口腔健康為整體健康、生活品質和幸福感的關鍵指標。許多研究指出口腔疾病與心血管疾病、糖尿病、肺炎、營養不良有關。長期照顧(簡稱長照)對象，尤其是居家失能、失智者，常因行動不便或缺乏相關支持，造成嚴重的就醫障礙，普遍有口腔健康不良之狀況。提供適當的口腔健康狀況評估及篩檢，可以有效監測失能、失智者之口腔健康狀況，即時轉介牙醫師，進一步預防其他疾病的發生。
目前長期照顧十年計畫2.0採用照顧管理評估量表(簡稱照管量表)評估失能者長照需要，但並未包括口腔健康狀況評估，因此在長照制度內，若能在照管量表外，建立一個簡易的口腔健康評估機制，對有問題的個案轉介牙醫師，將可大幅提升長照個案牙醫可近性。口腔健康評估量表(Oral Health Assessment Tool，簡稱OHAT)主要提供非牙醫專業人員評估使用，符合此目的。台灣先前的研究曾經探討在醫院、護理之家、精神科日間照護中心等地點使用OHAT的適用性，但未發現針對照顧管理專員(簡稱照專)進行之研究。因此，本研究之目的是對長照個案探究以非牙醫專業人員使用之OHAT評估量表在不同背景之照專與牙醫師評估結果之比較。由於時間與人力限制，藉由居家訪視評估驗證此模式之可行性有其困難度，故以機構住民為對象，檢視照專與牙醫師運用OHAT評估之結果，期望未來推廣到居家個案。
本研究之方法採用橫斷面研究與立意取樣方式，以東部某住宿式長照機構的50位住民為研究樣本。以一位資深牙醫師OHAT的評估結果為黃金標準，與照專的評估進行比較，後者包括花蓮縣長期照顧管理中心的20位照專，其中護理與社工背景各10位，共同以OHAT量表評估機構住民的口腔健康狀況。照專先接受OHAT量表之介紹再對住民進行評估。利用SPSS統計軟體進行資料分析。以ICC和Kappa值針對受檢住民口腔健康狀況評估結果，進行牙醫師與照專評估一致性之分析，並與牙醫師的評估結果比較，衡量照專評估的準確度、敏感度與特異度。
本研究之牙醫師與照專OHAT評估一致性分析結果如下。護理背景照專組ICC值為0.495(p < 0.001)，社工背景照專組ICC值為0.429(p < 0.001)。就Kappa值而言，護理背景照專組評估項目：嘴唇 -0.019、舌頭0.182、牙齦和黏膜組織0.028、唾液0.286、殘存自然牙0.338、假牙1、口腔清潔0.188、牙痛0.677;社工背景照專組評估項目：嘴唇0.150、舌頭0.006、牙齦和黏膜組織0.179、唾液 -0.053、殘存自然牙0.206、假牙1、口腔清潔0.072、牙痛0.511。
有關建議轉介牙醫師的準確度，在自由心證下，護理背景照專組為56%，而社工背景照專組為78%。若以OHAT量表評估分數訂定需轉介的條件(OHAT量表任一項目2分(異常)或殘存自然牙、假牙、牙痛任一項目1分(有變化))，則護理背景照專組的評估準確度大幅提升為72%，而社工背景照專組的評估準確度則略降低至70%，都具一般的準確度。在敏感度方面，若依照上述OHAT的轉介條件，護理背景照專組的評估敏感度由69%提升為81%，社工背景照專組的評估敏感度也由65%大幅提升至88%，整體上敏感度具有非常好的改善結果。
整體而言，本研究發現由照專進行OHAT口腔量表評估應為可行，照專運用OHAT評估時間平均只要2分鐘，口腔檢查範圍涵蓋廣，評估時間短，具有一般的一致性。尤其在訂定明確的轉介條件後，照專在轉介牙醫師方面具有良好的敏感度，可應用在長照個案之評估，以提升失能者牙醫服務之轉介與使用。因此建議在政策上，未來可將OHAT列入長照個案口腔健康狀況評估工具，由照專評估後進行必要之轉介，但應強化照專OHAT評估之訓練，以提升評估的一致性與準確度。期能提升有牙醫需求長照個案對牙醫醫療服務的可近性與使用率，透過口腔健康復能與服務，增進長照個案的健康與福祉。

Oral health is a key indicator of overall health, quality of life, and well-being. Many studies have shown that oral diseases are associated with cardiovascular disease, diabetes, pneumonia, and malnutrition. Long-term care (LTC) recipients, especially those with disability or dementia and therefore restrained at home, often suffer from limited access to medical services because of low mobility or lack of relevant support, and generally have poor oral health. Providing appropriate oral health assessment and screening can effectively monitor their oral health and give them immediate referrals to dentists to prevent the occurrence of other diseases.
