Community Dental Health

cover art

Cover Date:
September 2008
Print ISSN:
0265 539X
Vol:
25
Issue:
3

Editorial - Research on oral health and the quality of life – a critical overview

Research on oral health and quality of life has its origins in a series of seminal papers published in the mid 1970s to the late 1980s. These capitalized on changing definitions of health and emerging models of disease and its consequences such as that contained within the WHO’s International Classification of Impairment, Disability and Handicap. The intent of these papers was to provide a conceptual and theoretical basis for the development of subjective oral health indicators. These were concerned with assessing the extent to which oral disorders compromised physical and psychosocial functioning and were meant to complement the clinical indices that occupied centre stage in surveys of the oral health of populations and clinical groups. These papers began something of a paradigm shift in dental research; from a strictly biomedical model, which was narrow, biologically based and placed undue emphasis on disease, to a biopsychosocial model, which was more holistic, incorporated issues such as functioning and well-being and was more compatible with the primary purpose of health care, restoring and enhancing health. These papers stimulated the development of a number of measures of the functional and psychosocial impacts of oral disorders. The content, development and performance of the first ten were presented and compared at a major conference held at the University of North Carolina in 1997. Many, if not most, were expert rather than patientbased, and put together on a somewhat ad hoc basis without recourse to classical test theory. However, their psychometric properties in terms of validity, reliability and responsiveness were adequate and several, such as the Oral Health Impact Profile, the Geriatric (General) Oral Health Assessment Index, the Oral Impacts on Daily Living and the Child Oral Health Quality of Life Questionnaires perform well, have become accepted as standards and are becoming widely used in surveys and clinical outcome studies. A notable feature of the 1997 conference was a terminological shift, so that the measures available at the time were renamed as measures of ‘oral health-related quality of life’ (OHRQoL). This seemed like a good thing to do since the term ‘quality of life’ has a certain resonance and political and policy appeal and offered the potential to broaden the scope of enquiry into the consequences of oral disorders; from functional and psychosocial impacts to quality of life itself. It paralleled a similar shift in medicine and was compatible with influential contemporary models of disease and its outcomes, such as that of Wilson and Cleary (1995), which has ‘quality of life’ as its end-point. However, that the term ‘quality of life’, whether health-related or not, carries with it certain conceptual and methodological implications was and continues to be ignored. As have the numerous critical commentaries regarding the measurement of health-related quality of life and quality of life published in medical journals on which dental research might usefully have drawn. This points to a core weakness in ‘OHRQoL’ research; the general failure to consult the substantial literature on health and quality of life that has been produced by disciplines other than dentistry. Nevertheless, research has proliferated so that oral health and its quality of life outcomes has become a major research focus in dentistry, with the development of additional measures specific to populations or clinical groups and the publication of a plethora of papers. The extent of the growth in this field of enquiry can be illustrated by a scrutiny of electronic data bases. A search of electronic data bases furnished 39 references for the period 1995-1999 and 124 for the period 2000-2004. For 2005 to the present the number had reached 226. Given the volume of publications in the last decade, a critical overview of the field is difficult since there will inevitably be exceptions to any of the points raised. What follows then is a brief commentary on some of the main limitations of the work produced to date, along with suggestions as to where further research is needed. Most studies of OHRQoL are characterized by a lack of conceptual precision. Concepts are rarely defined and terms such as oral health, oral health-related quality of life and quality of life are used as if they were synonymous and interchangeable. Where they are defined, there is often little agreement about what the concepts refer to. Moreover, the measurement implications of these different concepts remain unexamined. New terms such as ‘smile-related quality of life’ have emerged, which, to say the least, appear to have no compelling theoretical or psychological basis. To use the term ‘quality of life’ as a universal suffix is to dilute its value and render it meaningless. Similarly with the term ‘positive health’. Proponents of the concept pop up on a regular basis to claim that most measures are at best limited or at worst misguided since they focus solely on negative oral health and ignore the positive. However, definitions and measures of positive oral health are conspicuous by their absence. While notions of positive health have been around for more than fifty years, the theoretical and methodological basis for positive oral health has not yet been the subject of a review paper or a conference symposium. It may well be that the inclusion of positive oral health would increase our understanding of

Correspondence to: David Locker BDS PhD DSc, Professor, Community Dentistry, Associate Dean, Graduate and Postgraduate Studies, Faculty of Dentistry, University of Toronto, Canada. E-mail: David.Locker@dentistry.utoronto.ca

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Articles from this issue

  • Title
  • Pg. Start
  • Pg. End

  1. Editorial - Research on oral health and the quality of life – a critical overview
  2. 130
  3. 131

  1. Comparison of two methods in deriving a short version of oral health-related quality of life measure.
  2. 132
  3. 136

  1. Oral health and its impact on the life quality of homeless people in Hong Kong
  2. 137
  3. 142

  1. The presenting complaints of low income adults for emergency dental care: An analysis of 35,000 episodes in Victoria, Australia.
  2. 143
  3. 147

  1. International variation in the incidence of oral and pharyngeal cancer
  2. 148
  3. 153

  1. Caries prevalence in 2-year-old children in the city of Zurich
  2. 154
  3. 160

  1. Association between breastfeeding duration and non-nutritive sucking habits
  2. 161
  3. 165

  1. I want braces: factors motivating patients and their parents to seek orthodontic treatment.
  2. 166
  3. 169

  1. Cariogenic and erosive potential of the medication used by HIV-infected children: pH and sugar concentration
  2. 170
  3. 172

  1. Prevalence of breath malodour in 7-11 year old children living in Middle Anatolia, Turkey.
  2. 173
  3. 177

  1. Enamel fluorosis in 12- and 15-year-old school children in Costa Rica. Results of a National Survey, 1999
  2. 178
  3. 184

  1. Restorative treatment threshold reported by Iranian dentists
  2. 185
  3. 190

  1. Short Communication - Fissure sealants on permanent first molars – consequences of a one-year delay
  2. 191
  3. 192