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Oral Health and Well-Being


From the Office of the Surgeon General, U.S. Department of Health and Human Services, May 2000

Oral Health and Quality of Life

Diseases and disorders that damage the mouth and face can disturb well-being and self-esteem. The effect of oral health and disease on quality of life is a relatively new field of research that examines the functional, psychological, social, and economic consequences of oral disorders. Most of the research has focused on a few conditions: tooth loss, craniofacial birth defects, oral-facial pain, and oral cancer. The impact of oral health on an individual's quality of life reflects complex social norms and cultural values, beliefs, and traditions. There is a long tradition of determining character on the basis of facial and head shapes. Although cultures differ in detail, there appear to be overall consistencies in the judgment of facial beauty and deformity that are learned early in life. Faces judged ugly have been associated with defects in character, intelligence, and morals.

The Impact of Craniofacial-Oral-Dental Conditions on Quality of Life

Missing teeth

People who have many missing teeth face a diminished quality of life. Not only do they have to limit food choices because of chewing problems, which may result in nutritionally poor diets, but many feel a degree of embarrassment and self-consciousness that limits social interaction and communication.

Craniofacial birth defects

Children with cleft lip or cleft palate experience not only problems with eating, breathing, and speaking, but also have difficulties adjusting socially, which affect their learning and behavior. The tendency to "judge a book by its cover" persists in the world today and accounts for many of the psychosocial problems of persons affected by craniofacial birth defects.

Oral-facial pain

The craniofacial region is rich in nerve endings sensitive to painful stimuli, so it is not surprising that oral-facial pain, especially chronic pain conditions where the cause is not understood and control is inadequate, severely affects quality of life. Conditions such as temporomandibular (jaw joint) disorders, trigeminal neuralgia, and postherpetic neuralgia (chronic pain following an attack of shingles affecting facial nerves) can disrupt vital functions such as chewing, swallowing, and sleep; interfere with normal activities at home or work; and lead to social withdrawal and depression.

Oral Cancer

Surgical treatment for oral cancer may result in permanent disfigurement as well as functional limitations affecting speaking and eating. Given the poor prognosis for oral cancer (the five-year survival rate is only 52 percent); it is not surprising that depression is common in these patients.


J Dent Res. 2000 Apr;79(4):970-5.

Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population.

Locker D, Clarke M, Payne B.

Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, ON, Canada.

Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?’ Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As a baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life coexist in the same subgroup of older adults.


Community Dent Oral Epidemiol. 1994 Dec;22(6):425-30.

Subjectively reported oral health status in an adult population.

Locker D, Miller Y.

Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Canada. This study describes the subjectively reported oral health status of an adult population aged 18 yrs. and over. The study used measures of the functional, social and psychological impact of oral disorders, originally developed for surveys of older adults, and aimed to determine whether or not they were sensitive to the oral health concerns of younger adults. It compared four age groups (18-29 yrs.; 30-49 yrs.; 50-64 yrs.; 65 yrs. and over) in terms of the following subjective oral health indicators: ability to chew, problems speaking, oral and facial pain; other oral symptoms; problems eating; problems with communication-social relations; limitations in activities of daily living and worry and concern. The initial hypothesis that few younger subjects would report the kinds of problems documented by these indicators was not supported. On all measures except ability to chew, younger subjects were as likely to be compromised by oral conditions as older subjects.


Community Dent Health. 2001 Mar;18(1):7-15.

Does dental care improve the oral health of older adults?

Locker D.

Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Canada.

OBJECTIVE: To assess the relationship between self-perceived change in oral health status and the provision of dental treatment in an older adult population. DESIGN: A longitudinal study with data collection at baseline and after three years. Information on change in oral health was obtained by interviews with study subjects and information on dental treatment over three years was obtained from subjects' dentists. SUBJECTS: Nine hundred and seven subjects took part at baseline and 611 at follow-up. Of the latter, 495 reported at least one dental visit during the three-year observation period and dental treatment information was available for 408. Outcome measures Global transition judgments and change scores derived from four oral health indexes were used to assess change in oral health status. RESULTS: Over the three-year period, one-tenth of subjects reported that their oral health had improved and one-fifth that it had deteriorated. Those who improved made significantly more dental visits and received significantly more dental services than those who deteriorated or did not change (P<0.0001). They also received a broader range of diagnostic, preventive and therapeutic services. The association between change and dental service provision remained after controlling for other potential determinants of oral health. CONCLUSION: The study suggests that improvements in the oral health of older adults depend upon access to comprehensive dental treatments which can address fully their clinical and self-perceived needs.


