.

References:

Chalmers, J.M., & Pearson, A. (2005). Oral hygiene care for residents with dementia: a literature review. Journal of Advanced Nursing, 52(4), 410-419.

Chalmers, J.M., Spencer, A.J., Wright, F.A.C., & Carter, K.D. (2005). The Oral Health Assessment Tool –Validity and reliability. Australian Dental Journal, 50(3), 191-199.

Chalmers, J.M., & Pearson, A. (2005). A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities. Gerondontology, 25(5), 227-233.

Kayser-Jones, J., Bird, W.F., Paul, S.M., Long, L., & Schell, E.S. (1995). An instrument to assess the oral health status of nursing home residents. The Gerontologist, 35(6), 814-824.

Comments: This tool is used for screening purposes only; the BOHSE should not be used to diagnose dental diseases and should not be used in lieu of objective assessments such as clinical oral examinations and dental radiographs, (i.e. does not replace the need for regular examinations).