The current 10-year Long-term Care Plan 2.0 adopts the care management assessment scale to assess the LTC needs of the disabled. However, the assessment of oral health is not included. Therefore, in the LTC system, if a simple oral health assessment mechanism can be established in addition to the care management assessment scale and the LTC recipients with oral health problems can be referred to dentists, the accessibility to dental services for LTC recipients will be greatly improved. The Oral Health Assessment Tool (OHAT) is mainly for the use of non-dental professionals, which is in line with this purpose. Previous studies in Taiwan have explored the applicability of the OHAT used in hospitals, nursing homes, psychiatric daycare centers, etc. However, no study has been found about the applicability of the OHAT for the care managers in Taiwan. The purpose of this research is to investigate the comparison of the assessments using the OHAT by the care managers with different backgrounds and the dentist for LTC recipients. It is difficult to verify the feasibility of this model based on the home visit assessment because of the limitations of time and manpower. Therefore, this study aims to examine the results of the assessments using the OHAT by the care managers and the dentist for the residents in the institution. It is expected that the proposed method can be extended to the assessments for the LTC recipients of home services in the future.
This study is designed as a cross-sectional study with purposive sampling. The 50 residents in the residential LTC institution in Eastern Taiwan were recruited as the study samples. A senior dentist's assessment using the OHAT was made as the gold standard, compared to the care managers’ assessments. The 20 care managers at the LTC Management Center in Hualien County, including 10 care managers with nursing background (CM-NB) and 10 care managers with social work background (CM-SB), used the OHAT to assess the oral health of the residents in the institution. The care managers assessed them after receiving an introduction to the OHAT. The SPSS statistical software was utilized for data analysis. The intraclass correlation coefficient (ICC) and the Cohen’s Kappa statistic were analyzed to evaluate the consistency of the assessments using the OHAT by the dentist and the care managers. Compared with the dentist’s results, the accuracy, sensitivity, and specificity of the assessments were measured.
The consistency results of the assessments using the OHAT by the dentist and the care managers are as follows. The ICC for CM-NB is 0.495 (p < 0.001) and the result for CM-SB is 0.429 (p < 0.001). The Kappa statistics of the assessment categories for CM-NB are -0.019 for lips, 0.182 for tongue, 0.028 for gums and tissues, 0.286 for saliva, 0.338 for natural teeth, 1 for dentures, 0.188 for oral cleanliness, and 0.677 for dental pain; the results for CM-SB are 0.150 for lips, 0.006 for tongue, 0.179 for gums and tissues, -0.053 for saliva, 0.206 for natural teeth, 1 for dentures, 0.072 for oral cleanliness, and 0.511 for dental pain.
