Mouth care · Care homes · Updated October 2026
Oral health assessment tool (OHAT)
Score the 8 areas of the Oral Health Assessment Tool: lips, tongue, gums and tissues, saliva, natural teeth, dentures, oral cleanliness and dental pain. Get an instant oral health score, a referral decision and a mouth care plan you can copy into care notes.
For guidance only. This screening tool does not replace a dental examination. Nothing you enter is saved or sent anywhere.
What is an oral health assessment?
An oral health assessment is a quick, structured check of a person’s mouth, teeth, gums and dentures. In care homes and home care, it helps staff spot problems early, plan daily mouth care and know when to call a dentist.
Poor oral health can cause pain, difficulty eating, weight loss, low mood and chest infections such as aspiration pneumonia. People living with dementia may not be able to say their mouth hurts, so a regular assessment is often the only way to find a problem.
Free download
Oral health assessment tool (OHAT) PDF
A printable OHAT form to complete on paper and keep in the person’s care records.
How to use the oral health assessment tool
- 1PrepareExplain what you are doing, wash your hands, wear gloves and use a torch. Remove dentures if worn.
- 2Score all 8 areasFor each area, choose the description that best matches what you see. Tap a number at the top to jump to an area.
- 3Check warning signsTick any warning signs, such as facial swelling or an ulcer that won’t heal.
- 4Record and actCopy the summary into care notes, update the mouth care plan and refer to a dentist if needed.
OHAT scoring guide
The Oral Health Assessment Tool was developed by Chalmers and colleagues in 2005 for care staff working with older people, including people living with dementia. Each area is scored 0, 1 or 2.
| Category | 0 · Healthy | 1 · Changes | 2 · Unhealthy |
|---|---|---|---|
| Lips | Smooth, pink and moist | Dry, chapped, or red at the corners | Swelling or a lump, a white, red or ulcerated patch, or bleeding or ulcers at the corners |
| Tongue | Normal, moist and pink, with natural roughness | Patchy, cracked (fissured), red or coated | A red or white patch, ulcerated or swollen |
| Gums and tissues | Pink, moist and smooth, with no bleeding | Dry, shiny, rough, red or swollen, or one ulcer or sore spot under dentures | Swollen, bleeding, ulcers, white or red patches, or general redness under dentures |
| Saliva | Moist tissues, with watery, free-flowing saliva | Dry, sticky tissues, little saliva, or the person says their mouth feels dry | Tissues parched and red, very little or no saliva, or thick, ropey saliva |
| Natural teeth | No decayed or broken teeth or roots | 1 to 3 decayed or broken teeth or roots, or very worn teeth | 4 or more decayed or broken teeth or roots, or fewer than 4 teeth |
| Dentures | No broken areas or teeth, worn regularly and labelled with the person’s name | 1 broken area or tooth, worn only 1 to 2 hours a day, loose, or not labelled | More than 1 broken area or tooth, missing or not worn, or loose and needs adhesive |
| Oral cleanliness | Clean, with no food, tartar or plaque in the mouth or on dentures | Food, tartar or plaque in 1 or 2 areas or on a small area of dentures, or bad breath | Food, tartar or plaque in most areas or on most of the dentures, or severe bad breath |
| Dental pain | No verbal, behavioural or physical signs of dental pain | Verbal or behavioural signs, such as pulling at the face, chewing the lips, not eating or agitation | Physical signs, such as a swollen cheek or gum, broken teeth or ulcers, as well as verbal or behavioural signs |
What the oral health score means
All areas score 0
A healthy mouth. Continue daily mouth care and reassess monthly, or sooner if anything changes.
Any area scores 1
Changes to watch. Increase mouth care, follow the plan for that area and reassess within a week.
Any area scores 2
Unhealthy. Refer to a dentist and record the referral in the care plan.
The total score (0 to 16) is useful for tracking change over time, but the decision to refer is based on the highest single score, not the total.
Oral health assessment example
Arthur, 84, has dementia and lives in a care home. He has been eating less and pulling at his cheek. His carer completes an oral health assessment:
- 0Lips, tongue and saliva: healthy
- 2Gums and tissues: red and swollen with an ulcer under his lower denture
- 1Dentures: loose and not labelled
- 1Oral cleanliness: food left on the denture
- 1Dental pain: pulling at his face and not eating
Arthur scores 5 out of 16, with a 2 for gums and tissues. His carer leaves the lower denture out, labels his dentures, increases mouth care to twice a day with support, and the nurse arranges a dental visit to adjust the denture.
Daily mouth care guidelines
- Brush twice a day, last thing at night and at one other time, with a soft toothbrush and a fluoride toothpaste (1,350 to 1,500ppm).
- Spit, don’t rinse, so the fluoride keeps working.
- Clean dentures every day with a soft brush and soap or denture cleaner, and remove them at night. Store them dry or in water as advised by the dentist.
