Source 25

I wanted to make sure that I could get the data table so I just posted the link.
http://download.journals.elsevierhealth.com/pdfs/journals/0975-962X/PIIS0975962X11600075.pdf

In the preamble of its constitution, WHO states that ‘health is a state of complete physical, mental and social well being and not merely the absence of disease and infirmity’. In dentistry, this new perspective on health suggests that the ultimate goal of dental care is not merely the absence of caries or periodontal disease or oral cancer but also the mental and social well being of the patient. The concept of oral health-related quality of life (OHRQOL) captures the aim of this new perspective.
There is an increased recognition of incorporating OHRQOL measures while evaluating oral health. It can be used to measure the impact of various oral diseases on the general population and high risk groups in order to study the success of various preventive and curative procedures on improving the QOL of an individual. This literature review attempts to explain various aspects of OHRQOL, its method of assessment, use in future research, and role that it can play in improving the current dental curriculum.

WHAT IS ORAL HEALTH-RELATED QUALITY OF LIFE?
There are various definitions of OHRQOL that are in use, but the most useful of these can be derived by understanding health- related QOL. This is explained by using the personal assess- ment of how the following factors affect his/her well being:
1. Functional factors
2. Psychological factors (concerning the person’s appear-
ance and self esteem)
3. Social factors (such as interaction with others). Experience of pain or discomfort
Oral health-related quality of life can be assessed when these parameters center around orofacial concerns (Figure 1).

Assessment of Oral Health-related Quality of Life
The priority according to OHRQOL demands that we have a solid, scientific basis for assessing it. Researchers, clinicians, and public health practitioners have a responsibility to document and evaluate OHRQOL using rigorous, reliable, and valid assessment tools. As the demand grew for measures of health status (in contrast to the clinical measures of disease status), researchers focused on developing standardized questionnaires that could be used in clinical settings or OHRQOL—the concept, its assessment and relevance in dental research and education
large population surveys. The measurement of OHRQOL is divided into three categories: societal indicators, global self- ratings of OHRQOL, and multiple-item questionnaires of OHRQOL.

Assessment of Societal Indicators
While assessing the societal impact of oral conditions, large population surveys inquire about the days of restricted activity, work loss, and school absenteeism due to bad oral health conditions (Table 1). These surveys typically yield the rate of impacts that are negligible for individuals while substantial when expressed in terms of the illness in a given year. This is partly owing to the fact that there is a high prevalence of oral conditions that causes disabling pain in the head and neck, and the tendency for many such oral diseases to persist and recur. Take for example, a US population survey revealed that bad oral health conditions lead to more days of work loss than those compared to stroke, or, in younger adults, as much work loss as all neoplasms considered together.
While societal measures are useful for demonstrating public health significance of oral diseases, there are obvious limitations in using measures such as work loss to assess OHRQOL. This can be proved by considering that even some severe levels of discomfort can occur without causing any work loss. Further, many individuals who are suffering may not be in the workforce. However, for those in the workforce, the need to take time off is influenced by the structure, organization, and delivery of dental services. Reisine5 found that 95% of the work loss episodes were for preventive or curative treatment. Finally, from a statistical perspective, societal indicators such as work loss, are simply too infrequent to be considered sensitive markers of impact in epidemiologic studies or clinical trials. This is particularly important in public health, where it is essential to document the burden of illness using measures that are meaningful to policy makers.
Assessment of Individuals’ Oral Health-related Quality of Life Using Global Self-ratings
An intuitively appealing method to assess OHRQOL is to ask a global question about self-rated oral health of the respondents. Consider asking, ‘how would you rate the health of your teeth, gums, and mouth?’ Responses are provided on a five-point ordinal scale ranging from ‘excellent’ to ‘very poor’. However, this process varies from individual to individual. For example, some people may regard their oral health to be excellent as long as they do not experience any dental pain, while others may consider it to be fair despite having lost several teeth.
The potential for different individuals to use different yardsticks in evaluating their oral health is not seen as a limitation, but as a strength because it permits them to integrate multidimensional experience and select the ones which are most salient. Another feature of single, global assessment is that they offer positive response and are not limited to measuring only the adverse impact of oral health. Finally, global self-ratings require a single question with a simple response format. Therefore, it is feasible for large interviews or questionnaires that explore numerous research questions, as it often occurs in national health surveys. However, it would be a mistake to interpret this as an average rating of the nation’s oral health, because there is no physical scale that can be attached to the response categories. For example, there is no specific reason to believe that the difference between ‘excellent’ and ‘very good’ is equivalent to that between ‘good’ and ‘fair’. This is despite the fact that the numerical differences between the scores assigned to these ratings are identical.
One approach to this psychometric problem is to offer a numerical scale to the respondents. A visual analog scale (VAS) that is used frequently in pain research is one such scale. However, it would be illusionary to believe that this improves the metric qualities of the response scale; because different respondents would use different subconscious yardsticks when deciding on where to mark the VAS. The ease of administering single-item questions make them ideal for large-scale health surveys, including surveys conducted across several countries.
Assessment of Individuals Oral Health-related Quality of Life Using Multiple-item Questionnaire
The other commonly used method to evaluate multiple dimensions of OHRQOL is to ask numerous questions from the subjects. For example, some questions that focus on function, some are concerned with pain or discomfort while others evaluate self-image and social interaction. This approach attempts to delineate specific experiences that encompass the researcher’s definition of OHRQOL. Typically, these multiple-item questionnaires capture more statistical variation than single-item questions. Hence, the motivation to develop multiple-item questionnaires often is both philosophical (researchers focus on a specific dimension of OHRQOL using a predetermined set of questions and response categories) and methodological (researchers attempt to capture maximum variation in OHRQOL).
Given that the definitions of OHRQOL are vague, it is not surprising that there is a significant heterogeneity in focus, length, and format of the multiple-item question- naires developed to evaluate OHRQOL. Questionnaires range in length from 3 to 56 items6–13 (Table 1). The format of questions and responses vary from simple, fact-based questions with yes–no response (e.g., Are there any types of food that you find difficult to chew?) to four-part questions that inquire about the frequency, severity and importance of a specific problem (e.g., oral impact on daily perfor- mances).13 While most questionnaires are limited to the negative impact of oral diseases, two questionnaires ask if oral conditions had either an adverse impact on the respon- dent’s well being (i.e., OHRQOL inventory7 and dental impact profile10). A common feature of the OHRQOL ques- tionnaires is that these can be analyzed as responses to indi- vidual questions and summarized as numeric scores. In many of the questionnaires, sub scales can be computed. For example, the oral health impact profile (OHIP)8 that has 7 substances, each measuring a hypothesized unique dimen- sion of OHRQOL (e.g., functional limitation). In some cases, these summary scores do not have a true metric. For example, the General Oral Health Assessment Index (GOHAI)6 that assigns a value of zero through five to all responses of ‘never’ to ‘always’, respectively, to each of the 12 items queried.
However, in some cases, summary scores are computed as the number of items endorsed at a particular threshold. For these, the values have a literal meaning. For example, an alternative method of summarizing the 49-item OHIP is by reporting the number of items answered with ‘occa- sionally’, ‘fairly often’, or ‘very often’. In such cases, the mean value has an intuitive meaning unlike the abstract concept of ‘between good and fair’ and hence may be more interpretable for users of the data. Recent methods that are used have fewer questions in the OHIP. These have been found to be more suitable in large population surveys.

