Dimensions of oral conditions and health-related quality of life among adults: a population based study

Abstract

Oral health is an integral part of general health and oral diseases are considered an important public health problem due to their prevalence, expense associated with treatment and their impact on individuals and societies. Over the last few decades, a paradigm shift from a Biomedical to a Bio-Psychosocial model of health stimulated the development of subjective measures of health and well-being. This idea is central to the concept of HRQoL, which encompasses individuals’ evaluations of physical, psychological, and social well-being associated with their health state. Although the relationship between oral and general health has been well established by clinical and epidemiological studies, a longstanding question remains on the impacts of oral conditions on general HRQoL. This evidence can have key implications for integrating oral and general health prevention strategies to the existing knowledge on common risk factors and co-occurrence of oral and general diseases. The general aim of the current thesis was to investigate the association between oral health dimensions and HRQoL among adults. Specific objectives were: 1) to verify if chronic oral health conditions are associated with HRQoL; 2) to estimate the association between dentition status and HRQoL; 3) to assess clustering of oral and general chronic conditions and to explore the association between the patterns of multimorbidity and HRQoL; and 4) to test a health-related quality of life conceptual model for oral health conditions. The objectives were addressed in four papers. Paper 1 was a systematic review, and was conducted in order to address specific objective 1. Specific objectives 2, 3 and 4 were addressed through the empirical component of the thesis. Secondary analyses were performed on the data of the EpiFloripa study, a population based prospective study viii conducted with adults (20-59 years) from Southern Brazil, in 2009 (n=1,720) and 2012 (n=1,223). Findings presented in this thesis indicate that a negative association between oral conditions and HRQoL exists. Individuals with more teeth had better HRQoL, and a functional dention was important for individuals’ HRQoL. However, there was a lack of evidence that a shortened dental arch (SDA) is negatively associated with HRQoL. Furthermore, individuals with general health conditions are more likely to also present oral health problems, and multimorbidity is negatively associated with HRQoL. Finally, our findings support Wilson and Cleary’s model for HRQoL as applied to untreated dental caries. The evidence provided by the current thesis reinforces the integration of oral and general health policies, aiming at reducing the burden of oral disease and improving quality of life.