The American Parkinson&#39;s Disease Association funded this work.

The Institutional Review Board (IRB) of The University of Texas Health Science Center at Houston has approved all methods described here.
1. General recommendations
<ol>
	<li>If time allows, complete the questionnaires and the oral health assessment on subsequent days or with a break between them as this reduces patient fatigue and resistance.</li>
	<li>Begin with the questionnaires to create rapport and trust between the screener and patient, which eases the transition to the oral screening, when the screener will be in close proximity to the patient&#39;s face and mouth.</li>
	<li>Always allow the patient to rest between questions if they request. Elaboration on the questionnaire items is not necessary, so as needed, gently keep the conversation on topic.</li>
	<li>For research purposes, randomize the order of the questionnaires and include information regarding the last time the patient had a meal or drink (other than water) and the last time the patient performed oral hygiene (i.e., brushing teeth, using oral rinse, etc.), as needed.</li>
	<li>Use proper infection control techniques. Be mindful of the sequence of physical contact the oral screener has with the patient and surrounding objects. For example, do not use examination gloves (or bare hands) to touch the patient&#39;s mouth, pick up a pen to write the results on paper, and then return to the patient&#39;s mouth.</li>
	<li>Recruit a second observer to serve as the scribe, writing the results of the oral screening on the paper questionnaires. 
	NOTE: This allows the oral screening to proceed more quickly and also serves as an infection control, limiting the oral screener&#39;s physical contact exclusively to the patient.</li>
	<li>Include all patients over 50 years of age. 
	NOTE: As the assessment is intended for use to rate oral health for possible referral to a dentist, the method can be used on all patients, including those who have dentures, are edentulous, bed-ridden, mute, or cognitively impaired. In the latter cases, ask caregivers for responses to the self-report questions.</li>
</ol>
2. Training
<ol>
	<li>Read the original research papers for the four oral health assessment tools included here. Pay particular attention to the Introduction and Discussion sections of the papers, as they describe why and for what populations each tool was created.</li>
	<li>Watch the video associated with this publication to see the oral health screening in action.</li>
	<li>Practice screening friends and family for oral health status using Table 1, Table 2, Table 3, Table 4, and the protocol described here. Repeat until an individual&#39;s oral screening can be repeated in under 30 min.</li>
</ol>
3. General Oral Health Assessment Index (GOHAI)9
<ol>
	<li>Ask the patient to sit comfortably to answer questions. Tell the patient to consider the last 3 months when answering. If the patient is unable to answer the questions due to a disability, have a caregiver answer the questions and make a note of this.</li>
	<li>Ask questions from Table 1 one at a time. Mark the patient&#39;s answers on a paper or digital copy of this GOHAI questionnaire. At the conclusion of the 12 questions, thank the patient and ask if he/she has any comments to add.</li>
	<li>Score the GOHAI in one of two ways, either the additive or simple count methods. 
	NOTE: Additive score: For the 3 questions worded in a positive way (questions 3, 5 and 7), reverse the codes (1 = never, 2 = seldom, 3 = sometimes, 4 = often, 5 = always to 1 = always, 2 = often, 3 = sometimes, 4 = seldom, 5 = never). Sum the response codes for the 12 answers. For this method, the GOHAI scores range from 12 to 60. The simple count GOHAI score is used to ensure that patients did not get confused using a 5-point scale. Score 0-points for &#34;never&#34; and &#34;seldom&#34; and 1-point for &#34;sometimes&#34; &#34;often&#34; and &#34;always&#34;. Summed GOHAI scores with the simple count method range from 0 to 12. In both cases, higher scores represent poorer oral health-related quality of life.</li>
</ol>
4. Swallowing subscale of the Radboud Oral Motor Inventory (ROMP)10
<ol>
	<li>Tell the patient to consider the last 3 months when answering the next 7 questions. If the patient is unable to answer the questions due to a disability, have a caregiver answer the questions and make a note of this.</li>
	<li>Ask questions from Table 2 one at a time. Mark the patient&#39;s answers on a paper or digital copy of this swallowing subscale of the ROMP. Thank the patient and ask if he/she has any comments to add.</li>
	<li>Sum the scores of each swallowing question for a total swallowing score. 
	NOTE: ROMP swallowing scores range from 7 to 35; higher scores represent worsened swallowing ability. The simple count method can also be used with this questionnaire (see step 3.3 for more information).</li>
</ol>
5. Brief Oral Health Status Examination (BOHSE)11
<ol>
	<li>Have a paper copy of the BOHSE for the oral screening and mark scores on it during examination of each oral and dental area (Table 3). Recruit a second observer to serve as a scribe to speed the examination and prevent infections.</li>
	<li>Ask the patient to sit comfortably and to expect observation of his/her neck, mouth, and teeth. Tell the patient he/she should not feel any discomfort and if they do, to communicate this by raising his/her hand.</li>
	<li>Stand in front of the seated patient. Cup fingers and gently palpate the submandibular and submental lymph nodes just anterior to the angle of the jaw. Ask the patient if he/she is tender to the touch. Select the BOHSE score for lymph nodes (0&#8722;2) that applies. 
	NOTE: Lymph nodes are small (~1 cm diameter) lumps beneath the skin but are not palpable if they are healthy. Infected lymph nodes are tender, soft, painful to the touch and are movable. Cancerous lymph nodes are hard, not painful and unmovable.</li>
	<li>Tell the patient that next is observation of his/her lips. Observe the lips and corners of the mouth for their color, dryness and any other abnormalities (such as ulcers, bleeding, crusty scars, sores with rounded edges or discoloration at the edge of the lips that meet the facial skin). Ask the patient for how long he/she has had any abnormalities observed. Select the BOHSE score for lips (0&#8722;2) that applies.</li>
