Original article The mouth care item of the MOBID pain scale: secondary analyses of unique video uptakes by dental professionals Anne H. Toxopeus 1 , Bettina S. Husebo 2,3 , Liv Inger Strand 4 , Suzanne Delwel 1,5 , Arjen J. van Wijk 6 , Erik J.A. Scherder 5 and Frank Lobbezoo 1 1 Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands; 2 Department of Global Public Health and Primary Care, Center for Elderly- and Nursing Home Medicine, University of Bergen, Bergen, Norway; 3 Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; 4 Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway; 5 Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; 6 Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands Gerodontology 2014; doi: 10.1111/ger.12115 The mouth care item of the MOBID pain scale: secondary analyses of unique video uptakes by dental professionals Purpose: The Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale has been developed for the assessment of pain in elderly individuals with severe dementia. From the initial draft of the MOBID, the teeth/mouth care item was removed due to its low correlation with the total score. However, the observation of this item was done by non-dental professionals only. The aim was to revisit the unique teeth/mouth care video uptake fragments with a group of experienced elderly care dentists, as to establish the reliability of this item. Material and methods: Using the Orofacial MOBID Pain Scale, 11 fragments were assessed by 12 spe- cialists during two sessions with a 4-week interval. The specialists scored whether or not they observed orofacial pain/discomfort-related behaviours (pain noises, facial expressions and/or defence) and/or dementia-related behaviours (anxiety, aggression and/or confusion). The threshold for agreement in scoring was arbitrarily set at 66.6%. As a next step, reliability was quantified using Cohen’s kappa. Results: For only two video fragments, substantial agreement was obtained during both sessions, while for three fragments, the agreement was substantial during one session only. In addition, only three observers were able to provide consistent scores. For two of those, the various kappa values could be qualified as moderate to good. Notably, all consistent scores pertained to dementia-related behaviours; not to orofacial pain/disability-related behaviours. Conclusion: Teeth/mouth care, as displayed on video uptakes, cannot be interpreted reliably by experi- enced elderly care dentists in terms of orofacial pain/discomfort-related behaviour or dementia-related behaviour with the Orofacial MOBID Pain Scale. Keywords: orofacial pain, dementia, non-verbal, nursing home care. Accepted 13 January 2014 Introduction According to professional caregivers in nursing homes and family members of nonverbal patients with dementia, being free from orofacial pain is the number one target outcome for long-term oral health care 1 . It is therefore striking that none of the currently available tools for the assessment of pain in nonverbal individuals has been designed for the specific assessment of orofacial or dental pain 2 . In their literature review, Lobbezoo et al. 2 pointed out the unfortunate fact that in the process of developing the Mobilization-Observa- tion-Behaviour-Intensity-Dementia (MOBID) Pain Scale, the teeth/mouth care item was removed from the instrument due to its low correlation with the total score 3 . Hence, only non-orofacial guided movement items remained in the instru- ment, which was subsequently found reliable and valid for the assessment of pain behaviour and © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd 1