Ability to estimate oral health status and treatment need in elderly receiving home nursing - a comparison between a dental hygienist and a dentist

The aim of this study was to compare the estimation ability of a dental hyg ienist to that of a dentist when, independently, recording the oral health status and treatment need in a population of elderly, receiving home nursin g. Seventy-three persons, enrolled in a home nursing long-time care program me, were recruited. For the oral examination a newly developed protocol wit h comparatively blunt measurement variables was used. The oral examination protocol was tested for construct validity and for internal consistency rel iability. Statistical analyses were performed using Wilcoxon matched pairs signed rank sum test for testing differences, while inter-examiner agreemen t was estimated by calculating the kappa-values. Comparing the two examiner s, good agreement was demonstrated for all mucosal recordings, colour, form , wounds, blisters, mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental hygienist recorded significantly more ch anges. The dental hygienist also recorded significantly higher plaque index values. Also regarding treatment intention and treatment need, the dental hygienist's estimation was somewhat higher. In conclusion, when comparing t he dental hygienist's and the dentist's ability to estimate oral health sta tus, treatment intention, and treatment need, some differences were observe d, the dental hygienist tending to register "on the safe side", calling att ention to the importance of inter-examiner calibration. However, for practi cal purpose the inter-examiner agreement was acceptable, constituting a pro mising basis for future out-reach activities.