Abstract
Background
Frail, community-dwelling older people increasingly experience oral health issues, yet often lack access to dental care. General practitioners (GPs) and nurse practitioners (NPs) are well-positioned to help identify oral health deterioration, but existing tools are impractical for use in primary care. The SHORT screening tool was developed to address this gap by combining three brief self-report questions for older people, designed to be suitable for non-oral health care professionals. This study aimed to identify the three best-performing items out of ten candidate questions, and to validate the resulting SHORT tool's diagnostic performance against clinical oral examination in older people in the Netherlands.Methods
A cross-sectional validation study was conducted in four general practices in the Netherlands. Participants aged ≥ 65 years who completed ten self-report items derived from a prior systematic literature and a Delphi consensus study, were included. A blinded oral examination, conducted by an oral health care professional, served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristic curve (AUC) were calculated for individual items and for the final SHORT tool, which included the three highest-AUC items.Results
Forty-seven patients were included, ranging in age from 65 to 93 years. Among the individual items, "dental checkup this year" (AUC = 0.80), "pain in teeth or mouth" (AUC = 0.78), and "dry mouth" (AUC = 0.68) showed the highest diagnostic accuracy and were therefore selected to construct the SHORT tool. The final tool achieved a sensitivity of 100% (95% CI: 86.7-100%) and NPV of 100% (95% CI: 80.6-100%), correctly identifying all participants needing referral. Specificity was 72.7% (95% CI: 51.8-86.8%), PPV was 80.6% (95% CI: 63.7-90.8%), and the AUC was 0.86 (95% CI: 0.76-0.95).Conclusion
The SHORT tool demonstrated high predictive value for identifying older people at risk of oral health deterioration in general practice. Its high sensitivity and feasibility for integration into primary care workflows suggest that it may support timely referral and increase oral health and oral health awareness among older people and their health care professionals. Further research should focus on implementation and broader applicability across healthcare settings.