, Measuring Oral Health
and Quality of Life
Edited by
Gary D. Slade
Proceedings of a conference held June 13-14, 1996, at the University of
North Carolina-Chapel Hill, North Carolina. The conference and this
publication supported jointly by the Agency for Health Care Policy and
Research and the National Institute of Dental Research, NIH Grant
#R13 HS09254. Support for attendance by seven individuals was provided
by the US Department of Veterans Affairs.
Conference Organizing Committee
Dr. Gary D. Slade, Principal Investigator
Dr. Ron Strauss, co-Principal Investigator
Dr. Kathryn Atchison
Dr. Nancy Kressin
Dr. David Locker
Dr. Susan Reisine
Published by:
Department of Dental Ecology,
School of Dentistry,
University of North Carolina.
September, 1997.
,S TATEMENT ON E QUAL E DUCATIONAL O PPORTUNITY
The University of North Carolina at Chapel Hill is open to people of all races, is
committed to equality of educational opportunity, and does not discriminate against
applicants, students, or employees based on race, color, national origin, religion, sex,
age, or disability. Any complaints alleging failure of this institution to follow this
policy should be brought to the attention of the Assistant to the Chancellor. The
University of North Carolina at Chapel Hill actively seeks to promote integration by
recruiting and enrolling a larger number of African American, Native American, and
other minority students.
P OLICY ON N ONDISCRIMINATION
It is the policy of The University of North Carolina at Chapel Hill that educational and
employment decisions be based on individuals' abilities and qualifications and not on
factors or personal characteristics that have no connection to academic abilities or job
performance. Among the traditional irrelevant factors are race, sex, religion, and
national origin. It is the policy of The University of North Carolina at Chapel Hill that
an individual's sexual orientation be treated in the same manner. This policy
prohibiting discrimination on the basis of sexual orientation does not apply to the
University's relationship with outside organizations, including the federal government,
the military, ROTC, and private employers.
To order copies of this publication, contact the Department of Dental Ecology,
University of North Carolina, CB#7450, Chapel Hill, NC 27599-7450, USA.
Phone [Int +1] 919/966-2787. FAX: [Int +1] 919/966-6761
Suggested citation style: (Chapter Author(s).. Chapter Title.) In: Slade GD, ed.
Measuring Oral Health and Quality of Life. Chapel Hill: University of North Carolina,
Dental Ecology 1997.
ii
, F OREWORD
This publication contains a selection of papers that were presented at a conference
entitled "Assessing oral health outcomes: measuring health status and quality of life".
The purpose of the conference, which was held on June 13 and 14, 1996 in Chapel Hill,
North Carolina, was to examine methods for measuring oral health related quality of
life, with the long-term objective of promoting use of those measures in oral health
outcomes research. The specific aims of the conference were:
1. To critically evaluate existing measures of oral health related quality of life - their
theoretical framework, method of administration, reliability, validity and potential
for use in oral health outcomes assessment;
2. To identify omissions/deficiencies in existing measures and recommend new
research directions for their use in future oral health outcomes research; and
3. To disseminate findings through a handbook that describes and critically analyzes
existing oral health related quality of life measures
The Chapters that follow address the third aim by presenting background papers and
details of eleven instruments that measure oral health related quality of life.
B ACKGROUND AND RATIONALE FOR THE CONFERENCE
The conference’s aims arose from a concern that there was a significant divide between
one group of researchers, predominantly from psychometric and social survey
backgrounds, who had developed instruments measuring oral health related quality of
life, and another group of researchers, primarily concerned with dental health services
and clinical trials, who potentially could use those instruments in the assessment of
oral health outcomes. A related problem was recognized more than two decades
earlier when Cohen and Jago first advocated the development of "sociodental"
indicators to capture non-clinical aspects of oral disease. 1 They argued that sociodental
indicators were necessary to broaden the narrow focus that had emerged within oral
epidemiology, which emphasized only the clinical parameters of disease, and therefore
failed to document the full impact of oral disorders within populations.
Since the initial work of Cohen and Jago, there had been an impressive amount of
research undertaken to develop sociodental indicators - although with the passage of
time, the term "oral health related quality of life" increasingly was adopted to define
these measures of subjective oral health status. This redefinition was consistent with
research that had gone ahead within other health-related disciplines that identified
"health related quality of life" as a multidimensional construct capturing subjective
aspects of health. 2 The multiple dimensions of health related quality of life range from
impairments (which are closely linked to clinically-defined health status) to social
function, and more global constructs such as opportunity. The dimensions have been
linked in conceptual models in which effects of impairments on disability or reduced
opportunity are mediated by intervening personal and environmental factors. 3,4 Within
medicine, these theoretical models have now been adapted to the more practical task of
linking general medical status and clinical care to quality of life. 5
iii
and Quality of Life
Edited by
Gary D. Slade
Proceedings of a conference held June 13-14, 1996, at the University of
North Carolina-Chapel Hill, North Carolina. The conference and this
publication supported jointly by the Agency for Health Care Policy and
Research and the National Institute of Dental Research, NIH Grant
#R13 HS09254. Support for attendance by seven individuals was provided
by the US Department of Veterans Affairs.
