Background:The Oral Health Assessment Tool (OHAT) was a component of the Best Practice Oral Health Model for Australian Residential Care study. The OHAT provided institutional carers with a simple, eight category screening tool to assess residents' oral health, including those with dementia. This analysis presents OHAT reliability and validity results. Methods: A convenience sample of 21 residential care facilities (RCFs) in urban and rural Victoria, NSW and South Australia used the OHAT at baseline, three-months and six-months to assess intra-and inter-carer reliability and concurrent validity. Results: Four hundred and fifty five residents completed all study phases. 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. 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.

The Australian Government endorsed a national evidence based oral health model when it introduced the first Nursing Home Oral and Dental Health Plan in 2010. Called Better Oral Health in Residential Care, it promotes a multidisciplinary approach with doctors, nurses, care workers and dental professionals sharing responsibility for the four key processes of oral health screening, oral health care planning, daily oral hygiene and access to dental treatment. Frail and dependent residents are most conveniently treated on‐site, hence an aged care/dental partnership is encouraged to facilitate the use of portable dental equipment in the delivery of dental care. Currently, few dentists provide services to residential aged care facilities (RACFs), with loss of clinical time in practice, difficulty in providing clinical care in a non‐dental environment and lack of referral pathways from the RACFs to the dentists contributing to the problem. The need to establish a model of care involving dental hygienists/oral health therapists in RACFs has merit. Minimal intervention treatment using glass ionomer cement (GIC) and silver fluoride is ideal in aged care. However, GIC has limitation in dry mouths with low pH caused by polypharmacy or disease. Palliative and definitive treatment techniques need to be individualized with consideration of a patient's ability to maintain their own mouths as well as their mental and physical competence. The range of products available to address the oral diseases common to the frail elderly is growing. The oral health care provider is required to establish a preventive regime that is tailored to the patient's needs, is realistic and under revision as the patient's needs change.

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