- Label dentures with the person’s name.
- Keep the mouth moist with regular drinks, and use lip balm on dry lips.
- Limit sugary food and drinks to mealtimes.
- Arrange regular dental check-ups, including for people with no natural teeth.
NICE guidance on oral health in care homes
NICE guideline NG48, Oral health for adults in care homes, recommends that care homes:
- Assess each resident’s mouth care needs when they move in, using a recognised tool.
- Record mouth care needs and the support required in the personal care plan.
- Review the assessment regularly and whenever the person’s needs change.
- Make sure staff are trained in mouth care and know how to get dental help.
- Have a policy on oral health and access to dental services.
The Care Quality Commission (CQC) may look at how you assess and support oral health when it inspects your service.
Red flags: when to get urgent dental or medical help
Get help the same day for
- Swelling of the face, jaw or neck.
- Dental pain that stops the person eating or drinking.
- Bleeding from the mouth that won’t stop.
Call 999 if swelling affects breathing or swallowing. Refer urgently to a dentist or GP for any ulcer, lump, or red or white patch that lasts more than 3 weeks, as this could be a sign of mouth cancer.
Other common oral health assessment tools
| Tool | Scoring | Best for |
|---|---|---|
| Oral Health Assessment Tool (OHAT) | 8 categories scored 0 to 2 | Designed for care staff in care homes, including for people with dementia. The most widely used tool in UK care homes. |
| Revised Oral Assessment Guide (ROAG) | 8 areas scored 1 to 3 | Covers voice, lips, mucosa, tongue, gums, teeth or dentures, saliva and swallowing. Common in hospitals and nursing care. |
| Brief Oral Health Status Examination (BOHSE) | 10 items scored 0 to 2 | Designed for people with dementia in long-term care. Takes a little longer but gives more detail. |
| Eilers Oral Assessment Guide (OAG) | 8 areas scored 1 to 3 | Developed for people having cancer treatment. Useful for spotting mouth problems caused by chemotherapy or radiotherapy. |
| Mouth Care Matters assessment | Screening questions and a care plan | An NHS England programme with a simple mouth care assessment and care plan for hospital wards and care settings. |
Mouth care for people living with dementia
- Choose a calm time and keep the same routine and staff where possible.
- Explain each step simply, and show the toothbrush before you start.
- Stand beside or behind the person, or use hand-over-hand support.
- If the person refuses, stop and try again later. Record what works.
- Watch for signs of mouth pain, such as pulling at the face, refusing food or new agitation.
About this oral health assessment tool
- Scoring is based on the Oral Health Assessment Tool (Chalmers et al., 2005), with descriptions written in plain English.
- If the person has no dentures, the dentures category is left out and the total is out of 14.
- The mouth care plan gives general advice. Always follow the person’s care plan and advice from their dentist.
- Nothing you enter is saved. Avoid entering names or other personal details.
Frequently asked questions about oral health assessment
What is an oral health assessment tool?
An oral health assessment tool is a short checklist that care staff use to look at a person’s mouth, record any problems and decide when to refer to a dentist. The most widely used in UK care homes is the Oral Health Assessment Tool (OHAT).
What does OHAT stand for?
OHAT stands for Oral Health Assessment Tool. It scores 8 categories: lips, tongue, gums and tissues, saliva, natural teeth, dentures, oral cleanliness and dental pain. Each is scored 0 (healthy), 1 (changes) or 2 (unhealthy).
How is the OHAT scored?
Each of the 8 categories is scored 0, 1 or 2, giving a total of 0 to 16. The total helps track changes over time, but any single score of 2 means the person should be referred to a dentist.
When should an oral health assessment be done in a care home?
NICE guidance (NG48) recommends assessing mouth care needs when a person moves into a care home, recording them in their care plan, and reviewing them regularly and whenever their needs change.
Who can carry out an oral health assessment?
Trained care staff, nurses and nursing associates can use the OHAT. It is a screening tool, not a dental examination, so it does not replace regular dental check-ups.
How often should dentures be cleaned?
Clean dentures at least once a day with a soft brush and soap or denture cleaner, rinse after meals, and remove them at night. Label dentures with the person’s name so they don’t get lost.
What toothpaste should older adults use?
Most adults should brush twice a day with a fluoride toothpaste containing 1,350 to 1,500ppm fluoride, spitting out rather than rinsing. A dentist may prescribe a higher-fluoride toothpaste for people at high risk of decay.
How do you give mouth care to someone with dementia?
Keep things calm and familiar, explain each step, try standing behind or beside the person, and use hand-over-hand support. If they refuse, try again later and record what works in the care plan.
Is there a free OHAT PDF?
Yes. You can download the free oral health assessment tool (OHAT) PDF to print and use on paper.
Is my information saved?
No. Your answers stay in your browser and are cleared when you leave the page. Avoid entering names or other personal details.