J Public Health Dent. 1997 Winter;57(1):40-7.

Dissatisfaction with oral health status in an older adult population.

Jokovic A, Locker D.

Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada.

OBJECTIVES: The aim of this study was to assess dissatisfaction with oral health in an older adult population and to identify factors associated with dissatisfaction. METHODS: Data were obtained from 907 community-dwelling older adults aged 50 years and older using personal interviews and clinical examinations. Bivariate and multivariate analyses examined the relationships among dissatisfaction with oral health and a variety of sociodemographic variables, clinical oral health measures, and measures of the functional and psychosocial impact of oral disorders. RESULTS: Overall, 14.3 percent of respondents were dissatisfied with their ability to chew, 21.6 percent with their dental appearance, and 5.6 percent with their ability to speak clearly. Almost one-third (30.8%) were dissatisfied with at least one of these dimensions of oral health. Edentulous subjects were more likely to be dissatisfied than dentate subjects. The multivariate regression model for dentate subjects contained seven variables that explained 31 percent of the variance in dissatisfaction scores. For the edentulous, the model contained three variables that accounted for 53 percent of the variance. CONCLUSIONS: These results suggest that demographic, clinical, and psychosocial impact variables are associated with dissatisfaction with oral health. However, psychosocial impact variables had by far the strongest independent effect.


Community Dent Health. 1992 Jun;9(2):109-24.

The burden of oral disorders in a population of older adults.

Locker D.

Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Ontario, Canada.

This paper describes the burden of oral disorders in a population of adults aged 50 years and over living independently in the community. In so doing it uses clinical, functional, experiential and psychosocial impact measures to document the oral health status of this section of the population. The data reveal that substantial proportions of subjects report that their quality of life was compromised in some way by oral problems. Although only 24.1 per cent were edentulous, 30.5 per cent were unable to chew one or more foods; 37.2 per cent reported oral or facial pain in the previous four weeks and 67.5 per cent experienced one or more other oral symptoms. One third reported problems with eating and communication--social interaction, 18.7 per cent worried a great deal about their oral health and 30.8 per cent were dissatisfied with some aspect of their oral health status. Income was consistently associated with all health status measures examined, demonstrating the scope of inequalities in oral health. In addition, regression analysis showed that low income groups had higher scores on a psychosocial impact scale after controlling for clinical, functional and experiential oral health indicators. The paper illustrates the utility of a model of disease and its consequences derived from the international classification of impairments, disabilities and handicaps in exploring oral health.


Aust Dent J. 1994 Dec;39(6):358-64.

Social impact of oral conditions among older adults.

Slade GD, Spencer AJ.

Department of Dentistry, University of Adelaide.

Oral symptoms and their effects on well-being provide an indication of the social impact of oral disease and can be used to document the burden of illness within populations. This report presents findings about the social impact of oral disease among a random sample of 1217 non-institutionalized persons aged 60 years and over living in Adelaide and Mt Gambier. They completed a questionnaire containing 49 questions about the effect of oral conditions on dysfunction, discomfort and disability. Over 5 per cent of dentate persons and over 10 per cent of edentulous persons reported impacts such as difficulty in chewing, discomfort during eating and avoidance of foods 'fairly often' or 'very often' during the previous 12 months. Impacts on social roles and interpersonal relationships were reported by up to 5 per cent of persons. Edentulous persons reported social impact more frequently, particularly in areas related to chewing and eating. Older age was associated with significantly greater amounts of impact among dentate persons, while edentulous males reported significantly more impact than edentulous females. There were larger variations among dentate persons according to their dental utilization patterns, with the highest levels of impact reported by individuals who usually attended for dental problems and who had attended the previous year. The high frequency of social impact reported in this study no doubt reflects extensive levels of disease experience, including high rates of missing teeth and edentulism, among older adults.


J Public Health Dent. 1993 Summer;53(3):151-7.

Oral signs, symptoms, and behaviors in older Floridians.

Gilbert GH, Heft MW, Duncan RP.

Department of Oral and Maxillofacial Surgery, University of Florida, Gainesville 326100416.