	<li>Tell the patient that next is observation inside his/her mouth. Ask the patient to open his/her mouth and stick out his/her tongue. Observe the status of the tongue for color, dryness and any other abnormalities such as ulcers and bleeding.</li>
	<li>Touch the tongue (with examination gloves) and assess for texture. Ask the patient for how long he/she has had any abnormalities observed. Select the BOHSE score for tongue (0&#8722;2) that applies. 
	NOTE: If the patient cannot protrude the tongue for as long as needed, grasp the tongue with thumb and forefinger and gently hold the tongue outside the oral cavity.</li>
	<li>Observe inside his/her mouth at the inside of the cheeks and the floor and roof of the mouth for their color, dryness and any other abnormalities such as ulcers and bleeding. Use a tongue depressor as needed to stretch open the cheeks and a penlight for better observation. Ask the patient for how long he/she has had any abnormalities observed. Select the BOHSE score for tissue inside cheek, floor and roof of mouth (0&#8722;2) that applies.</li>
	<li>Examine the patient&#39;s gums, using a tongue depressor to gently press his/her gums and evaluate for firmness and coloration. Ask the patient if he/she has any loose teeth or soreness around his/her teeth. Select the BOHSE score for gums (0&#8722;2) that applies. 
	NOTE: The gums should not have redness, bleeding, food debris or plaque at the triangle between the teeth.</li>
	<li>Tell the patient that next is looking at his/her saliva and touching his/her tongue with a tongue depressor. Observe for oral tissue dryness and salivary flow (i.e., by saliva pooling in the floor of the mouth). Ask the patient if his/her mouth feels dry when eating or if he/she has difficulty swallowing food without drinking water. Select the BOHSE score for saliva (0&#8722;2) that applies.</li>
	<li>Tell the patient next is inspection of the teeth. Count all of the natural (original) teeth and write the number at the bottom of the BOHSE table. Look for decayed, broken or chipped teeth while looking at the natural teeth. Select the BOHSE score for natural teeth (0&#8722;2) that applies. 
	NOTE: Decayed teeth may have discoloration or breakdown of the tooth surface, widening of the fissures of the tooth, and there may be small holes in the white enamel or even brown or black visible discolored spots.</li>
	<li>Look at the condition of any artificial teeth (i.e., dentures, implants, or crowns). Look for chips and wear. Ask the patient: if he/she has partial dentures or has had any tooth replacements or implants, if he/she has lost any artificial teeth or other oral appliances in the past, and how often and for what purposes the artificial teeth are worn. Select the BOHSE score for artificial teeth (0&#8722;2) that applies.</li>
	<li>Count the pairs of teeth in the chewing position. 
	NOTE: These are maxillary (upper) and mandibular (lower) teeth that contact when the jaw is closed, enabling bite. The pairs of teeth can be natural or artificial. For example, teeth 8 and 25 (Figure 1) are one pair; if one of them is missing, do not count as a pair.</li>
	<li>Score overall oral cleanliness by observing the entire oral cavity and teeth for food particles (called food debris), and tartar (called calculus). Select BOHSE score for oral cleanliness that applies (0&#8722;2). Thank the patient for his/her willingness to participate and ask if he/she has any comments to add. 
	NOTE: Dental calculus is a crusty deposit at the gum line of the tooth that can trap stains on the teeth and cause yellow discoloration.</li>
	<li>Sum the scores of each BOHSE item for a total BOHSE score. 
	NOTE: BOHSE scores range from 0 to 20; higher numbers represent poor oral health. Refer the patient to a dentist if any score for an item is a 2.</li>
</ol>
6. Simplified Oral Hygiene Index (OHI-S)12
<ol>
	<li>Ask the patient to sit comfortably. Tell the patient that a dye will be applied to his/her teeth to be able to see plaque accumulation. Explain that the dye may stay in the mouth for a few hours if he/she doesn&#39;t brush his/her teeth, but it will slowly fade away.</li>
	<li>Hold the plastic blister pack containing the plaque disclosing dye swab. Locate the cotton tip with the pink line around it. Remove the other half of the plaque disclosing dye swab from its plastic blister pack, leaving the end with the pink line in the plastic. Locate the cotton tip with the pink line around it. With the thumb and index finger of each hand grasping either side of the pink line, break the cotton tip from the shaft by giving the pink line a sharp snap with both hands. Confirm that the pink dye, stored in the hollow shaft of the swab, drains quickly to the other cotton tip. 
	NOTE: The pink disclosing dye will discolor clothing, skin, and gums, so be careful to touch the swab tip only to teeth. The dye adheres to tooth plaque and may remain in the mouth for hours, unless brushed or wiped away.</li>
	<li>Swab the six tooth surfaces depicted in red in Figure 1 with pink disclosing dye: the labial surfaces (outer side) of the upper right (tooth 8) and lower left (tooth 24) central incisors, the lingual surfaces (tongue-side) of the selected lower molars (teeth 19 and 30), and the buccal surfaces (cheek-side) of the selected upper molars (teeth 3 and 14). In the absence of the indicated upper or lower central incisor, substitute the central incisor (tooth 9 or 25, respectively) on the opposite side of the midline. Substitute upper (teeth 1, 2, 15, or 16) and lower molars (teeth 17, 18, 31, or 32) as needed. Gently rinse with water and score the debris index using the criteria in Figure 2 under the section &#34;Debris Index Before Tooth Brushing&#34;.</li>
	<li>Provide oral hygiene instructions if the debris index is high.</li>
	<li>Calculate debris index by adding the debris scores for buccal, lingual and labial, and then divide the total by the number of examined surfaces.</li>
</ol>

