Oral health is an integral part of overall health and is a marker of health status. It influences several functions central to overall health and quality of life. Poor oral health and untreated oral diseases and conditions can affect the most basic human needs, including the ability to eat and drink, swallow, maintain proper nutrition, smile, and communicate. Poor oral health and hygiene can even expedite serious health conditions such as pneumonia [1, 2], heart diseases, [3] eating disorders, and inadequate nutrition, [4] etc.
Oral health is defined by the World Health Organisation as ‘Being free of chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal disease, tooth decay and tooth loss, and other diseases and disorders that affect the mouth and oral cavity.’ [5] The FDI World Dental Federation defines oral health as the ability to speak, smile, smell, taste, touch, chew, swallow, and confidently convey emotion without pain, discomfort, or disease. [6]
The structures in the oral cavity including teeth, gums, tongue, palate, buccal cavity are vital for speech and swallowing and speech-language pathologists (SLPs) provide services (prevent, assess, diagnose, and treat) to individuals with an array of speech and swallowing disorders across the lifespan. The assessment and management of the body functions and structures used to communicate and swallow are included in the scope of practice of an SLP. [7] As a part of the assessment, the SLPs identify abnormalities in the structure or function of a patient’s oral cavity. Therefore, SLPs are in a unique position to identify the need for oral health care and to provide basic management when appropriate. Part of this scope of practice includes the evaluation and management of oral health to varying degrees. SLPs are included in the professionals who routinely assess oral hygiene and health. [8] Integrating basic oral health care into speech-language pathology practice has the potential to improve oral health equity for several priority populations. [9]
Though Dentists are trained professionals to evaluate the dental and oral health status, when assessing an individual with a communication deficit, they often find it difficult to do the routine oral evaluation. This highlights the importance of add on oral health and hygiene evaluation in the scope of practice of an SLP. The SLPs have extensive knowledge of the normal structures and functions of oral and pharyngeal structures that would facilitate appropriate assessment of oral health. Oral health assessment can help identify any oral health concerns and the management plan may include providing oral health education or referral to an oral health professional. [10]
The assessment of oral health is particularly critical in patients with dysphagia. Patients with oropharyngeal dysphagia who are nil by mouth or on limited oral intake often show poor oral hygiene. [11] The oral cavity serves as a host for multiple microorganisms, including the ones that may be responsible for pneumonia. The thick saliva, in those with xerostomia, serves as a medium for microorganisms to multiply. While performing the swallowing assessment with different boluses, particularly in individuals with pharyngeal dysphagia, these microorganisms can enter the lungs, and if aspirated it can lead to pneumonia.
Oral health is found to be poor in the geriatric population due to several underlying health issues. The prevalence of stroke and other neurological disorders are high in elderly adults. [12] The improvement in oral hygiene can help in the reduction in aspiration pneumonia in individuals with stroke history (Sørensen et al., 2013). Individuals with dementia and cognitive problems also show poor oral health that includes gum problems, unhealthy teeth, a high amount of oral plaques, reduced secretion of saliva, and infections (Delwel et al., 2018).
Individuals of all age groups with a developmental disability also have a high risk of having poor oral health (Scott et al., 1998). Poor oral health and hygiene are common in autism spectrum disorder (Murshid, 2014), intellectual disability (Maltais et al., 2020; Salles et al., 2012), and neurological disabilities including cerebral palsy (Serras&Clav, 2021). Some children with these disorders can have sensory issues and abnormal reflexes which serve as a barrier for adequate oral care. Children with disability need extensive dental care. [13]
There are different tools to assess the oral health such as Oral Health Assessment Guide (OHAG), [14] Subjective Oral Health Status Indicators, [15] Oral health quality of life (OHQoL), [16] Oral health impact profile (OHIP), [17] Oral Health Quality of Life Inventory (OH-QoL), [18] Brief Oral Health Status Examination, [19] The Holistic and Reliable Oral Assessment Tool (THROAT), [20] Revised Oral Assessment Guide (ROHAG), [21] Oral Health Assessment Tool (OHAT), [22] etc. Some of these have been developed for use by non-dental professionals such as nurses, personal care attendants and allied health or medical professionals. [22]
Simpelaere et al. (2016) investigated the feasibility and reliability of the OHAT [22] as used by speech pathologists, to become part of a comprehensive clinical swallowing examination. The findings of this study showed that the OHAT was a feasible and reliable oral health assessment tool that can be used in clinical practice by SLPs to screen oral health in a standardised manner in elderly individuals with dysphagia. [23]
Despite the availability of several tools to assess oral health and despite the fact that oral health assessment and management is a part of scope of practice of SLPs, it is not known whether SLPs, particularly in India are evaluating oral health as a part of routine oral peripheral mechanism examination in all persons with speech and swallowing disorders. To date, there are no studies that have investigated the awareness of SLPs in India about oral health, and integration of oral assessment and management in their clinical practice. Understanding this will help in improving services and practices to persons with speech and swallowing disorders. Keeping this in view, the present study was conceived. The study aims to determine the level of awareness and knowledge of oral health and hygiene amongst the SLPs practicing in India. The study also aims to investigate the practice patterns pertaining to oral health assessment and management among these SLPs.