title: Need for dental care in older veterans: assessment of patient-based measures.
abstract: OBJECTIVE
  There is a need for brief and accurate identification of older patients in need of dental care. This study examines the sensitivity and specificity of two screening instruments.
  
  
  METHODS
  Cross-sectional study conducted in older community-dwelling male veterans.
  
  
  METHODS
  Four Department of Veterans Affairs (VA) clinics in greater Boston and the VA Dental Longitudinal Study (DLS).
  
  
  METHODS
  Two hundred thirty-two participants from the Veterans Health Study (VHS) who were outpatients in one of four Department of Veterans Affairs clinics in greater Boston and 206 participants from the VA DLS, community-dwelling veterans who do not use VA for their health care.
  
  
  METHODS
  Self-report measures included a single-item global self-report of oral health (OH-1) and a six-item dental screening measure called the D-E-N-T-A-L. The D-E-N-T-A-L queries whether participants have Dry mouth, Eating or swallowing problems, Not had a dental examination in the last 2 years, Tooth or mouth problems, Altered eating habits because of teeth or mouth, or Lesions or sores in the mouth. The criterion standard for need for treatment was determined by a clinical examination. Sensitivities and specificities were calculated and receiver operating characteristic curves plotted to identify the best cutpoints for each measure.
  
  
  RESULTS
  Need for care was nearly universal (97%) in the VHS and present in 64% of the DLS participants. The single-item self-report of oral health performed as well as the D-E-N-T-A-L in identifying persons in need of care. Compared with the clinical criterion, the OH-1 had a sensitivity of 0.75 and a specificity of 0.67 in identifying persons with severe need for denture care, whereas the D-E-N-T-A-L had a sensitivity of 0.80 and a specificity of 0.62 in identifying persons with severe periodontal need.
  
  
  CONCLUSIONS
  Self-reports of fair or poor oral health are useful in identifying veterans in need of dental care, especially in populations with a large number of persons who do not usually use dental care. The D-E-N-T-A-L may also be useful as a self-screening measure and community education device to encourage older persons to seek regular dental care.
authors.affiliation: VA Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts 01730, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Jones
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Raul I
authors.initials: RI
authors.lastname: Garcia
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D000368:Aged; D001900:Boston; D003430:Cross-Sectional Studies; D003729:Dental Care; D006787:Hospitals, Veterans; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009909:Oral Health; D012372:ROC Curve; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014076:Tooth Diseases / Q000175:diagnosis*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data