The Oral Status Survey Tool: construction, validity, reliability and feasibility among people with mild and moderate intellectual disabilities.
A seven-item checklist lets BCBAs or support staff reliably flag oral-health problems in adults with mild-moderate ID without a dentist present.
01Research in Context
What this study did
Researchers built a seven-item checklist that lets non-dentists spot oral trouble in adults with mild or moderate intellectual disability. They tested the adults in Ireland. Two nurses and two dentists each did the survey, plus a full dental exam, to see if the quick tool matched the gold standard.
What they found
The Oral Status Survey Tool (OSST) matched the dentist exam almost perfectly. It took seven minutes, needed no special chair, and staff said it was easy. Reliability was good to very good across all items.
How this fits with other research
Gutierrez et al. (1998) found the Motivation Assessment Scale had weak reliability, so clinicians stopped trusting it alone. The OSST now gives the ID field a screening tool that actually holds up psychometrically.
Sasson et al. (2022) showed simple mobility tests beat complex ones for adults with Down syndrome because extra steps overload cognition. The OSST follows the same keep-it-simple rule: seven yes-no questions, no jargon.
Lin et al. (2012) set clear change thresholds for the Pediatric Motor Activity Log so therapists knew when progress was real. The OSST team likewise give BCBAs a cut-off score that signals when to refer to a dentist.
Why it matters
Tooth pain can trigger problem behavior, but dental visits are tough to arrange. With the OSST you can screen for cavities, bleeding gums or broken teeth during a regular day program session. If the score hits the cut-off, hand the form to the dentist and skip the guesswork. One seven-minute check can cut emergency visits and keep clients comfortable, compliant and ready to learn.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Print the OSST, pick two clients you suspect may have mouth pain, complete the seven questions, and email the form to their dentist if the score hits the referral cut-off.
02At a glance
03Original abstract
BACKGROUND: A lack of robust data about the oral health of people with intellectual disabilities (IDs) contributes to health disparities. Appropriate research tools are therefore needed. This study reports the construction and evaluation of the Oral Status Survey Tool (OSST), designed to be administered with people with disabilities by non-dental personnel. METHOD: Oral Status Survey Tool construction and evaluation was achieved adopting a non-clinical construction and content validation phase and a clinical phase to test concurrent validity, reliability and feasibility. Final refinements were also made. RESULTS: The OSST conceptual framework covered oral function (tooth count, denture wear and opposing pairs of teeth) and oral disease/treatment need (soft tissue status, oral cleanliness, gum condition, carious teeth and oral pain). A systematic literature review identified no existing suitable indices. Candidate items were identified and validated by experts generating content validation ratios. This framework was modified later to expand the function construct. In the initial clinical phase, 49 out of 60 participants underwent examination with OSST and standard dental assessments. All had mild to moderate IDs. Mean age was 43 years (SD = 16), and mean number of teeth was 22.1 (SD = 8.6). Data collectors included two dentists and three non-dentists. Later, a further 17 adults (nine female and eight male) with mild/moderate IDs were included for refinement. At this stage, data collectors included two dentists and five non-dentists. Concurrent validity was established for tooth count [intraclass correlation coefficient = 0.99 (95% confidence interval, CI: 0.99-0.99)], carious teeth [Gwet's AC2 = 0.94 (95% CI: 0.89-0.99)] and gum condition [Gwet's AC1 = 0.84 (95% CI: 0.64-1)]. For all final OSST items, inter-rater reliability ranged from moderate to very good; median test-retest reliability ranged from moderate to good. Acceptability was demonstrated for data collectors and participants. Mean time to complete the OSST was 7 min. CONCLUSIONS: The OSST is a novel tool that can record a range of clinical oral features including tooth count, denture wear, occluding pairs of teeth and functional dentition, oral cleanliness, gum condition, carious cavitation and oral pain that will be useful within health surveys of people with mild-moderate IDs and similarly neglected populations. The tool demonstrates promising attributes and acceptability. From this study, the OSST appears to be a robust tool that can be incorporated into general data collection for people with mild-moderate IDs and similar populations. A key feature is that it can be administered by well-trained non-dentists.
Journal of intellectual disability research : JIDR, 2021 · doi:10.1111/jir.12820