The accuracy rates of referral to dentist according to the unguided judgment for CM-NB and CM-SB are 56% and 78%, respectively. If the criterion for referral is specified based on the scores of the categories in the OHAT (the score of any category in the OHAT is 2 (unhealthy) or the score of natural teeth, dentures, or dental pain is 1 (changes)), the accuracy for CM-NB is greatly improved to 72%, while it slightly decreases to 70% for CM-SB. In terms of sensitivity, if the OHAT referral criterion mentioned above is followed, it increases from 69% to 81% for CM-NB, and it greatly increases from 65% to 88% for CM-SB. It is observed that the sensitivity is significantly improved.
Overall, this study finds that it is feasible for care managers to perform the assessments using the OHAT. In addition, the assessment using the OHAT by the care manager takes only 2 minutes on average. This mechanism provides a wider oral examination range, less time in assessment, and fair consistency. Especially, with a specified referral criterion, good sensitivity is achieved for referral by care managers, which can be applied to the assessments for LTC recipients to improve the referral and usage of dental services for the disabled. Therefore, with enhanced assessment consistency and accuracy brought by further OHAT training for care managers, it is suggested that the OHAT can be included in the oral health assessments for LTC recipients and care managers can give needed referrals for future health policy. With the implementation of the mechanism, proper dental services are expected to be more accessible and utilized by LTC recipients to improve their health and overall well-being.

目錄
中文摘要 i
英文摘要 iii
目錄 v
圖目錄 vii
表目錄 viii
第一章 緣起 1
第一節 研究背景 1
第二節 研究目的 3
第三節 研究問題 3
第四節 研究之重要性 3
第五節 重要名詞定義 4
第二章 文獻探討 5
第一節 長照個案之需求與醫師在長照制度之任務 5
第二節 口腔健康狀況之探討 8
第三節 長照機構住民口腔健康相關研究 14
第四節 口腔健康評估量表(Oral Health Assessment Tool) 15
第三章 研究方法 23
第一節 研究設計 23
第二節 研究架構 23
第三節 研究假說 23
第四節 研究對象 24
第五節 研究變項與測量 24
第六節 資料處理與分析方法 27
第四章 研究結果 29
第一節 照顧管理專員與住民之基本資料分析 29
第二節 口腔健康評估量表評估結果 32
第三節 不同組別人員評估結果 34
第四節 不同背景照顧管理專員之轉介牙醫師評估結果 36
第五節 不同障礙類別與生活自理能力的住民之評估結果 38
第五章 討論 40
第一節 研究方法之探討 40
第二節 口腔健康評估量表評估結果分析 42
第三節 不同組別人員評估結果分析 44
第四節 不同背景照顧管理專員之轉介牙醫師評估結果分析 46
第五節 不同障礙類別的住民之評估結果分析 46
第六節 研究限制 47
第六章 結論與建議 48
參考文獻 50

內政部戶政司(2022)。全國人口資料庫統計地圖。
https://gis.ris.gov.tw
林亭枝、謝天渝、吳逸民(2005)。口腔健康狀況與全身系統疾病相關性之探討。東港安泰醫護雜誌，11(2)，69–77。
https://doi.org/10.7078/TSMHMNJ.200506.0069
邱弘毅、王英偉、熊昭(2021)。2017年國民健康訪問調查結果報告。國家衛生研究院。
邱善筠、張家豪、傅進華、陳美燕(2020)。腦中風病人之口腔健康狀態與口腔衛生行為及其影響因素。護理雜誌，67(5)，44–55。
https://doi.org/10.6224/JN.202010_67(5).07