Six hundred community-dwelling older Floridians were interviewed regarding the presence of reported signs of dental conditions, dental and oral symptoms, behavioral impact from dental conditions, and orofacial sensory changes. The prevalence of any single oral sign, symptom, or behavioral impact was generally low. A notable exception was the 39 percent prevalence of dry mouth. However, from 10 percent to 29 percent of persons had at least one of these dental signs, dental symptoms, dental behavioral impacts, or sensory changes. These findings are consistent with a noteworthy burden from nonoptimal oral health status, and these burdens were significantly more prevalent in irregular dental attenders, persons with lower household incomes, and persons who reported poorer general health. Inclusion of these non-disease items in an assessment of oral health status seems warranted, and would allow a broader evaluation of oral health outcomes.


J Oral Rehabil. 1998 Jan;25(1):15-27.

Satisfaction with chewing ability in a diverse sample of dentate adults.

Gilbert GH, Foerster U, Duncan RP.

Claude D. Pepper Center for Research on Oral Health in Aging, University of Florida, Gainesville 32610-0416, USA.

The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. Two objectives of the FDCS were to: (i) describe satisfaction with chewing ability in a diverse sample of dentate adults; and (ii) quantify the associations between satisfaction with chewing ability and other measures of oral health. Approximately 16% of subjects reported that they were dissatisfied or very dissatisfied with their chewing ability. Bivariate and multivariate results provided consistent evidence of the construct validity of a proposed multidimensional model of satisfaction with chewing ability. Multiple regression analysis suggested that dissatisfaction with chewing ability was independently associated with 12 specific clinical and self-reported measures of oral disease/ tissue damage, pain, functional limitation, and disadvantage. The self-reported measures of oral health and the proposed model of satisfaction with chewing ability improve our understanding of this important oral health outcome in diverse population groups.


Community Dent Oral Epidemiol. 1997 Aug;25(4):301-13.

Oral disadvantage among dentate adults.

Gilbert GH, Duncan RP, Heft MW, Dolan TA, Vogel WB.

Claude D. Pepper Center for Research on Oral Health in Aging, Gainesville, FL 326100416, USA.

Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.


J Am Geriatr Soc. 1990 Nov;38(11):1239-50.

Oral diseases in older adults.

Dolan TA, Monopoli MP, Kaurich MJ, Rubenstein LZ.

Department of Community Dentistry, University of Florida, College of Dentistry, Gainesville 32610.

In the case presented, a 65-year-old man with multiple dental, medical, and social problems benefited from interdisciplinary assessment and treatment. Despite his poor oral-health status and oral-health behaviors upon admission, patient education and dental therapy resulted in improved daily oral hygiene, elimination of oral diseases, and improved oral function. The overall quality of life of any individual, particularly an older one, can be enhanced through oral-disease prevention, health promotion, and, when indicated, dental therapy. This patient was treated in a hospital environment with a well-established team approach to geriatric care. However, regardless of the care setting, the physician can play a key role in improving the oral health status and quality of life of older adults by including an oral screening examination as part of the periodic comprehensive geriatric assessment, recognizing oral pathology, requesting dental consultations and encouraging appropriate dental service utilization.


Community Dent Oral Epidemiol. 2003 Feb;31(1):21-9.

Two-year incidence of oral disadvantage, a measure of oral health-related quality of life.

Chavers LS, Gilbert GH, Shelton BJ.

Department of Diagnostic Sciences, School of Dentistry, University of Alabama at Birmingham, AL 35294-0007, USA.

Dental research has progressed from describing the burden of oral disease using traditional epidemiologic measures of incidence and prevalence, to measuring how oral disease, oral signs, and oral symptoms affect the daily activities and the overall quality of life of the individual. However, longitudinal evaluation of these associations remains rare. OBJECTIVES: To (i). describe the 2-year incidence and patterns of oral disadvantage; (ii). identify dimensions of oral health measures that are significant antecedents of oral disadvantage; and (iii). determine which oral health dimensions are the most strongly predictive of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth and were 45 years or older. Incidence rates, odds ratios, and 95% confidence intervals were used to describe oral disadvantage and its relation to other measures of oral health. RESULTS: Nearly one-half of the participants experienced oral disadvantage at least once during 24 months of follow-up. The strongest antecedents associated with oral disadvantage were toothache pain and chewing difficulty. CONCLUSIONS: The incidence of oral disadvantage is substantial and consistent with the notion that oral health has a substantial impact on quality of life. Measures of oral pain and oral functional limitation were more strongly predictive of oral disadvantage than disease and tissue damage antecedents.