The authors have nothing to disclose.

Here we demonstrate a widely accessible and comprehensive methodology to assess oral health. These tools include the GOHAI9, the swallowing subscale of the ROMP10, the BOHSE11, and the OHI-S12. Currently, oral health professionals such as dentists, dental therapists, dental hygienists, and dental assistants nearly exclusively evaluate oral health. They have the advantage of training, dental chairs, and instruments for advanced...

Oral health affects overall health. Oral movement serves to move food and debris immediately from the mouth, and together with the protective functions of saliva, they are the body&#39;s natural defense mechanism against oral infections and tooth decay1. Lack of oral health leaves individuals highly prone to accumulation of oral pathogens, inflammation, and infection that can spread to the body. For example, patients with type II diabetes are at higher risk of developing periodontitis, an inflammatory gum disease. So too, patients with periodontitis are more likely to develop type II diabetes, as periodontal disease can affect glycemic control2,3. Poor oral health is linked with many additional systemic, or body-wide diseases, including heart disease, stroke, and osteoporosis4,5,6.
The need to screen patients for oral health status, then, is not only important for diagnosing oral disease, but also assessing systemic disease risk. This is particularly important in older individuals, who more often develop inflammatory chronic conditions6. Further, poor oral health begets social isolation, dehydration, and malnutrition. Patients with infirmities such as dementia, stroke, and Parkinson&#39;s disease (PD) often develop dysphagia, or have trouble swallowing7. In addition to causing unsightly drooling, this life-threatening condition can cause oral bacteria to be swallowed inadvertently into the lungs. Aspiration pneumonia is a common outcome and major cause of death in the elderly8.
Our objective is to provide an oral screening protocol that non-dental professionals can use for research or health purposes. We describe a compilation of existing oral screening tools that together are a comprehensive and expedient assessment of oral health. We chose these tools primarily to allow dental students to collect data in research studies and gain patient experience. Legal restrictions limit the techniques students (i.e., non-degreed, non-licensed trainees) can perform; this compilation is designed to be conducted by any pretrained or calibrated student. In addition, nurses, caregivers, and family members may also use these protocols in the oral health monitoring of senior adults. These tools include the General Oral Health Assessment Index (GOHAI)9, the swallowing subscale of the Radboud Oral Motor Inventory (ROMP)10, the Brief Oral Health Status Examination (BOHSE)11, and the Simplified Oral Hygiene Index (OHI-S)12. Oral characteristics assessed include intraoral and extraoral structures, soft and hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact this oral health status has on the patient&#39;s quality of life. Anyone can complete this oral screening legally and safely, even those without dental training or dental instruments. The brief nature of the oral screening allows caregivers and researchers to track changes in oral health easily across time.
In addition to the fact that almost anyone can learn to administer this oral screening, an advantage of this method is that it includes both screener and self-report components. Thus, concrete measures of oral health can be partnered with the functional and emotional perceptions of the patient.
Self-report components (patients&#39; opinions of their oral health)
General Oral Health Assessment Index
The GOHAI is a self-reported measure of oral health quality of life status in older adults9. The survey has 12 questions that rate oral function, oral pain and discomfort, and psychosocial impacts (Table 1). Used to assess oral health in over 200 scientific publications, the GOHAI questionnaire has been shown to be sensitive to the provisions of dental care13 and to predict subjective well-being after 10 years14. Furthermore, a caregiver can complete the GOHAI if the patient is unable to communicate effectively15.
Several questionnaires exist to measure oral health-related quality of life; the most popular include the Oral Impacts on Daily Performances (OIDP)16, the Oral Health Impact Profile (OHIP)17,18, and GOHAI. The OIDP measures eight daily performances in frequency and severity but is not specifically designed for elderly patients. The OHIP was originally designed as a 49-statement survey but was later shortened to 14 statements (OHIP-14)19. Several studies have compared the effectiveness of OHIP-14 and GOHAI. All conclude that both assessments are comparable, although a few studies show that elderly people with high oral health needs may identify better with GOHAI, and that GOHAI may be more sensitive to objective values of oral functioning20,21,22,23,24,25,26. Therefore, we chose to use the GOHAI over the OHIP-14.
Swallowing subscale of the Radboud Oral Motor Inventory