OHRQOL—the concept, its assessment and relevance in dental research and education
Direction for Future Research
The currently used method of assessing OHRQOL has fol- lowing limitations:
1. While some questionnaires focus on adverse impacts of
OHRQOL, additional methods are needed to capture positive dimensions of health. This is particularly important for tracking improvement amongst people who are initially free of any adverse symptoms.
2. Previous studies have concentrated on limited factors associated with OHRQOL. There is a need to identify additional determinants of OHRQOL, including psychological and social variables and those describing organization of the health care system.
3. There are only few studies on the impact of specific treatments of QOL. Additional research is needed to evaluate the treatment of existing disease, its prevention, and enhancement of health. Also, more studies on the latest techniques such as effect of implants on OHRQOL15 should be conducted.
4. Clinical decision making calls for integration of additional outcomes besides OHRQOL, including clinical indices, patient satisfaction, longevity, and cost. However, OHRQOL has been evaluated as a primary outcome in most of the studies and methods that have not been developed to permit a clinician to systemically incorporate OHRQOL with the other relevant patient outcomes.
Oral Health-related Quality of Life and Need to Refocus Dental Education
Oral Health-related Quality of Life plays a central role in the future of dental education. Considering the structural factors that will shape dental health care in future, the challenges that oral health care providers face currently, and the recommendations for the future of dental education, the dental education community must begin to evaluate whether it is preparing future health care providers to be:
1. Truly patient centric
2. Culturally competent
3. Able to work from an interdisciplinary perspective that
places oral health in the context of a patient’s overall health
Oral Health-related Quality of Life is useful in refocus-
ing the content of educational efforts on these three goals.

CONCLUSION
Research on trends in dentistry and dental education shows that in future, fewer dentists will take care of the increasing number of patients. Therefore, educating these patients about promoting good oral health and preventive care will be crucial. Research also shows that certain population segments are drastically underserved. Dental education has to make a contribution if this situation is to change. Finally, with rapidly changing knowledge base and technology in all health-care fields, interdisciplinary considerations and collaborations become increasingly important. QOL measures are not only being used in population surveys but also in randomized clinical trials, technology assessment in health care and evaluation of health-care delivery systems.