邱逸榛、蔡宜燕、李佳琳、劉彥君(2017)。臺灣南部護理之家失智症住民口腔健康與問題行為之相關探討。長期照護雜誌，21(3)，303–317。
https://doi.org/10.6317/LTC.21.303
翁瑞萱、徐愫萱、璩大成、謝明軒、吳淑雯、黃肇明、周姚均(2019)。建構社區整合照顧模式之醫養結合。北市醫學雜誌，16，60–67。
https://doi.org/10.6200/TCMJ.201910/SP_16.0006
黃茂栓(2016)。104–105年度成年與老年人口腔健康調查計畫全程計畫執行總報告。衛生福利部委託科技研究計畫。
黃蕙文、魏芳君、黃三珊、黃淑吟(2019)。提升精神科日間照護中心個案口腔健康維護能力之改善方案。精神衛生護理雜誌，14(1)，44–53。
https://doi.org/10.6847/TJPMHN.201906_14(1).05
葉俊吟、王芊仅、胡芳文(2014)。住院高齡者口腔健康與營養狀態之探討。台灣老年醫學暨老年學雜誌，9(3)，68–83。
https://doi.org/10.29461/TGG.201408_9(3).0002
蔡宗益、李荔芳、林庭光、蕭伊祐(2019)。簡述臺灣長期照護現況與挑戰。台灣老年醫學暨老年學雜誌，14(1)，44–50。
https://doi.org/10.29461/TGGa.201902_14(1).0004
蔡宜燕、劉彥君、李佳琳、楊月穎、邱逸榛(2015)。口腔健康評估量表-非牙醫專業人員中文版發展與信效度檢定。長庚護理，26(4)，400–409。
https://doi.org/10.3966/102673012015122604003
衛生福利部(2021)。110年居家失能個案家庭醫師照護方案。
衛生福利部中央健康保險署(2021)。109年國人全民健康保險就醫疾病資訊。
衛生福利部國民健康署(2014)。民國九十六年台灣地區中老年身心社會生活狀況長期追蹤(第六次)調查成果報告。
衛生福利部國民健康署(2018)。民國一百零四年中老年身心社會生活狀況長期追蹤調查成果報告。
衛生福利部國民健康署(2022)。民國一百零八年中老年身心社會生活狀況長期追蹤調查成果報告。
衛生福利部統計處(2021)。109年度全民健康保險醫療統計年報。
衛生福利部綜合規劃司(2022)。衛生福利部110年度施政績效報告。
黎家銘、詹鼎正、李紹誠、梁忠詔、邱泰源(2018)。基層醫師在長照2.0的角色和功能。台灣醫學，22(3)，261–271。
https://doi.org/10.6320/FJM.201805_22(3).0005
Allen, E. M., Matthews, J. B., O'Halloran, D. J., Griffiths, H. R., & Chapple, I. L. (2011). Oxidative and inflammatory status in Type 2 diabetes patients with periodontitis. Journal of Clinical Periodontology, 38(10), 894–901.
https://doi.org/10.1111/j.1600-051X.2011.01764.x
Alman, A. C., Johnson, L. R., Calverley, D. C., Grunwald, G. K., Lezotte, D. C., Harwood, J. E., & Hokanson, J. E. (2011). Loss of alveolar bone due to periodontal disease exhibits a threshold on the association with coronary heart disease. Journal of Periodontology, 82(9), 1304–1313.
https://doi.org/10.1902/jop.2011.100647
Ansai, T., Takata, Y., Soh, I., Awano, S., Yoshida, A., Sonoki, K., Hamasaki, T., Torisu, T., Sogame, A., Shimada, N., & Takehara, T. (2010). Relationship between tooth loss and mortality in 80-year-old Japanese community-dwelling subjects. BMC Public Health, 10, 386.
https://doi.org/10.1186/1471-2458-10-386
Awano, S., Ansai, T., Takata, Y., Soh, I., Akifusa, S., Hamasaki, T., Yoshida, A., Sonoki, K., Fujisawa, K., & Takehara, T. (2008). Oral health and mortality risk from pneumonia in the elderly. Journal of Dental Research, 87(4), 334–339.
https://doi.org/10.1177/154405910808700418
Bots‐VantSpijker, P. C., Bruers, J. J., Bots, C. P., Vanobbergen, J. N., De Visschere, L. M., de Baat, C., & Schols, J. M. (2016). Opinions of dentists on the barriers in providing oral health care to community‐dwelling frail older people: A questionnaire survey. Gerodontology, 33(2), 268–274.