Community Dent Oral Epidemiol. 2001 Dec;29(6):412-23.

Is negative affectivity associated with oral quality of life?

Kressin NR, Reisine S, Spiro A 3rd, Jones JA.

Center for Health Quality, Outcomes and Economic Research, VAMC, 200 Springs Rd., Building 70, Bedford, MA 01730, USA.

OBJECTIVES: The personality trait of negative affectivity (NA) is associated with reports of worse physical health, more symptoms and worse health-related quality of life but its associations with oral quality of life (OQOL) are unexplored. In this study we examined the association of NA with OQOL. METHODS: We drew on data from two samples of older men: The VA Dental Longitudinal Study (DLS; n=177) and the Veterans Health Study (VHS; n=514), which included three measures of oral quality of life: the Oral Health-Related Quality of Life Measure (OHQOL), the Oral Health Impact Profile (OHIP), and the Geriatric Oral Health Assessment Instrument (GOHAI). For each OQOL measure, and the GOHAI and OHIP subscales, two regression models were estimated to examine the marginal change in variance due to NA: the first model included age, number of teeth, and self-rated oral health, and the second added NA. RESULTS: In both bivariate and multivariate analyses, higher NA was consistently associated with worse scores on the OQOL measures. In the regression analyses, NA explained an additional.01 to 18% of the variance in OQOL, explaining the most variance in the OHIP and the least in the OHQOL. The addition of NA explained more variance in the more subjective, psychologically oriented GOHAI and OHIP subscales than it did in the more objective, physical function oriented subscales. CONCLUSIONS: Psychosocial factors such as personality are significantly associated with quality of life ratings. Such associations should be taken into account when OQOL measurements are used and interpreted.


Community Dent Oral Epidemiol. 1988 Oct;16(5):271-3.

Oral disorders and treatment implications in people over 75 years.

MacEntee MI, Scully C.

University of British Columbia, Department of Clinical Dental Sciences, Vancouver,Canada.

The oral health of subjects over 75 yrs. and living independently in the southwest of Britain was assessed. The majority (80%) of the sample was edentulous, and a large proportion of both edentate and dentate subjects were using dentures. More than half of the denture wearers were using loose, very unhygienic, or structurally defective dentures. Mucosal pathoses were quite common, although most of the lesions were denture-induced stomatitis found in association with unhygienic dentures. The dentate subjects had, on average, 11 natural teeth, frequently with evidence of root caries and deep periodontal pockets or extreme bone loss. The oral health problems suggest that there is a significant need to develop effective methods of improving oral hygiene in this age group. The prosthetic treatment is related principally to denture repairs while there is a need to control root caries among the growing population of elderly dentate people.


J Dent Educ. 1993 Dec; 57(12):853-62.

The oral health burden in the United States: a summary of recent epidemiologic studies.

Caplan DJ, Weintraub JA.

Department of Dental Ecology, School of Dentistry, University of North Carolina at

Chapel Hill 27599-7450.

The nation's health care system is currently under scrutiny. A topic of great interest to the dental community is whether dentistry should be included in a plan for national health reform, and if so, what procedures should be covered. To answer this question, 1) the current oral disease burden in the United States should be assessed, and 2) factors associated with this burden should be described. This paper reviews several recent large-scale epidemiologic surveys of oral health in the United States, summarizes their major findings, outlines important risk factors for oral disease, and makes recommendations regarding future oral epidemiologic surveys. The discussion is limited to the following conditions: dental caries, periodontal diseases, tooth loss, edentulism, oral cancer, and orofacial clefts. Five out of six 17-year-olds have at least one decayed, missing, or filled tooth surface (DMFS), with a mean of eight DMFS per 17-year-old. However, 25 percent of the country's children have 75 percent of the dental caries; minority children, rural dwellers, those with minimal exposure to fluoride, and those from less educated or poorer families tend to have a greater caries experience. Root caries, gingivitis, periodontal pockets, and loss of periodontal attachment are more common among older individuals. Whites have more teeth than do Blacks of similar ages, and edentulism is more common among those with less education and income. Of those ages 65+, over 40 percent are edentulous and only 2 percent have all 28 teeth. An estimated 30,000 new cases and 8,000 deaths were attributed to oral cancer in 1991, with Black males having higher incidence and mortality rates than other subgroups. Oral clefts occur in about one in 700 total births, with Native Americans having the highest incidence.

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