Multiple options exist for nurse researchers who wish to measure oral health. The primary issue is one of validity; that is, actually capturing the components of oral health one wishes to examine.
Should a researcher collect unstimulated saliva, stimulated saliva, or both? The answer to this question depends on what aspect of salivary flow or composition the researcher is interested in investigating. Unstimulated whole saliva often yields valuable information and usually correlates to clinical conditions more accurately than stimulated saliva. For example, Bardow, Nyvad, and Nauntofte (2001)
found that unstimulated saliva flow was a better predictor of tooth mineral loss than stimulated saliva flow. On the other hand, if a researcher wants to examine the effect of an activity that naturally stimulates saliva flow (such as toothbrushing) on oral immunity, then the collection and measurement of stimulated saliva might be a better choice. The population that the researcher is interested in studying may also dictate the type of saliva that should be collected. When the population under investigation is critically ill mechanically ventilated patients or severely cognitively impaired elders, the collection of stimulated saliva is not realistic and poses potential harm to patients.
We have used a variety of the techniques described in this article as measures of oral health in our own research. In our studies of the relationship of oral health to pneumonia risks associated with intubation and mechanical ventilation in critically ill subjects (Grap, Munro, Elswick, Sessler, & Ward, 2004
; Munro, Grap, Hummel, Elswick, & Sessler, 2002
), we measure dental plaque, salivary flow and immune components, and both oral and endotracheal microbial flora. In our studies of pneumonia risk in frail and functionally dependent nursing home elders (Jablonski, Munro, Grap, & Elswick, 2005
), we use dental plaque, denture plaque, salivary flow and immune components, and both oral and denture microbial flora as outcome measures. In our research regarding exacerbations of chronic obstructive pulmonary disease (COPD), data include dental plaque, salivary volume and immune components, sputum volume and immune components, and both oral and sputum microbial flora. All of our research studies assess dental plaque using the UM-OHI because this tool enables assessment of the distribution of plaque on tooth surfaces. Understanding patterns of accumulation of plaque and the effectiveness of interventions in different areas of the mouth (for example, buccal surfaces versus lingual surfaces) may be important in designing and testing oral care interventions. In intervention studies of critically ill adults, we use plaque discloser invisible to the naked eye (UV-light sensitive) to avoid cueing study personnel who provide oral interventions. In descriptive studies of nursing home elders and patients with COPD, we use visible plaque discloser. Although all of our studies measure unstimulated salivary volume, in critically ill patients we collect saliva from the dependent sublingual pocket with a sterile disposable pipette, whereas in nursing home elders and patients with COPD, we collect saliva via passive drool. Thus, although we have commonality in oral health research interests, measures and procedures must be selected based on the research question and population of interest.