https://doi.org/10.1111/ger.12155
Cerveira, F. R., Matos, M., & Sa‐Couto, P. (2022). Development of the European Portuguese version of the oral health assessment tool: Content validity and reliability study in an elderly population. Special Care in Dentistry. Advance online publication.
https://doi.org/10.1111/scd.12724
Chalmers, J. M., King, P. L., Spencer, A. J., Wright, F. A., & Carter, K. D. (2005). The oral health assessment tool—validity and reliability. Australian Dental Journal, 50(3), 191–199.
https://doi.org/10.1111/j.1834-7819.2005.tb00360.x
Charadram, N., Maniewicz, S., Maggi, S., Petrovic, M., Kossioni, A., Srinivasan, M., Schimmel, M., Mojon, P., Müller, F., & e-Delphi working group (2021). Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care‐dependent older people: An e‐Delphi study. Gerodontology, 38(1), 41–56.
https://doi.org/10.1111/ger.12501
Coleman, P., & Watson, N. M. (2006). Oral care provided by certified nursing assistants in nursing homes. Journal of the American Geriatric Society, 54(1), 138–143.
https://doi.org/10.1111/j.1532-5415.2005.00565.x
Cunha, B. A. (2001). Pneumonia in the elderly. Clinical Microbiology and Infection, 7(11), 581–588.
https://doi.org/10.1046/j.1198-743x.2001.00328.x
Czwikla, J., Herzberg, A., Kapp, S., Kloep, S., Schmidt, A., Rothgang, H., Schwendicke, F., & Hoffmann, F. (2021). Home care recipients have poorer oral health than nursing home residents: Results from two German studies. Journal of Dentistry, 107, 103607.
https://doi.org/10.1016/j.jdent.2021.103607
Danielsen, R., Dillenberg, J., & Bay, C. (2006). Oral health competencies for physician assistants and nurse practitioners. Journal of Physician Assistant Education, 17(4), 12–16.
https://doi.org/10.1097/01367895-200617040-00002
Ervin, R. B., & Dye, B. A. (2009). The effect of functional dentition on Healthy Eating Index scores and nutrient intakes in a nationally representative sample of older adults. Journal of Public Health Dentistry, 69(4), 207–216.
https://doi.org/10.1111/j.1752-7325.2009.00124.x
Everaars, B., Weening-Verbree, L. F., Jerković-Ćosić, K., Schoonmade, L., Bleijenberg, N., de Wit, N. J., & van der Heijden, G. (2020). Measurement properties of oral health assessments for non-dental healthcare professionals in older people: A systematic review. BMC Geriatrics, 20(1), 4.
https://doi.org/10.1186/s12877-019-1349-y
Finotto, S., Bertolini, G., Camellini, R., Fantelli, R., Formisano, D., Macchioni, M. G., & Mecugni, D. (2020). Linguistic-cultural validation of the oral health assessment tool (OHAT) for the Italian context. BMC Nursing, 19, 7.
https://doi.org/10.1186/s12912-020-0399-y
Hirotomi, T., Yoshihara, A., Ogawa, H., & Miyazaki, H. (2015). Number of teeth and 5‐year mortality in an elderly population. Community Dentistry and Oral Epidemiology, 43(3), 226–231.
https://doi.org/10.1111/cdoe.12146
Ho, B. V., van de Rijt, L., Weijenberg, R., van der Maarel‐Wierink, C. D., & Lobbezoo, F. (2022). Oral Health Assessment Tool (OHAT) deputized to informal caregivers: Go or no go? Clinical and Experimental Dental Research, 8(1), 76–83.
https://doi.org/10.1002/cre2.481
Janket, S. J., Qvarnström, M., Meurman, J. H., Baird, A. E., Nuutinen, P., & Jones, J. A. (2004). Asymptotic dental score and prevalent coronary heart disease. Circulation, 109(9), 1095–1100.
