September 2008

Research on oral health and quality of life has its origins in a series of seminal papers published in the mid 1970s to the late 1980s. These capitalized on changing definitions of health and emerging models of disease and its consequences such as that contained within the WHO’s International Classification of Impairment, Disability and Handicap. The intent of these papers was to provide a conceptual and theoretical basis for the development of subjective oral health indicators. These were concerned with assessing the extent to which oral disorders compromised physical and psychosocial functioning and were meant to complement the clinical indices that occupied centre stage in surveys of the oral health of populations and clinical groups. These papers began something of a paradigm shift in dental research; from a strictly biomedical model, which was narrow, biologically based and placed undue emphasis on disease, to a biopsychosocial model, which was more holistic, incorporated issues such as functioning and well-being and was more compatible with the primary purpose of health care, restoring and enhancing health. These papers stimulated the development of a number of measures of the functional and psychosocial impacts of oral disorders. The content, development and performance of the first ten were presented and compared at a major conference held at the University of North Carolina in 1997. Many, if not most, were expert rather than patientbased, and put together on a somewhat ad hoc basis without recourse to classical test theory. However, their psychometric properties in terms of validity, reliability and responsiveness were adequate and several, such as the Oral Health Impact Profile, the Geriatric (General) Oral Health Assessment Index, the Oral Impacts on Daily Living and the Child Oral Health Quality of Life Questionnaires perform well, have become accepted as standards and are becoming widely used in surveys and clinical outcome studies. A notable feature of the 1997 conference was a terminological shift, so that the measures available at the time were renamed as measures of ‘oral health-related quality of life’ (OHRQoL).