Oral Health

About the Data
Basic Screening Survey for Older Adults

The Basic Screening Survey is a non-invasive, open-mouth screening developed by the Association of State and Territorial Dental Directors (ASTDD). The survey assesses and monitors the oral health status of four key populations (i.e., children in Head Start/Early Childhood programs, kindergarteners, third graders, and older adults). This page contains information about the Basic Screening Survey for Older Adults.

The Basic Screening Survey (BSS) for Older Adults was developed by the Association of State and Territorial Dental Directors (ASTDD) in 1999 to establish a set of protocols to describe the oral health status of individuals 65 years and older using an open-mouth survey. Dental hygienists trained and calibrated in BSS data collection carry out the open-mouth screening, while data recorders enter data electronically in Epi InfoTM. Older adults screened may include individuals who eat meals at congregate meal sites and residents of long-term care facilities including, skilled nursing facilities and assisted living facilities. The 2016 Minnesota BSS for Older Adults surveyed older adults in skilled nursing facilities (nursing homes).

  • Oral health status of older adults living in Minnesota skilled nursing homes as measured by the prevalence of:
    • Impaired dental function (lacks functional dentition – has fewer than 20 natural teeth).
    • Untreated tooth decay (decay that is not filled or restored).
    • Treatment urgency.
    • Denture ownership and use.
    • Contact of back teeth (posterior occlusal contacts).
    • Food bits, plaque and tartar build-up (substantial oral debris).
    • Severe gum (gingival) inflammation.
    • Residual tooth roots.
    • Loose teeth (obvious tooth mobility).
    • Periodontal care need.
    • Severe dry mouth (dry, cracked lips and/or tongue due to lack of saliva).
    • Suspicious soft tissue lesion (possible wound, ulcer, abscess, infection or tumor).
  • Oral health disparities among older adults living in Minnesota skilled nursing homes by:
    • Age group (65 to 74 years, 75 to 84 years, 85 to 94 years, and 95 years and older).
    • Sex (male and female).
    • Race (white and non-white).
  • Minnesota’s older adult population 65 years and older is expected to grow by more than 510,000 people between 2015 and 2035. There will be a greater number of older adults in need of ongoing dental care and treatment.
  • If left untreated, dental disease can cause pain, discomfort, tooth loss, difficulty speaking, chewing, or swallowing, loss of self-esteem, loss of confidence, and lower quality of life. These conditions can lead to poor nutrition, social isolation, depression, or more serious health concerns.
  • Oral health is an important part of overall health. Regular oral care, preventive dental visits, and treatment can reduce or prevent tooth loss, pain, or other conditions.
  • Create awareness of the current oral health status of older adults living in nursing homes among educators, dental professionals, long-term care facility administrators, and healthcare and public health professionals, researchers, students, grant makers, policy makers, the media and the public.
  • Identify health disparities, risk factors for and patterns of disease over time.
  • Plan, evaluate and carry out disease prevention and health promotion activities.
  • Target prevention efforts and resources towards groups identified as having higher rates of the measured oral conditions.
  • Propose and support health-related legislative initiatives.
  • The data only represents adults aged 65 and older living in Minnesota nursing homes in 2016. This data does not include the oral health status of Minnesota older adults living at home, with relatives, in assisted living facilities, or in transitional care facilities.
  • How often or the type of dental or oral health services provided within skilled nursing facilities. This includes treatment history, last dental exam, or dental records of residents screened.
  • Nursing home residents’ income level or dental and health insurance status (private, group, public program or Indian Health Services, or uninsured).

In 2016, the Minnesota Department of Health Oral Health Program carried out the BSS for Older Adults in Minnesota nursing homes.

Type of Study: Descriptive, cross-sectional (prevalence), observational study. Oral Health Program staff assessed oral health indicators (measures) and demographic factors at a single point in time for each resident.

Sampling method and eligibility: The Oral Health Program used the Association of State and Territorial Dental Directors (ASTDD) recommended sampling methodology and worked closely with the ASTDD lead surveillance and epidemiology expert on sampling and weighting.

The sampling methodology includes an implicit stratified probability sample with a random start and constant selection interval of 12.4 from a sorted list of all 373 Medicare or Medicaid eligible, licensed skilled nursing facilities (nursing homes) with at least 30 beds in the state of Minnesota (sampling frame). There were 31 total nursing homes sampled. This methodology increases precision of estimates and reduces selection bias.

Two variables used in implicit stratification were: Rural Urban Commuting Areas (RUCA) and Area Agency on Aging (AAAs) based on the physical address of the facility. If a selected facility declined to participate, the replacement facility selected was matched by RUCA score and AAA of the declining facility.

All residents aged 65 and older (with consent of their legal guardians if applicable) within the final participating nursing homes sample were given the opportunity to be screened/surveyed.

Sample and population size

Table 1. Comparison of sample and population characteristics.