https://doi.org/10.1161/01.CIR.0000118497.44961.1E
Kapila, Y. L. (2021). Oral health’s inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. Periodontology 2000, 87(1), 11–16.
https://doi.org/10.1111/prd.12398
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.
https://doi.org/10.1093/geront/35.6.814
Kikutani, T., Yoshida, M., Enoki, H., Yamashita, Y., Akifusa, S., Shimazaki, Y., Hirano H., & Tamura, F. (2013). Relationship between nutrition status and dental occlusion in community‐dwelling frail elderly people. Geriatrics & Gerontology International, 13(1), 50–54.
https://doi.org/10.1111/j.1447-0594.2012.00855.x
Klotz, A. L., Zajac, M., Ehret, J., Hassel, A. J., Rammelsberg, P., & Zenthöfer, A. (2020). Development of a German version of the oral health assessment tool. Aging Clinical and Experimental Research, 32(1), 165–172.
https://doi.org/10.1007/s40520-019-01158-x
Kwon, S. R., Lee, S., Oyoyo, U., Wiafe, S., De Guia, S., Pedersen, C., Martinez, K., Rivas, J., Chavez, D., & Rogers, T. (2021). Oral health knowledge and oral health related quality of life of older adults. Clinical and Experimental Dental Research, 7(2), 211–218.
https://doi.org/10.1002/cre2.350
Manchery, N., Henry, J. D., Lam, B., Kochan, N. A., Deutsch, A., Brodaty, H., Sachdev, P. S., & Nangle, M. R. (2022). Memory decline in older individuals predicts an objective indicator of oral health: Findings from the Sydney Memory and Ageing Study. BMC Oral Health, 22(1), 93.
https://doi.org/10.1186/s12903-022-02128-y
Marshall, T. A., Warren, J. J., Hand, J. S., Xie, X. J., & Stumbo, P. J. (2002). Oral health, nutrient intake and dietary quality in the very old. Journal of the American Dental Association, 133(10), 1369–1379.
https://doi.org/10.14219/jada.archive.2002.0052
Matsuo, K., & Nakagawa, K. (2016). Reliability and validity of the Japanese version of the oral health assessment tool (OHAT-J). Journal of the Japanese Society for Disability and Oral Health, 37(1), 1–7.
https://doi.org/10.14958/jjsdh.37.1
de Mello, A. L., Zimermann, K., & Gonçalves, L. H. (2012). Avaliação da saúde bucal de idosos por enfermeiros: Validade e confiabilidade do instrumento ASBTO [Nurse's assessment of oral health of elderly people: OHAT validity and reliability]. Revista Gaúcha de Enfermagem, 33(2), 36–44.
https://doi.org/10.1590/s1983-14472012000200007
Minakuchi, S., Tsuga, K., Ikebe, K., Ueda, T., Tamura, F., Nagao, K., Furuya, J., Matsuo, K., Yamamoto, K., Kanazawa, M., Watanabe, Y., Hirano, H., Kikutani, T., & Sakurai, K. (2018). Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology, 35(4), 317–324.
https://doi.org/10.1111/ger.12347
Parmar Dental. (2019). Obstacles and Solutions in Delivering Dental Care to LTC Patients.
https://www.oralhealthgroup.com/blogs/obstacles-and-solutions-in-delivering-dental-care-to-ltc-patients/#
Quagliarello, V., Juthani‐Mehta, M., Ginter, S., Towle, V., Allore, H., & Tinetti, M. (2009). Pilot testing of intervention protocols to prevent pneumonia in nursing home residents. Journal of the American Geriatrics Society, 57(7), 1226–1231.
https://doi.org/10.1111/j.1532-5415.2009.02311.x
Rapp, L., Sourdet, S., & Lacoste-Ferré, M. H. (2021). Oral health and undernutrition in the frail elderly persons. The Journal of Nutrition, Health & Aging, 25(4), 484–491.
https://doi.org/10.1007/s12603-020-1546-6
Registered Nurses’ Association of Ontario. (2008). Oral Health: Nursing Assessment and Interventions. Registered Nurses’Association of Ontario (RNAO).