Dysphagia (swallowing difficulty) commonly affects the elderly population due to muscle atrophy. It can affect up to 35% of elderly people over 75 years of age, and it greatly increases the risk for malnutrition and aspiration pneumonia27. The percentage of affected patients increases to more than 50% if the patient has a neurological disorder (e.g., Parkinson&#39;s disease, Alzheimer&#39;s disease, multiple sclerosis, stroke, and others)28. Most objective measures of dysphagia are too invasive for the elderly, or require the expertise of a professional (i.e., clinician or speech and language pathologist) as well as specialized equipment (i.e., endoscope or videofluoroscope). Therefore, using a validated self-assessment questionnaire is a good alternative when students are collecting data or caregivers must quickly assess dysphagia in a patient for referral to a specialist.
There are over two dozen self-evaluation questionnaires for dysphagia, each specific for a certain type of patient29,30,31,32. The most comprehensive and popular is the Swallowing Quality-of-Life (SWAL-QOL) questionnaire33, which is designed for many different types of patients, including patients with neurodegenerative disorders. However, this questionnaire is rather long, consisting of 44 questions.
A patient may be overwhelmed answering a battery of questionnaires and sitting for long sessions while examiners collect data, especially if the patient is suffering an age-related disorder. The ROMP was originally created to measure dysphagia, sialorrhea, and speech problems in patients with PD10. The swallowing portion of the ROMP consists of 7 questions with a 5-point Likert scale response option (Table 2). It can be administered in a short time and even in frail elderly. Therefore, this compilation includes the swallowing portion of the ROMP. For research purposes, investigators may evaluate other swallowing assessment surveys to ensure use of the best option for their research goals32.
Screener components (screener&#39;s rating of patients&#39; oral health)
Brief Oral Health Status Examination and Simplified Oral Hygiene Index
Oral health has improved over the years, with more elderly keeping their teeth and thus needing oral care into their last decades34,35. Certain sectors of this population, however, remain with poor oral health. Specifically, elderly people living in long-term care facilities and those suffering age-related diseases have prevalent oral problems including caries (i.e., cavities), gingivitis, plaque accumulation, denture problems, and mucosal lesions36,37,38,39. Ideally, elderly have a dental visit at least twice a year and upon admittance to a long-term care facility, but most often this is not the case. The final two components of our oral health assessment employ observation of the oral cavity but without the need of dental expertise or professional dental instruments.
Few oral health assessments are designed for a lay or inexperienced person to evaluate oral health. The index for Activities of Daily Oral Hygiene (ADOH) is an assessment of physical ability to perform oral hygiene and evaluates an elderly individual complete flossing, brushing, topical fluoride application, and oral rinses40. Whereas this tool is a good option to record the progressive loss of oral hygiene capacity by elderly people, it does not assess oral status and is involved and time consuming. The Oral Health Screening Tool for Nursing Personnel (OHSTNP) was recently published and validated41. This oral screening tool has 12 items, including many that are very similar to the BOHSE. The screening includes evaluation of basic nutrition and oral functioning during meal intake and swallowing. Yet, no other studies corroborate its validity. The Oral Health Assessment Tool (OHAT) is an 8-item tool, derived from the BOHSE, widely used to screen oral health in residents of long-term care, including those with dementia42. Therefore, we include the BOHSE (Table 3) as it is well-established, reliable, validated and can be used by lay personnel11,42,43. To include measurement of plaque accumulation, we added the OHI-S (Table 4) with a modification to help nurses, caregivers, and health students calculate debris index easily without interfering with dental license restrictions12,44.
Together, these four oral health assessments comprise a short and easy evaluation tool that can be used by nurses and caregivers to quickly assess oral health status in elderly individuals at home, long-term care or even the hospital before referring to a dental professional. This compilation is also useful to engage health students in research and patient interaction, particularly helping future dental professionals care for the growing elderly population.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Hurriview Plaque Indicating Snap-n-Go Swabs</td>
			<td>Henry Schein</td>
			<td>916553</td>
			<td></td>
		</tr>
		<tr>
			<td>Non-latex examination gloves</td>
			<td>VWR</td>
			<td>76246-462</td>
			<td>any vendor will do; optional if you use only tongue depressor to touch the mouth</td>
		</tr>
		<tr>
			<td>Small flashlight or pen light (Energizer LED Pen Flashlight)</td>
			<td>VWR</td>
			<td>500033-336</td>
			<td>any vendor will do; unnecessary, but helpful</td>
		</tr>
		<tr>
			<td>Sterile, individually wrapped tongue depressor</td>
			<td>VWR</td>
			<td>500011-108</td>
			<td>any vendor will do</td>
		</tr>
	</tbody>
</table>

