Setting oral health goals that include oral health-related quality of life measures: a study carried out among adolescents in Thailand Incorporação da qualidade de vida relacionada à saúde bucal em metas de saúde bucal: estudo conduzido em adolescentes tailandeses

The aim of this study was to assess the association between oral diseases and condition-specific oral health-related quality of life (CS-OHRQoL) as a basis for proposing OHRQoL-based goals for the population of 15-year-olds in Thailand. Oral examinations and OHRQoL interviews were conducted with 871 15-year-olds as part of the Sixth Thailand National Oral Health Survey. The severity of oral impacts was categorized using “intensity”. Associations between oral diseases and CS-OHRQoL were analyzed using chi-square and logistic regression. Thirty-nine percent of 15year-olds experienced moderate/higher levels oral impacts on quality of life. Compared to those individuals with no tooth decay, adolescents with one or four or more decaying teeth were three and seven times more likely to experience moderate/ higher impacts, respectively. Adolescents with extensive gingivitis in 3 or more mouth sextants were twice as likely to experience moderate/higher CS-impacts. Based on these findings, it is proposed that goals should focus on untreated decaying teeth and extensive gingivitis. Oral health goals for 15-year-olds should include specific OHRQoL measures. Dental Caries; Adolescent; Gingivitis; Oral Health; Quality of Life Introduction The major goal of the dental profession is to improve peoples’ quality of life 1. Therefore, quality of life measures must be included in setting oral health goals for the profession. Incorporating quality of life measures into national oral health goals is vital because oral health is not the absence of oral diseases, but the physical, psychological and social well-being in relation to oral status 2. The World Dental Federation (FDI)/ World Health Organization (WHO)/International Association for Dental Research (IADR) collaboration published guidelines recommending the development of broader oral health goals rather than only using oral disease goals 3. The guidelines stressed the importance of oral health-related quality of life (OHRQoL). They stated that the goals of oral health services were “to minimize the impact of diseases of oral and craniofacial origin on health and psychosocial development” 3 (p. 286). They encouraged local actions to adopt such a broader approach to goal setting and oral health service planning. The FDI/ WHO/IADR guidelines also provided examples of goals for reductions in specific oral diseases that are known to cause impacts on quality of life. A number of OHRQoL indexes have been developed and applied to compliment clinical indices 4. Although some countries have included OHRQoL measures in their national oral health surveys 5,6,7,8,9 and some studies have proposed ARTIGO ARTICLE Krisdapong S et al. 1882 Cad. Saúde Pública, Rio de Janeiro, 28(10):1881-1892, out, 2012 specific applications of OHRQoL to oral health service planning 10,11, no country had ever comprehensively included OHRQoL measures in setting oral health goals for the population. Previous oral health goals for the Thai population were disease-based and typical of those set by many countries. The oral health goals for adolescents in the year 2000 stated that not less than 75% of 18-year-olds should retain all 28 permanent teeth, and all 18-year-olds should have at least two sextants, on average, with healthy periodontal tissues (Community Periodontal Index; CPI = 0) 12. In 2007, the Thai government published its oral health goals for 2020 in accordance with the FDI/WHO/IADR guidelines and a theoretical framework for linking clinical status and quality of life was developed. The ultimate goal of the Thai Oral Health Service is: “people of all ages should have oral health that enables good quality of life and social well-being” 13 and clinical goals were set based on the assumption that a reduction in oral diseases would lead to better quality of life. Clinical data from previous National Oral Health Surveys 14,15 was used to provide a baseline and only one oral health goal was set for adolescents: not more than 60% of 17 to 19-yearolds should have periodontal disease (CPI = 1 or above) 13. Although evidence suggests a positive association between oral status and OHRQoL, the defined clinical goal for Thai adolescents was theoretical and not supported by scientific evidence of an association. Relatively few studies exist on the association between oral disease and OHRQoL in adolescent populations and their findings are inconclusive. Dental caries and progressive forms of periodontal disease were significantly associated with adolescents’ OHRQoL 16,17,18, while findings regarding general periodontal disease, missing teeth and dental fluorosis were equivocal 16,17,19,20. Moreover, most of the studies used generic OHRQoL measures that have poorer discriminative ability than condition-specific (CS) measures 21,22. As the latest Thai oral health survey included condition-specific OHRQoL measures and Thai oral health goals for 2020 explicitly mention OHRQoL as the ultimate goal of the oral health service, it was considered important to assess the relation between clinical and OHRQoL measures using a CS-OHRQoL measure developed in Thailand. Findings from the Thai oral health survey regarding overall OHRQoL in 15-year-olds suggested that, although oral impacts in this age group were very common (83%), the prevalence of severe and very severe impacts was only 8%. In addition, oral ulcers and toothache were the main perceived causes of overall oral impacts 23. In addition to the information from the above study, data from Thailand is used to illustrate the broader principle of setting oral health goals as recommended by the FDI/WHO/IADR guidelines. The objectives of this study were therefore to assess the association between specific oral diseases and CS-OHRQoL and classify adolescents in terms of level of risk of adverse effects on quality of life. Finally, based on these findings, the study aimed to propose OHRQoL-based oral health goals for this age group in Thailand.