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ORAL HEALTH AND QUALITY OF LIFE DR NIZAM ABDULLAH BDS, PHD, DDPHRCS (ENG.) OBJECTIVES Explain quality of life and oral Health Quality of life (QOL) Explain the quality-of-life dimension Appraise diseases associated with oral health Elaborate the concept of disease, impairment and disability WHAT IS QUALITY OF LIFE? An individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. WHO 1997 -The degree of well being, satisfaction and standardized living. QUALITY OF LIFE Influenced by: Physical health, Psychological state, Personal beliefs, Social relationships and The environment. PRINCIPLES OF RENWICK & BROWN’S (1996) “CENTER FOR HEALTH PROMOTION MODEL” QOL refers to the extend to which a person enjoys the key aspects of his/her life. QOL -the degree of enjoyment that results from possibilities that have taken on importance to the person; QOL –is unique to each individual There are 3 life domains: Being, Belonging, and Becoming. Being reflects "who one is" 3 sub-domains: 1. Physical Being: physical health, personal hygiene, nutrition, exercise, grooming, 2. Psychological Being: self esteem, self-concept and self-control. 3. Spiritual Being: the personal values, standards of conduct, and spiritual beliefs Belonging -the person's fit with his/her environments. 3 Sub-domains. 1. Physical Belonging describes the person's connections with his/her physical environments 2. Social Belonging includes links with social environments, 3. Community Belonging represents access to resources, health and social services BECOMING Activities carried out to express oneself and to achieve personal goals, hopes, and aspirations. Practical Becoming- day-to-day activities, domestic activities, Leisure Becoming activities that promote relaxation and stress reduction. Growth Becoming activities for maintenance or improvement of knowledge and skills and adapting to change COMPONENT OF QOL Physical Health-activities of daily living Psychological health-feelings, fear, depression Spiritual health-Religion, personal interior power Social relations-friends, family social suppoer Environment- physical, home, climate, noise, PRINCIPLES OF RENWICK & BROWN’S (1996) “CENTER FOR HEALTH PROMOTION MODEL” QOL is multidimensional, dynamic and evolving QOL arises from ongoing interaction with the environment QOL is bio-psycho-social QOL components are common to all people and the human condition, i.e. not different for people with disability. It was conceived as equally applicable to people with and without disabilities. Disability doesn’t imply increased or decreased QOL QOL meaning is individual MEANING OF QUALITY OF LIFE It expresses a value judgment: the experience of living, as a whole or in some aspect, is judged to be “good” or “bad”, “better” or “worse”. WHAT IS ORAL HEALTH QUALITY OF LIFE? US Surgeon General's Report on Oral Health Definition “A multidimensional construct that reflects (among other things) people’s comfort, eating, sleeping, social interaction, self-esteem and satisfaction with respect to oral health" ORAL HEALTH QUALITY OF LIFE Focus on the relevance of oral health and QOL Shift from viewing oral health and disease as counting DMFT or attachment loss in perio disease -to patient centered perspective of oral health- -from the oral cavity only to the person as a whole OHRQOL is associated with: Functional factors, Psychological factors, Social factors, and Experience of pain or discomfort “Oral health problem can lead to needless pain and suffering, causing devastating complications to an individual well-being, with financial and social costs that significantly quality of life” “US Dept of Health and human services 2000” NO! Disparities in oral health have emerged as a major public health problem Caries affects 60% to 90% of school-aged children in most industrialised countries. ARE ORAL DISEASES A THREAT FOR GLOBAL HEALTH? Yes, Oral health is an integral part of general health Most oral diseases share the common environmental and behavioual risk factors with chronic diseases (Cardiovascular diseases, obesity & cancer) Approaches to promote better oral health and to reduce inequalities should consider the interrelation between oral health and general well-being as well as: The individual behaviour Physiological determinants Social determinants DISEASES ASSOCIATED WITH ORAL HEALTH Diabetes Heart Disease Stroke Pregnancy Issues Osteoporosis Respiratory Infections ORAL HEALTH LINKS TO SYSTEMIC DISEASES Periodontal Oral Health and Diabetes Persons with noninsulin–dependent diabetes mellitus are 3 X more likely to develop periodontal disease (clinical attachment loss) then non-diabetics Evidence exists that chronic periodontal disease can disrupt diabetic control. Periodontal diseases make it difficult for patients to control their diabetes. ORAL HEALTH LINKS TO SYSTEMIC DISEASES Periodontal Disease and Heart Disease: Individuals with perio disease are almost 2x as likely to suffer fr coronary artery disease Several theories: Oral bacteria can affect the heart when entering blood stream, attaching to fatty plaques in the coronary arteries contributing to clot formation ORAL HEALTH LINKS TO SYSTEMIC DISEASES Strokes Studies suggest that there is a relationship between periodontal disease and stroke. One study showed people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection (Paradeep et al, J Period. Res; 2010) Oral Health and Systemic Disease Preterm Low Birth Weight Babies Severe periodontal disease in pregnant women can lead to significant increase in the risk of delivering preterm low birth weight babies (Corbella et al, Odontology, 2011). Theorize that oral pathogens release toxins that reach the human placenta via mother’s blood and affect fetal growth ORAL HEALTH LINKS TO SYSTEMIC DISEASES Respiratory Diseases Scientists have found that oral bacteria can be aspirated into the lung to cause respiratory diseases (pneumonia) or exacerbate existing respiratory diseases (COPD) WHY DO WE HAVE TO KNOW ABOUT THIS... Quality of life focuses on health, not disease: health is “a complete state of physical, mental, and social well-being, and not just the absence of infirmity” (constitution of the World Health Organisation, 1948) To understand patient care-seeking: To evaluate effectiveness of treatment: IMPORTANT QUESTIONS Who is making the evaluation—the person living the life or an observer (Clinician)? What criteria are being used for evaluation? What types of clinical decisions are justified by reference to quality-of- life judgment? EXAMPLES IN DENTISTRY Orthodontic treatment is it necessary? Replace missing tooth with implant or partial denture or bridge?? CONCEPT OF DISABILITY Disease : A pathological process and its manifestations Impairment: Actual damage of a part of a body anatomy or abnormality that occurs consequent to a disease Disability: The inability to carry out certain functions or activities, as a result of the impairment Handicap: Fatal disadvantage in life which occurs consequent to an impairment or disability, ITEMIZED ASSESSMENTS: IMPAIRMENT, DISABILITY AND HANDICAP* Disease or Biological process disorder Loss of bodily part or function- at Impairment the organ level Inability to perform everyday Disability activities- at the person level Handicap Disadvantage- at the societal level * From: International Classification of Impairment, Disability and Handicap, Geneva, WHO 1980 ORAL HEALTH-RELATED QUALITY OF LIFE DIMENSIONS QOL Physical well-being Mental well-being Social well-being OHQOL dimensions include Functional Psychological CONCLUSIONS AND CLINICAL IMPLICATIONS Tooth loss, dental decay and other common dental diseases are strongly associated with adverse impacts on quality of life Younger adults report adverse impacts on quality of life at least as frequently as older adults Dental treatments can reduce adverse impacts on quality of life

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