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Oral health care is a rising and integral part of evaluating the comprehensive health of an individual. Poor oral health can impact an individual’s daily activities due to physical pain and disfigurement, or from embarrassment regarding poor dental practices. It is also correlated with various illnesses such as poor nutrition, diabetes, cardiovascular diseases, and respiratory diseases [1]. Hence, it is vital to evaluate the impact of oral health on an individual. A model known as Oral health-related quality of life (OHRQL) is used to evaluate this impact in both a theoretical and a clinical perspective.
World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity” [2]. They also define quality of life as “a person’s perceptions of their position in life according to their culture, goals, expectations, standards, and priorities” [3]. A model known as Health-related quality of life (HRQoL) is used to relate these two concepts and measure the impact of a disease while considering the influence potential environmental, social, and financial factors [4].
Oral health-related quality of life (OHRQL) is a concept based off the HRQoL model that focuses on oral health. The theoretical model incorporates various factors including biological factors such as oral-facial appearance, psychological factors such as ability to manage disease, environmental factors such as access to oral health care, and cultural factors [5]. For example, the initial assessment of physical oral health includes determining if a patient is experiencing pain, bleeding or has spaces between teeth, and if functions such as chewing or talking cause any discomfort [5]. In addition, social/emotional factors can include if a patient is feeling attractive, anxious, or unhappy whereas environmental factors can include a patient’s school or occupation [5]. Assessment of this analysis allows a physician to correlate a patient’s social/emotional experiences and physical function and devise appropriate treatment goals and outcomes based on these experiences [5].
Oral health-related quality of life (OHRQL) is not only important from an individual perspective, but also from a systemic perspective. Studies identified factors that could affect OHRQL and highlight oral healthcare disparities and access to care especially from a socioeconomic and racial/ethnic perspectives [5]. For instance, treatment may be limited in rural areas due to lack of dental care facilities whereas treatment may also be limited in developed countries due to high treatment costs and transportation difficulties [5].
In addition, a study in Canada demonstrated that “children from low-income families have poorer OHRQL than children from high-income families, indicating a socio-economic disparity” [5]. This disparity may be a result of increased preventative dental care as the socioeconomic status increases [6]. It may also be due to an increase in access to aesthetic dental care [6].
For example, “issues such as missing teeth, early extraction and later malocclusion are averted early, and thus improve oral health perceptions of adolescents” in households from a higher socio-economic status [6]. Whereas children from a low socio-economic status are likely to have a lower OHRQL due to increased dental carries from the lack of preventive care [6]. Furthermore, presence of symptoms such as dental carries can have a negative impact on the OHRQL. This is commonly seen in the elderly where need for dental treatment, fewer teeth and poor cognitive status often affects the patient’s perception of their OHRQL [5]. By evaluating these systemic disparities, health policies and programs can be established to decrease the discrepancies in access to treatment and treatment quality.
Oral health care is often overlooked and neglected by individuals. However, oral illnessessuch as dental carries, periodontal diseases and oral cancers are a major source of disease in developing countries. For instance, dental carries affect 60-90% of school children and vastmajority of adults in industrialized countries [7]. In addition, there often is a correlation between oral health and general health as they share common risk factors related to diet, such as use of tobacco and consumption of alcohol [7].
Furthermore, they also may share similar systemic disparities such as differences in education and socioeconomic status. Hence, it is vital to assess the oral health-related quality of life. Evaluating the OHRQL of an individual can increase the quality of care, assess compliance in treatment leading to better outcomes. Furthermore, evaluating from a systemic perspective allows for creation and implementation of programs and policies to increase education and preventive measures, increase access to quality care, and measure the impact of these programs and policies for improvement in the future. Hence, assessing oral health-related quality of life is necessary to determine and improve a person’s health status.
References:
1. Tynan, A., Deeth, L., & McKenzie, D. (2018). An integrated oral health program for rural residential aged care facilities: a mixed methods comparative study. BMC health services research, 18(1), 515. https://doi.org/10.1186/s12913-018-3321-5
2. Callahan, D. (1973). The WHO definition of 'health'. Hastings Center Studies, 77-87.
3. Pakkhesal, M., Riyahi, E., Naghavi Alhosseini, A., Amdjadi, P., & Behnampour, N. (2021). Impact of dental caries on oral health related quality of life among preschool children: perceptions of parents. BMC oral health, 21(1), 68. https://doi.org/10.1186/s12903-021-01396-4
4. Guyatt, G. H., Feeny, D. H., & Patrick, D. L. (1993). Measuring health-related quality of life. Annals of internal medicine, 118(8), 622-629.
5. Sischo, L., & Broder, H. L. (2011). Oral health-related quality of life: what, why, how, and future implications. Journal of dental research, 90(11), 1264–1270. https://doi.org/10.1177/0022034511399918
6. Malele-Kolisa, Y., Yengopal, V., Igumbor, J., Nqcobo, C. B., & Ralephenya, T. (2019). Systematic review of factors influencing oral health-related quality of life in children in Africa. African journal of primary health care & family medicine, 11(1), e1–e12. https://doi.org/10.4102/phcfm.v11i1.1943
7. Petersen, P. E. (2005). Priorities for research for oral health in the 21st Century-the approach of the WHO Global Oral Health Programme. Community Dent Health, 22(2), 71-4.
Contributors:
Author: Bhagya Arikala
Editor: Kayjah Taylor
Health Scientist: Bhagya Arikala