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The ability to measure oral health is central to successful, patient-oriented clinical practice. In this regard, there have been a variety of definitions of oral health over the years, with the most recent being one by the FDI. Specific quality measures have been designed to assess, for example, the technical excellence of restorations, periodontal health, tooth wear, and, depth of caries (e.g. ICDAS). However, a single index that would produce a composite score of oral health could be considered desirable and the ideal criteria for this are discussed, namely, that it should be reproducible and valid, readily understood and capable of being used by dentists with minimal instruction and training. The profession has now entered the era of personalised medicine where risk factors need to be identified and patients educated about these, thus empowering them to work with their care provider and at home to take responsibility for their own dental health. As a result, a variety of oral health assessments, which include assessments of risk factors, have now become available: examples of these are described, with suggestions regarding the implementation of such into a clinician's practice being given.
CPD/Clinical Relevance: The ability to measure oral health is central to successful clinical practice.
Article
The World Health Organization1 describes health in holistic terms as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. This definition is broader than our traditional definitions of health, including patient-centred outcomes, which, in dentistry, we capture using quality-of-life measures and patient-reported outcomes. However, historically, dental health, and more recently, oral health has been measured in a number of ways. A common method of describing dental health was the DMFT or DMFS index (decayed missing and filled teeth or surfaces).2 However, this measure has been considered to have limitations (Table 1).
Many such measures of oral conditions do not assess their impact on a patient's quality of life, and, increasingly the drive is to record socio-dental indicators, defined by Locker as ‘measures of the extent to which dental and oral disorders disrupt normal role functioning’ should be applied.3 A study by Locker and Miller examined eight subjective oral health status indicators: the ability to chew and speak; oral pain and symptoms; ease of eating and communication; impact on daily life and worry/concern about appearance or health of teeth or mouth.4 The results indicated that it may be possible to identify populations in need of treatment and prevention using subjective indicators alone. However, it is the view of the principal author that examination of a patient (and speaking with them) is essential to measure their oral health. This is particularly pertinent in the COVID-19 era, where the role of remote consultations has a place, but may not facilitate the formulation of a diagnosis.
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