[Clinical assessment of oral health between physician and dentist--a pilot study on inter-examiner reliability]. / Wie verlässlich ist die klinische Erhebung von Mundgesundheitsparametern durch Arzte bei geriatrischen Patienten? : Eine Pilotstudie zur Ubereinstimmung zwischen den Untersuchungsergebnissen eines Arztes und eines Zahnarztes.

OBJECTIVE: Very little is known about the ability of physicians to assess oral health of geriatric patients. The aim of this pilot study was to assess the in ter-examiner reliability in assessment of oral health for a dentist and a physician, and to evaluate the influence of training in dental findings for the physician on inter- examiner reliability. METHODS: Inter-examiner reliability between a physician and a dentist was tested in a primary geriatric hospital with 126 participants 60 years old or more (mean 77 years; 32% men) using the Revised Oral Assessment Guide (ROAG) and additional items relating to caries and dentures (14 items). Calculated were kappa-coefficients, and percentage agreement between the examiners before (n = 50) and after (n = 51) training for the physician in dentistry (n = 25 for the common training session). RESULTS: Before the training both kappa-values and percentage agreement were not acceptable in the different categories. After the training, with the exception of the categories swallow and tongue, the reliability of all items was moderate or good. The number of occasions on which the physician underestimated the clinical finding compared to the dentist - indicating a clinical finding was overlooked - decreased for every item; for retention of denture and decayed teeth this decrease was significant. CONCLUSION: Screening for oral health performed by a physician was insufficient regarding the different clinical aspects. Training in the use of an oral health assessment tool improved the reliability of the screening. Because of the low number of examiners the results should be interpreted as a pilot investigation on this new topic.

A German version of the GOHAI.

OBJECTIVES: Translation, reliability analysis and validation of a German version of the Geriatric/General Oral Health Assessment Index (GOHAI) was the aim of this study. METHODS: Translation was performed by a forward-backward process. Validity was assessed as convergent validity in comparison with another self-perceived assessment of oral health (OHIP-14) and as group validity (n = 218; mean age 73 years). Reliability was proved in terms of internal consistency, inter-item and item-scale correlations, and stability (test-retest procedure; n = 36; mean age 77 years). The responsiveness to change in oral health status was assessed by pre- and post-treatment comparison (n = 21; mean age 63 years). RESULTS: A German version of the GOHAI is presented. Convergent validity was sufficient (r = -0.76 compared with OHIP-14); group validity could be demonstrated for self-perceived need for treatment, chewing problems, number of own teeth, caries lesions present and dental status. The internal consistency was high (Cronbach's alpha = 0.92) as were inter-item and item-scale correlations, for which good homogeneity of the index was apparent. The test-retest correlation for the summary score was r = 0.84, single item correlations ranged from r = 0.36 to r = 0.89. The GOHAI sum score increased significantly after patients received new dentures, indicating responsiveness of the GOHAI to clinical change in the expected direction. CONCLUSIONS: The German version of the GOHAI had sufficient reliability, validity and responsiveness to be used as measure of oral health-related quality of life in cross-sectional and longitudinal studies of the elderly.

Oral health-related quality of life and somatization in the elderly.

OBJECTIVE: Somatization disorders are frequent in the elderly, and previous studies have revealed that psychological factors affect the outcome of measurement of oral health-related quality of life (OHRQoL). The objective of this study was, therefore, to investigate the correlation between OHRQoL and somatization. METHODS: One-hundred and twenty-five participants aged 60 years or older (mean age 76.6 years; 40 males) from a primary geriatric medical hospital participated in this cross-sectional study. OHRQoL was assessed by using the Oral Health Impact Profile (OHIP), somatization by using the somatization subscale of the Symptom Check List (SCL-90-R). To obtain dental data we performed a clinical dental examination. RESULTS: In bivariate analyses the most consistent correlation with somatization was found for overall OHIP sum score and the subscales physical pain and functional limitation (r > 0.4). Participants with high somatization scores had high OHIP sum scores. In multivariate analysis somatization led to additional explanation of the variance of the OHIP sum score and of all OHIP subscales. CONCLUSIONS: There is consistent correlation between OHRQoL and somatization. When evaluating OHRQoL in the elderly (using the OHIP) further evaluation of somatization should be considered for thorough interpretation of the results.