Sample
(n = 944)
Population
(N = 66,469)
Characteristics Number Unweighted percent Weighted percent Number Percent
Age group
65 to 74 years 122 12.9% 15.2% 14,267 21.0%
75 to 84 years 261 27.6% 27.8% 21,429 32.0%
85 to 94 years 436 46.2% 45.3% 24,854 37.0%
95 years and older 125 13.2% 11.7% 5,919 9.0%
Sex
Female 655 69.4% 67.4% 42,492 64.0%
Male 289 30.6% 32.7% 23,977 36.0%
Race and ethnicity
White 892 94.5% 93.0% 62,066 93.0%
Black 17 1.8% 2.5% 1,301 2.0%
Asian 4 0.4% 0.5% 446 1.0%
American Indian/Alaska Native 7 0.7% 0.9% 387 1.0%
Hispanic/Latino 2 0.2% 0.2% 306 1.0%
Multiracial 0 0.0% 0.0% 150 0.0%
Unknown or missing 22 2.3% 2.7% 1,963 3.0%

Note: 2016 Basic Screening Survey for Older Adults sample includes 944 analyzable of 1,032 residents aged 65 and older screened from 31 Medicare/Medicaid eligible skilled nursing facilities with 30 or more beds. The 2016 population includes 66,469 residents aged 65 and older from all Medicare/Medicaid eligible skilled nursing facilities.

Data collection: Licensed dental hygienists and data recorders carrying out the BSS for Older Adults received training on how to apply the ASTDD standardized protocols for oral health screening and data collection. Data were collected electronically using Epi InfoTM software with validation protocols to minimize data entry errors.

Demographic data (age, sex, race and ethnicity) were provided by the facility from patient records for all screened residents. MDH did not keep any identifiable data. All ASTDD recommended and optional oral health indicators were collected during the screening. See “What are the data indicators?” and “How are the data indicators calculated?” in the next sections.

Data analysis and weighting: Data analysis and weighting was completed using SAS 9.4 software on a Citrix server, following ASTDD expert guidance.

Weight = Proportion of the number of Medicare or Medicaid eligible licensed skilled nursing beds within *Area Agency on Aging (AAA) and **facility location, divided by the proportion of residents screened within *AAA and **facility location.

*AAA = Arrowhead, Central, Land of Dancing Sky, Metropolitan, Minnesota River or Southeastern and *Facility location = rural or urban based on the RUCA score of the physical address of the facility.

Funding: The 2016 BSS for Older Adults was funded through grants from Delta Dental of Minnesota Foundation, the Centers for Disease Control (CDC) and Prevention and the Health Resources and Services Administration (HRSA).

This survey included all recommended and optional indicators from the ASTDD’s “Basic Screening Surveys: An Approach to Monitoring Community Oral Health: Older Adults” manual.

Treatment urgency: Percentage of older adults aged 65 years and older with an urgent treatment need. This refers to how soon a person should visit the dentist for clinical diagnosis and any necessary treatment. Treatment urgency has three categories:

  • None: The individual has no obvious pain, infection, or swelling. Follow regular dental checkup schedule.
  • Early care: The individual has untreated tooth decay, but no signs or symptoms that include pain, infection, swelling, broken or missing tooth or filling, or ill-fitting dentures that are difficult to use. Seek care within several weeks.
  • Urgent care: The individual has untreated tooth decay with symptoms that include pain, infection, swelling, or a suspicious lesion. Seek care within 24 to 48 hours.

Periodontal care need: Percentage of dentate older adults aged 65 years and older who need advanced periodontal care. This may include a need to have their teeth cleaned before their next regularly scheduled visit or within the next few months.

Untreated decay: Percentage of dentate older adults 65 years and older with tooth decay that has not been treated (restored or filled) determined by visual inspection only; not with a dental explorer. This includes obvious breakdown of enamel or cementum. Broken or fractured teeth (root fragments) are considered untreated decay unless otherwise restored.

Contact of back teeth (posterior occlusal contacts): Percentage of older adults 65 years and older with opposing pairs of natural, dental implant or denture back teeth (premolars and molars) that are able to come in contact with one another while biting down or eating as determined by visual inspection.

Residual tooth roots: Percentage of dentate older adults 65 years and older with visible fractured or broken teeth at or below the gum line.

Loose teeth (obvious tooth mobility): Percentage of dentate older adults 65 years and older with loose teeth. This is determine by gently wiggling teeth with a gloved finger, tongue blade, or dental mirror.

Food bits, plaque and tartar build-up (substantial oral debris): Percentage of dentate older adults 65 years and older with substantial oral debris based on the Oral Hygiene Index [pdf]. This includes hard or soft matter such as food covering two-thirds or more of any tooth surface.