oral health assessment by lay personnel for older adults

Oral health is an often-undervalued contributor to overall health. The literature, however, underscores the myriad of systemic diseases influenced by oral health, including type II diabetes, heart disease, and atherosclerosis. Thus, assessments of oral health, called oral screenings, have a significant role in assessing risk of disease, managing disease, and even improving disease by oral care. Here we present a method to assess oral health quickly and consistently across time. The protocol is simple enough for non-oral health professionals such as students, family, and caregivers. Useful for any age of patient, the method is particularly key for older individuals who are often at risk of inflammation and chronic disease. Components of the method include existing oral health assessment scales and inventories, which are combined to produce a comprehensive assessment of oral health. Thus, oral characteristics assessed include intraoral and extraoral structures, soft and hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact this oral health status has on the patient&#39;s quality of life. Advantages of this method include its inclusion of measures and perceptions of both the observer and patient, and its ability to track changes in oral health over time. Results acquired are quantitative totals of questionnaire and oral screening items, which can be summed for an oral health status score. The scores of successive oral screenings can be used to track the progression of oral health across time and guide recommendations for both oral and overall health care.

This compilation of oral health assessment tools was evaluated in different elderly populations. One patient with dementia (D-06) was selected to demonstrate how to interpret the results of an elderly person by a caregiver. All patients signed a consent form prior to enrollment and the studies have IRB approval.
Using the four assessment tools to evaluate a patient 
Patient D-06 completed the GOHAI question...

