INSIGHTS

The Oral Health Assessment Tool (OHAT): a plain-English guide for aged care facilities

The oral health assessment tool (OHAT) is a structured visual inspection designed to be used by non-dental health professionals (typically a registered nurse) to identify oral health problems in older people and determine whether a referral to a dentist is needed. If you work in residential aged care and want to understand what OHAT is, how it is structured, and how results are supposed to connect to care plans and dental referrals, this article covers the basics.

What the oral health assessment tool is

OHAT was developed in Australia as a modified version of the Kayser-Jones Brief Oral Health Status Examination (BOHSE). SA Dental Service (part of SA Health) produces and maintains the tool and its supporting guidance; their page on oral health care assessment and planning is the canonical source.

SA Dental describes its purpose clearly: "Oral health assessment is the first step in helping to maintain oral health. This does not take the place of a comprehensive dental examination but is used to identify whether a person has oral health problems and is in need of a dental referral." That framing (screening for problems and triggering appropriate referral, not replacing dentistry) defines what OHAT is for.

The assessment itself is a visual inspection. It does not require specialist equipment. SA Dental's guidance states that "it is recommended that an appropriate health professional such as a registered nurse or doctor perform an Oral Health Assessment using the Oral Health Assessment Tool (OHAT) on admission and repeat as required". SA Dental's guidance also notes it "can be easily done at the same time as other general health assessments, on a regular basis or when clinically indicated." This is designed to fit alongside existing assessment workflows, not to be a standalone burden.

For the OHAT form itself, SA Dental makes it available at their residential care toolkit. The form is © SA Dental Service; this article describes what it covers but does not reproduce it.

The eight categories OHAT covers

SA Dental's guidance states that "the oral health assessment tool (OHAT) consists of a visual inspection using eight categories of oral health: lips, tongue, gums and oral tissue, saliva, natural teeth, dentures, oral cleanliness, dental pain." Here is a brief description of what each category is looking at:

• Lips. The condition of the lip tissue: dryness, cracking, sores or swelling that may indicate infection or systemic changes.
• Tongue. The texture and appearance of the tongue surface: coating, smoothness, ulcers or patches that may need attention.
• Gums and oral tissue. The condition of gum tissue and the lining of the mouth: redness, swelling, bleeding or lesions that could indicate gum disease or other pathology.
• Saliva. Whether saliva flow appears adequate: dry mouth (xerostomia) is common in older people, often as a side effect of medication, and affects both comfort and oral health.
• Natural teeth. The condition of any remaining natural teeth: decay, fractures, or loose teeth that may cause pain or affect eating.
• Dentures. The fit and condition of full or partial dentures: cracks, missing teeth, or poor fit that can cause sores or difficulty eating.
• Oral cleanliness. The overall cleanliness of the mouth: the presence of food debris, plaque or deposits on teeth or dentures.
• Dental pain. Behavioural or verbal signs that the person may be experiencing oral pain, particularly relevant for residents with cognitive impairment who may not be able to report pain directly.

Each category is rated across three levels: healthy, changes, or unhealthy. SA Dental describes the logic: "The eight oral health categories are assessed as healthy, changes or unhealthy. A healthy or changes assessment can be managed by oral health care planning, using the oral health care planning guidelines." Only an "unhealthy" rating across any category triggers the recommendation to refer to a dental professional.

How OHAT fits into entry and ongoing assessment

SA Dental's guidance states that management should be based on a Model of Oral Health Care which integrates four key oral health processes into general care: oral health assessment, oral health care planning, assistance with daily oral hygiene, and referral for dental treatment. The OHAT is the starting point (assessment), and the rest of the model flows from it.

In practice, an admission oral health assessment using OHAT gives the facility a baseline. It tells you what the resident's oral condition is when they arrive, flags anything that needs immediate referral, and informs the oral health care plan that should be part of their broader care planning. Ongoing reassessment (at care plan review intervals or whenever there is a change in the resident’s condition) keeps that picture current.

Australian aged care providers are now operating under the strengthened Quality Standard 5 (Clinical Care). The ACQSC's guidance for Standard 5 is explicit: "The provider conducts a comprehensive clinical assessment on commencement of clinical care services, at regular intervals and when needs change." It also requires that providers "implement processes to monitor clinical conditions and reassess when there is a change in… oral health." For more on the regulatory context, see our article on what the strengthened Quality Standards expect for oral and dental care.

From OHAT results to care plans and referrals

The three-level rating structure (healthy, changes, unhealthy) maps directly to an action pathway. SA Dental's guidance puts it plainly: "A 'healthy' or 'changes' assessment can be managed using the Oral Health Care Planning Guidelines. An 'unhealthy' assessment indicates a referral to a dental professional is recommended."

That means the OHAT result works as a decision trigger, not just a score to file. A "healthy" result feeds into a routine oral care plan and a schedule for reassessment. A "changes" result points to specific areas of the care plan to address, for example, more frequent mouth care, a different denture-cleaning routine, or increased saliva management. An "unhealthy" result in any category should generate a referral to a dentist.

SA Dental's guidance notes that "as most referrals are likely to be of a non-urgent nature, this information should be included in discharge planning advice and correspondence." For residents who are transitioning out of hospital care into residential aged care, that referral information should travel with them. For long-stay residents, the referral should be tracked: a recommendation that disappears without an outcome is not a completed referral.

Strengthened Quality Standard 5 aligns with this directly. ACQSC requires that providers refer and facilitate access to relevant health professionals and medical, rehabilitation, allied health, oral health, specialist nursing and behavioural advisory services to address the individual's clinical needs. Facilitating access means following through, not just recommending.

AIHW research into OHAT use in Australian residential care facilities found that "in the Australian residential aged care community, it is the carers who play an essential role in the delivery of oral hygiene care and the maintenance of residents' oral health." That reinforces the point: OHAT is used by nurses and completed through a visual inspection, but the daily care it informs is delivered by carers. Both ends of the chain need to be functioning (structured assessment at one end, consistent daily care at the other) for oral health outcomes to improve.

Where Smile Advisor fits

Smile Advisor is designed to complement the work a facility does between formal OHAT assessments. A carer takes a few guided photos on a smartphone; a registered dental clinician reviews them and returns a clear screening report. When a dental visit is recommended, it is captured as a tracked referral with urgency attached, so access to a dentist can be evidenced. Daily oral care can be recorded as it happens. This is screening, not diagnosis. Smile Advisor does not replace OHAT, a dental examination, or the clinical judgement of the registered nurse or dentist. See how it works for detail, or talk to us about your facility.

Published 6 August 2026.