Severe dry mouth (xerostomia): Percentage of older adults aged 65 years and older with severe dry mouth determined by dry, cracked lips, a dry cracked or fissured tongue, or tissue that sticks to teeth because of lack of saliva.

Severe gum (gingival) inflammation: Percentage of older adults aged 65 years and older with gum inflammation based on the Gingival Index. This includes marked redness and edema, ulceration, or spontaneous bleeding.

Suspicious soft tissue lesion: Percentage of older adults aged 65 years and older with a suspicious soft tissue lesion that the screener feels should be evaluated by a dentist or primary care doctor. This may include red or white patches that could be a wound, ulcer, abscess, tumor or fungal infections such as candidiasis.

Impaired dental function (has fewer than 20 natural teeth): Percentage of older adults aged 65 years and older that lack functional dentition – has fewer than 20 natural teeth as defined by the Centers for Disease Control and Prevention (CDC) is necessary to eat, speak and socialize without the need for dentures. The number of teeth are counted separately for the lower and upper jawbone (arch) and includes wisdom teeth (third molars), primary teeth and fractured or broken teeth (root fragments).

Tooth loss: Percentage of older adults aged 65 years and older that are missing one or more natural teeth. Tooth loss has two categories.

  • Partial tooth loss: individual is missing at least one, but not all of their natural teeth (1 to 31 teeth missing).
  • Complete tooth loss (edentulism): individual is missing all of their natural teeth (28 to 32 teeth missing).

Denture ownership: Percentage of older adults aged 65 years and older with full or partial dentures as determined by visual inspection and/or asking the survey participant whether they have dentures.

Denture use: Percentage of older adults aged 65 years and older that use full or partial dentures. Screeners asked whether or not the survey participant used dentures while eating and whether or not upper and/or lower jawbone (arch) dentures are used.

Treatment urgency

The number of older adults with no urgent treatment needs, early treatment needs, or urgent treatment needs divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Periodontal care need

The number of dentate older adults who need advanced periodontal care divided by the total number of dentate older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Untreated decay

The number of dentate older adults with untreated decay divided by the total number of dentate older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Posterior occlusal contacts

The number of older adults with posterior occlusal contacts divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Residual tooth roots

The number of dentate older adults with root fragments divided by the total number of dentate older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Loose teeth (obvious tooth mobility)

The number of dentate older adults with obvious tooth mobility divided by the total number of dentate older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Food bits, plaque and tartar build-up (substantial oral debris)

The number of dentate older adults with substantial oral debris divided by the total number of dentate older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Severe dry mouth (xerostomia)

The number of older adults with severe dry mouth divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Severe gum (gingival) inflammation

The number of older adults with severe gum inflammation as measured by the Gingival Index divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Suspicious soft tissue lesion

The number of older adults with a suspicious soft tissue lesion divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Impaired dental function (has fewer than 20 natural teeth)

The number of older adults with fewer than 20 natural teeth present divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Tooth loss

The number of older adults with partial or complete tooth loss divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Dentures ownership

The number of older adults who had dentures divided by the total number of older adults in the analyzable sample screened, multiplied by 100 to get a percent.

Denture use

The number of older adults who said they used their dentures divided by the total number of older adults in the analyzable sample screened who had dentures, multiplied by 100 to get a percent.

Note: Analyzable sample = 940 of 1,032 residents aged 65 and older from 31 Medicare/Medicaid eligible skilled nursing facilities with 30 or more beds. Weighting was applied to each indicator so that estimates were more representative of the facility characteristics from which the sample was drawn.

  • Adults aged 65 and older living in Minnesota nursing homes in 2016.
  • In 2016, there was an estimated 66,469 residents aged 65 and older living in Minnesota nursing homes.
  • The BSS for Older Adults is a cross-sectional (prevalence) survey design that assesses exposures or risk factors, disease and health outcomes at the same time. The data may not be able to tell you whether or not some exposures or risk factors came before or after the disease or health behavior outcome. Only associations between exposures or risk factors and disease or health behaviors can be identified, not causes.
  • The findings cannot be generalized to older adults in Minnesota who do not live in nursing homes.
  • The low proportion of non-White or Hispanic residents does not allow for analysis on race and ethnicity. Out of the 944 residents aged 65 and older in the analyzable sample screened, only 30 were non-White or Hispanic.
  • Possible selection bias. Residents with legal guardians required consent from guardian to be eligible for a screening. Any correlation between consent from guardian and outcome measures would bias results of the survey.


  • Minnesota Department of Health, Oral Health Program.

Minnesota Department of Health Oral Health Program (2016). Basic Screening Survey for Older Adults. Collected by the Minnesota Oral Health Program. St. Paul, Minnesota: Accessed from MN Public Health Data Access Portal. [Add URL] Retrieved month, year.

To learn more about the Basic Screening Survey for Older Adults, see the Basic Screening Survey for Older Adults, or contact the Minnesota Oral Health Program: health.oral@state.mn.us