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Population based norming of the UK oral health related quality of life measure (OHQoL-UK©) C. McGrath and R. Bedi Br Dent J 2002; 193: 521–524

Comment

The impact of oral health and oral disease on quality of life is an area of rapid growth in research and conceptual development. Over the last decade investigators have been concerned with the development of research tools and the examination of inequalities in oral health related quality of life between groups defined by age, social class and ethnicity. This research has clearly established that the impact of the oral cavity on life quality can be determined reliably and validly and that the presence of dental and oral disease has a negative impact on the quality of life, including difficulties in eating, socialising, and other activities.1

Recently however, researchers, including Professor Bedi and Dr McGrath, have suggested that simply assessing the negative impact of dental disease on quality of life fails to appreciate the very positive contribution that the healthy dentition makes upon everyday life. The development of the OHQoL-UK is an attempt to incorporate both the negative and positive aspects of quality of life, building upon new conceptual models of health.2

Such an approach is not without controversy. Are the positive aspects of oral health generally appreciated? It could be argued that people tend not to notice the role our teeth have in, say, speech until something goes wrong. McGrath and Bedi's data provide an interesting, if tentative, insight into this question. Examining the percentage of respondents who indicated that they felt their 'teeth, gums and/or false teeth' had 'no effect' on the specific OHQoL-UK items we find that this ranged from 37% for 'comfort' to 78% for 'finances'. The example of finances would fit well with the idea that the healthy dentition is not normally associated with any impact on quality of life. In this case the absence of a negative is not necessarily perceived as a positive for all people. For other items though, it is clear that teeth are seen as having a positive effect – a good example is 'appearance' where 58% report a positive effect. There would appear to be individual variation in the extent to which oral health is seen as associated with impact. It might be expected that this would relate to the complexity of an individual's understanding of 'oral health'.3 There is still a great deal of research to be carried out in this area, the authors are to be congratulated for their groundbreaking work.