Rouxel, P., Heilmann, A., Demakakos, P., Aida, J., Tsakos, G., & Watt, R. G. (2017). Oral health-related quality of life and loneliness among older adults. European Journal of Ageing, 14(2), 101–109.
https://doi.org/10.1007/s10433-016-0392-1
Şahin, N. E., & Jablonski, R. A. (2019). Psychometric properties of the oral health assessment tool Turkish Version. Cukurova Medical Journal, 44(Suppl 1), 513–520.
https://doi.org/10.17826/cumj.567995
Saremi, A., Nelson, R. G., Tulloch-Reid, M., Hanson, R. L., Sievers, M. L., Taylor, G. W., Shlossman, M., Bennett, P. H., Genco, R., & Knowler, W. C. (2005). Periodontal disease and mortality in type 2 diabetes. Diabetes Care, 28(1), 27–32.
https://doi.org/10.2337/diacare.28.1.27
Shimazaki, Y., Nonoyama, T., Tsushita, K., Arai, H., Matsushita, K., & Uchibori, N. (2020). Oral hypofunction and its association with frailty in community‐dwelling older people. Geriatrics & Gerontology International, 20(10), 917–926.
https://doi.org/10.1111/ggi.14015
Simpelaere, I. S., Van Nuffelen, G., Vanderwegen, J., Wouters, K., & De Bodt, M. (2016). Oral health screening: Feasibility and reliability of the oral health assessment tool as used by speech pathologists. International Dental Journal, 66(3), 178–189.
https://doi.org/10.1111/idj.12220
Sumi, Y., Miura, H., Nagaya, M., Michiwaki, Y., & Uematsu, H. (2006). Colonisation on the tongue surface by respiratory pathogens in residents of a nursing home—a pilot study. Gerodontology, 23(1), 55–59.
https://doi.org/10.1111/j.1741-2358.2006.00093.x
Tang, S., Finlayson, G., Dahl, P., Bertone, M. F., Schroth, R. J., & Manitoba Dental Association. (2019). Dentists’ views on providing care for residents of long-term care facilities. Journal of the Canadian Dental Association, 85, j8.
Thapa, R., Chimoriya, R., & Arora, A. (2021). The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: A systematic review. BMC Geriatrics, 21(1), 35.
https://doi.org/10.1186/s12877-020-01989-8
Tsukada, S., Ito, K., Stegaroiu, R., Shibata, S., & Ohuchi, A. (2017). An oral health and function screening tool for nursing personnel of long‐term care facilities to identify the need for dentist referral without preliminary training. Gerodontology, 34(2), 232–239.
https://doi.org/10.1111/ger.12255
U.S. Department of Health and Human Services. (2000). Oral Health in America: A Report of the Surgeon General. U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.
Vargas, C. M., Kramarow, E. A., & Yellowitz, J. A. (2001). The oral health of older Americans. Aging Trends, 3, 1–8.
Willumsen, T., Karlsen, L., Næss, R., & Bjørntvedt, S. (2012). Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Gerodontology, 29(2), e748–e755.
https://doi.org/10.1111/j.1741-2358.2011.00554.x
Yellowitz, J. A., & Schneiderman, M. T. (2014). Elder's oral health crisis. Journal of Evidence Based Dental Practice, 14 Suppl, 191–200.
https://doi.org/10.1016/j.jebdp.2014.04.011
Yoshida, M., Hiraoka, A., Takeda, C., Mori, T., Maruyama, M., Yoshikawa, M., & Tsuga, K. (2022). Oral hypofunction and its relation to frailty and sarcopenia in community‐dwelling older people. Gerodontology, 39(1), 26–32.
https://doi.org/10.1111/ger.12603