Watch this Scientific Journal Video about Oral Health Assessment by Lay Personnel for Older Adults at JoVE.com

Oral Health Assessment by Lay Personnel for Older Adults

The goal of this protocol is to enable non-dental professionals to assess oral health status for research or health-screening purposes. Aspects assessed include lips, tongue, soft and hard tissues, natural and artificial teeth, oral cleanliness, plaque, swallowing, and impact of oral health on quality of life.

Oral health is an often-undervalued contributor to overall health. The literature, however, underscores the myriad of systemic diseases influenced by oral ...

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12.5K Views.  The University of Texas Health Science Center at Houston School of Dentistry. The goal of this protocol is to enable non-dental professionals to assess oral health status for research or health-screening purposes. Aspects assessed include lips, tongue, soft and hard tissues, natural and artificial teeth, oral cleanliness, plaque, swallowing, and impact of oral health on quality of life.

Video: Oral Health Assessment by Lay Personnel for Older Adults

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers

Salivary measures have emerged in bio-behavioral research that are easy-to-collect, minimally invasive, and relatively inexpensive biologic markers of stress. This article we present the steps for collection and analysis of two salivary assays in research with frail, community residing older adults-salivary cortisol and salivary alpha amylase. The field of salivary bioscience is rapidly advancing and the purpose of this presentation is to provide an update on the developments for investigators interested in integrating these measures into research on aging. Strategies are presented for instructing family caregivers in collecting saliva in the home, and for conducting laboratory analyses of salivary analytes that have demonstrated feasibility, high compliance, and yield quality specimens. The protocol for sample collection includes: (1) consistent use of collection materials; (2) standardized methods that promote adherence and minimize subject burden; and (3) procedures for controlling certain confounding agents. We also provide strategies for laboratory analyses include: (1) saliva handling and processing; (2) salivary cortisol and salivary alpha amylase assay procedures; and (3) analytic considerations.

We demonstrate: (1) procedures for collection of salivary samples in cognitive impaired older adults by family caregivers in the home setting, (2) procedures for measuring stress activity via salivary cortisol and alpha amylase, and (3) representative profiles. Protocols that allow researchers to study stress-linked processes advance our understanding of biological sensitivity and susceptibility.

Salivary measures have emerged in bio-behavioral research  that are easy-to-collect, minimally invasive, and relatively inexpensive  biologic markers of ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Oral Biofilm Sampling for Microbiome Analysis in Healthy Children

Oral biofilm and its molecular analysis provide a basis for investigating various dental research and clinical questions. Knowledge of biofilm composition leads to a better understanding of cariogenic and periopathogenic mechanisms. Microbial changes taking place in the oral cavity during childhood are of interest for several reasons. The evolution of the child oral microbiota and shifts in its composition need to be analyzed further to understand and possibly prevent the onset of disease. At the same time, advanced knowledge of the natural composition of oral biofilm is needed. Early stages of caries-free permanent dentition with healthy gums provide a widely unaffected subgingival habitat that can serve as an in situ baseline for studying features of oral health and disease. Analysis of children's oral biofilm during different stages in life is thus an important theme in the field. Modern molecular analysis methods can provide comprehensive information about the bacterial diversity of such biofilms. To enable microbiota data comparison, it is important to standardize each step in the procedure for molecular data generation. This procedure spans from clinical sampling, Next Generation Sequencing (NGS), bioinformatic data processing, to taxonomic interpretation. One of the most critical factors here is biofilm sampling. Sampling in children is even more challenging in particular due to limited space in subgingival areas. We thus focus on the use of paper points for subgingival sampling. This article provides a detailed protocol for oral biofilm sampling of the subgingival sulcus, the mucosa, and saliva in children.

Changes in the oral microbiome throughout childhood are of growing interest. Comparison of different microbiome studies reveals a lack of standardized sampling protocols. Limited space makes sampling the sound subgingival sulcus of children challenging. Paper point sampling is presented here in detail as the method of choice for this area.

