Oral Health Assessment Tool

Resident: __________________________________ Completed by: __________________________________ Date: _______________________

Resident: n is independent n needs reminding n needs supervision n needs full assistance

n Will not open mouth n Grinding or chewing n Head faces down n Refuses treatment
n Is aggressive n Bites n Excessive head movement n Cannot swallow well
n Cannot rinse and spit n Will not take dentures out at night

Dental Dental
Healthy Changes Unhealthy Referral Healthy Changes Unhealthy Referral
Lips Natural Teeth
n n n n Yes n n n n Yes
Smooth, pink, Dry, chapped or Swelling or No decayed 1- 3 decayed 4 or more
n No n No
moist red at corners lump, red/ or broken teeth or broken teeth/ decayed or
white/ulcerated or roots roots, or teeth broken teeth/
bleeding/ very worn down roots or fewer
ulcerated than 4 teeth,
at corners * or very worn
down teeth *

Tongue Dentures
n n n n Yes n n n n Yes
Normal moist, Patchy, fissured, Patch that is No broken areas 1 broken area or 1 or more broken
n No n No
roughness, pink red, coated red and/or or teeth, worn tooth, or worn areas or teeth,
white/ulcerated, regularly, and 1-2 hours per denture missing
swollen * named day only or not /not worn, need
named adhesive, or
not named *

Gums and Oral Tissue Oral Cleanliness

n n n Yes n n n Yes
Moist, pink, Dry, shiny, rough, Swollen, bleeding, Clean and no Food, tartar, Food particles,
n No n No
smooth, red, swollen, ulcers, white/ food particles or plaque 1-2 areas tartar, plaque
no bleeding sore, one ulcer/ red patches, tartar in mouth of mouth, or on most areas
sore spot, sore generalised or on dentures small area of of mouth,
under dentures redness under dentures or on most
dentures * of dentures *

Saliva Dental Pain

n n n n Yes n n n n Yes
Moist tissues Dry, sticky Tissues parched No behavioural, Verbal &/or Physical pain signs
n No n No
watery and tissues, little and red, very verbal or behavioural (swelling of cheek
free flowing saliva present, little/no saliva physical signs signs of pain or gum, broken
resident thinks present, saliva of dental pain such as pulling teeth, ulcers),
they have a dry is thick, resident at face, chewing as well as verbal
mouth thinks they have a lips, not eating, &/or behavioural
dry mouth * changed signs (pulling
behaviour. at face, not
eating, changed
behaviour) *

* Unhealthy signs usually indicate referral to a dentist is necessary

Assessor Comments

© SA Dental Service 2009