There has been an explosion of interest in how oral health status affects people's lives and how dental care can enhance them.1 Over the past decade or so, a plethora of patient-centred measures have been developed to assess the impact of oral health and oral health care on people's lives, with assessment focusing on the impact on one (such as eating) or more dimensions of quality of life.2 This study assessed the impact on social and sexual activities by employing a SIQ composed of two parts, first, functional impact (four items) and second, social activities (five items). This may be a welcome addition to the armamentarium for assessing the consequences of oral health and oral health care because it has long been recognised that oral health can affect sexual activities. The assessment of this effect has remained a problem, however. It is not so much, “what to ask?” but, “can you ask?” about the impact of oral health on sexual activities: thus, for the most part, it has been neglected in dental research.

One national study in the United Kingdom of the importance of oral health to life quality highlighted how oral health's effect on romance was one of the most important ways it can affect quality of life, as perceived by the public.3 Moreover, several of the existing oral health-related quality of life measures incorporate some assessment of the impact of oral health on social and sexual activates: questions are included that relate to ‘sex appeal’, kissing, romantic relationships, romantic life and leisure activities.4 Unfortunately, the proposed SIQ here does not go much further (items relate to “kissing” and “uneasy in sex relations”). Furthermore, it is unclear what to do with the SIQ: is it a battery, a subscale or an index? It would appear from the manuscript that responses to individual questions are the unit of analysis, which raises a number of psychometric issues. The key issue, however, is whether asking about kissing and uneasiness in “sex relations” really assesses the impact of oral health on sexual activities. Can these questions comprehensively assess or at least have content validity in the assessment of sexual activities? The bottom line is — and someone has to say it — “what is the effect of oral health on oro-genital sex?”. There, I've said it. Now who is going to ask it?

If one accepts the SIQ is a valid measure of social and sexual activity (and there is little evidence to support this) then this study contains some very interesting findings. Namely, edentulism has a negative impact on social and sexual life and mandibular overdentures provide less unease in intimate activities than conventional mandibular dentures. The study benefits from being a RCT and there have been several papers published arising from this research project, supporting its appropriate methodological approach. Let us hope the research will open up a whole new way of looking at the value of oral health and oral health care!