Oral biofilm and its molecular analysis provide a basis for investigating various dental research and clinical questions. Knowledge of biofilm composition ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Invasive Hemodynamic Assessment for the Right Ventricular System and Hypoxia-Induced Pulmonary Arterial Hypertension in Mice

Pulmonary arterial hypertension (PAH) is a chronic and severe cardiopulmonary disorder. Mice are a popular animal model used to mimic this disease. However, the evaluation of right ventricular pressure (RVP) and pulmonary artery pressure (PAP) remains technically challenging in mice. RVP and PAP are more difficult to measure than left ventricular pressure because of the anatomical differences between the left and right heart systems. In this paper, we describe a stable right heart hemodynamic measurement method and its validation using healthy and PAH mice. This method is based on open-chest surgery and mechanical ventilation support. It is a complicated procedure compared to closed chest procedures. While a well-trained surgeon is required for this surgery, the advantage of this procedure is that it can generate both RVP and PAP parameters at the same time, so it is a preferable procedure for the evaluation of PAH models.

Here, we present a protocol to perform an invasive hemodynamic assessment of the right ventricle and pulmonary artery in mice using an open-chest surgery approach.

Pulmonary arterial hypertension (PAH) is a chronic and severe cardiopulmonary disorder. Mice are a popular animal model used to mimic this disease. ...

A Training Program Using an Agility Ladder for Community-Dwelling Older Adults

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. The purpose of this study is to report the physical fitness benefits of a training program for independent community-dwelling older adults using an agility ladder. Each training session lasted approximately 30 minutes, and the benefits were achieved with two sessions per week for 14 weeks. Training was timed and involved four different drills and varying levels of difficulty through time. The exercises were performed at the School of Physical Education of the University of Campinas, S&#227;o Paulo state, Brazil. The study participants (n = 16; mean age of 66.9 &#177; 5.0 years) were instructed to perform the exercises as quickly as possible without making mistakes and were assisted by a physical trainer when they made mistakes. Assessments were performed both before and after training using five functional tests (i.e., Illinois agility, five times sit-to-stand, timed up-and-go, walking usual speed, and one-leg stand). Although the study sample was not compared with a control group, the results indicate that training protocols using an agility ladder are easy and practical and improve physical function performance in older adults.

The aim of this study is to present an agility training program for older people. The feasibility of this program is described, and the training protocol demonstrated by video imaging.

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. ...

Knee Arthrocentesis in Adults

Arthrocentesis of the knee is a procedure in which a needle is inserted into the knee joint, and synovial fluid is aspirated. An arthrocentesis can be diagnostic or therapeutic. Synovial fluid may be removed for testing to determine the nature of the knee effusion. If septic arthritis is suspected, urgent arthrocentesis before initiation of antibiotic treatment is indicated. Moreover, arthrocentesis can also aid in diagnosing crystal-induced arthritis such as gout or pseudogout, or non-inflammatory arthritis such as osteoarthritis. Identifying the cause of the knee effusion can guide treatment. Furthermore, removing fluid from a knee can reduce intraarticular pressure to decrease pain and improve range of motion. There is no absolute contraindication to performing this procedure, but in selecting the needle entry site, an area of skin that is infected should be avoided. Therefore, caution should be exercised when a patient presents with suspected cellulitis over the knee joint to avoid the potential risk of causing iatrogenic septic arthritis. A knee that has undergone arthroplasty should be assessed for arthrocentesis by an orthopedic surgeon. Arthrocentesis of the knee is typically performed with the patient supine. The site for needle insertion is marked, and then the skin is disinfected. After a local anesthetic is administered, a needle is inserted along the pathway that was anesthetized. Synovial fluid is aspirated, and then the needle is withdrawn. Pressure is applied until any bleeding stops. The synovial fluid can be analyzed for infection and inflammation but cannot directly confirm a diagnosis of internal derangement or autoimmune causes of arthritis. In addition to the history and physical examination, laboratory findings and imaging can clarify the etiology of a knee effusion.

Here the protocol describes arthrocentesis of the knee, a procedure in which a needle is inserted into the knee joint, and synovial fluid is aspirated. Synovial fluid may be removed for testing to determine the nature of the knee effusion. Arthrocentesis of the knee is typically performed with the patient supine.

Arthrocentesis of the knee is a procedure in which a needle is inserted into the knee joint, and synovial fluid is aspirated. An arthrocentesis can be ...

Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults

There is increasing interest in the use of the forced oscillation technique (FOT) or oscillometry to characterize respiratory mechanics in healthy and diseased individuals. FOT, a complementary method to traditional pulmonary function testing, utilizes a range of oscillatory frequencies superimposed on tidal breathing to measure the functional relationship between airway pressure and flow. This passive assessment provides an estimate of respiratory system resistance (Rrs) and reactance (Xrs) that reflect airway caliber and energy storage and dissipation, respectively. Despite the recent increase in popularity and updated Technical Standards, clinical adoption has been slow which relates, in part, to the lack of standardization regarding the acquisition and reporting of FOT data. The goal of this article is to address the lack of standardization across laboratories by providing a comprehensive written protocol for FOT and an accompanying video. To illustrate that this protocol can be utilized irrespective of a particular device, three separate FOT devices have been employed in the case examples and video demonstration. This effort is intended to standardize the use and interpretation of FOT, provide practical suggestions, as well as highlight future questions that need to be addressed.

As the use of forced oscillation technique (FOT) is increasingly utilized to characterize respiratory mechanics, there is a need to standardize methods with respect to nascent technical guidelines and various manufacturer's recommendations. A detailed protocol is provided including FOT assessment and interpretation for two cases to facilitate the standardization of methods.

There is increasing interest in the use of the forced oscillation technique (FOT) or oscillometry to characterize respiratory mechanics in healthy and ...

Semi-Automated Planimetric Quantification of Dental Plaque Using an Intraoral Fluorescence Camera

Dental plaque accumulation is quantified using clinical indices or, otherwise, the planimetric plaque index (PPI),&#160;which measures the relative area of a tooth that is covered by plaque deposits. Compared to clinical indices, the PPI has a higher discriminatory power, but traditional planimetry is a time-consuming analysis, as the plaque-covered and clean tooth areas have to be determined manually for each image using image-processing software. Here, we present a method for the semi-automated planimetric quantification of dental plaque, which allows for the rapid processing of up to 1,000 images simultaneously. The method exploits the enhanced contrast between disclosed plaque, sound tooth surfaces, and soft tissues in fluorescence images acquired with an intraoral camera. Careful execution of the clinical procedures and accurate image acquisition are crucial steps for the successful semi-automated identification of the plaque-covered areas. The method is suitable for planimetry on sound facial and oral tooth surfaces, on most composite resin restorations, and on teeth with orthodontic brackets, but not on metallic restorations. Compared to traditional PPI recordings, semi-automated planimetry considerably reduces the amount of time spent on the analysis, as well as the subjective human input, thus increasing the reproducibility of planimetric measurements.

This study presents a semi-automated digital image analysis procedure for the planimetric quantification of disclosed dental plaque based on images acquired with an intraoral fluorescence camera. The method allows for the rapid and reliable quantification of dental plaque in the research environment.

Dental plaque accumulation is quantified using clinical indices or, otherwise, the planimetric plaque index (PPI),&#160;which measures the relative area ...

Capturing Oral Submucous Fibrosis Tissue Samples for Spatial-Omics Analysis

Isolation of Cells with Morphological and Spatial Information from Oral Submucous Fibrosis Samples by Laser Capture Microdissection

Oral submucous fibrosis (OSF) is a common type of potentially malignant disorder in the oral cavity. The atrophy of epithelium and fibrosis of the lamina propria and the submucosa are often found on histopathological slides. Epithelial dysplasia, epithelial atrophy, and senescent fibroblasts have been proposed to be associated with the malignant transformation of OSF. However, because of the heterogeneity of potentially malignant oral disorders and oral squamous cell carcinoma, it is difficult to identify the specific molecular mechanisms of malignant transformation in OSF. Here, we present a method to obtain a small number of epithelial or mesenchymal cells carrying morphological data and spatial information by laser capture microdissection on formalin-fixed paraffin-embedded tissue slides. Using a microscope, we can precisely capture microscale (~500 cells) dysplastic or atrophic epithelial tissue and fibrotic subepithelial tissue. The extracted cells can be evaluated by genome or transcriptome sequencing to acquire genomic and transcriptomic data with morphological and spatial information. This approach removes the heterogeneity of bulk OSF tissue sequencing and the interference caused by cells in non-lesioned areas, allowing for precise spatial-omics analysis of OSF tissue.

Author Spotlight: Unlocking the Mysteries of Oral Potential Malignancies 

Laser capture microdissection of oral submucous fibrosis tissues allows for precise extraction of cells from histological regions of interest for the analysis of multi-omics data with morphological and spatial information.

Oral submucous fibrosis (OSF) is a common type of potentially malignant disorder in the oral cavity. The atrophy of epithelium and fibrosis of the lamina ...