Conference Organizing Committee
Dr. Gary D. Slade, Principal Investigator
Dr. Ron Strauss, co-Principal Investigator
Dr. Kathryn Atchison
Dr. Nancy Kressin
Dr. David Locker
Dr. Susan Reisine
Published by:
Department of Dental Ecology,
School of Dentistry,
University of North Carolina.
September, 1997.
,S TATEMENT ON E QUAL E DUCATIONAL O PPORTUNITY
The University of North Carolina at Chapel Hill is open to people of all races, is
committed to equality of educational opportunity, and does not discriminate against
applicants, students, or employees based on race, color, national origin, religion, sex,
age, or disability. Any complaints alleging failure of this institution to follow this
policy should be brought to the attention of the Assistant to the Chancellor. The
University of North Carolina at Chapel Hill actively seeks to promote integration by
recruiting and enrolling a larger number of African American, Native American, and
other minority students.
P OLICY ON N ONDISCRIMINATION
It is the policy of The University of North Carolina at Chapel Hill that educational and
employment decisions be based on individuals' abilities and qualifications and not on
factors or personal characteristics that have no connection to academic abilities or job
performance. Among the traditional irrelevant factors are race, sex, religion, and
national origin. It is the policy of The University of North Carolina at Chapel Hill that
an individual's sexual orientation be treated in the same manner. This policy
prohibiting discrimination on the basis of sexual orientation does not apply to the
University's relationship with outside organizations, including the federal government,
the military, ROTC, and private employers.
To order copies of this publication, contact the Department of Dental Ecology,
University of North Carolina, CB#7450, Chapel Hill, NC 27599-7450, USA.
Phone [Int +1] 919/966-2787. FAX: [Int +1] 919/966-6761
Suggested citation style: (Chapter Author(s).. Chapter Title.) In: Slade GD, ed.
Measuring Oral Health and Quality of Life. Chapel Hill: University of North Carolina,
Dental Ecology 1997.
ii
, F OREWORD
This publication contains a selection of papers that were presented at a conference
entitled "Assessing oral health outcomes: measuring health status and quality of life".
The purpose of the conference, which was held on June 13 and 14, 1996 in Chapel Hill,
North Carolina, was to examine methods for measuring oral health related quality of
life, with the long-term objective of promoting use of those measures in oral health
outcomes research. The specific aims of the conference were:
1. To critically evaluate existing measures of oral health related quality of life - their
theoretical framework, method of administration, reliability, validity and potential
for use in oral health outcomes assessment;
2. To identify omissions/deficiencies in existing measures and recommend new
research directions for their use in future oral health outcomes research; and
3. To disseminate findings through a handbook that describes and critically analyzes
existing oral health related quality of life measures
The Chapters that follow address the third aim by presenting background papers and
details of eleven instruments that measure oral health related quality of life.
B ACKGROUND AND RATIONALE FOR THE CONFERENCE
The conference’s aims arose from a concern that there was a significant divide between
one group of researchers, predominantly from psychometric and social survey
backgrounds, who had developed instruments measuring oral health related quality of
life, and another group of researchers, primarily concerned with dental health services
and clinical trials, who potentially could use those instruments in the assessment of
oral health outcomes. A related problem was recognized more than two decades
earlier when Cohen and Jago first advocated the development of "sociodental"
indicators to capture non-clinical aspects of oral disease. 1 They argued that sociodental
indicators were necessary to broaden the narrow focus that had emerged within oral
epidemiology, which emphasized only the clinical parameters of disease, and therefore
failed to document the full impact of oral disorders within populations.
Since the initial work of Cohen and Jago, there had been an impressive amount of
research undertaken to develop sociodental indicators - although with the passage of
time, the term "oral health related quality of life" increasingly was adopted to define
these measures of subjective oral health status. This redefinition was consistent with
research that had gone ahead within other health-related disciplines that identified
"health related quality of life" as a multidimensional construct capturing subjective
aspects of health. 2 The multiple dimensions of health related quality of life range from
impairments (which are closely linked to clinically-defined health status) to social
function, and more global constructs such as opportunity. The dimensions have been
linked in conceptual models in which effects of impairments on disability or reduced
opportunity are mediated by intervening personal and environmental factors. 3,4 Within
medicine, these theoretical models have now been adapted to the more practical task of
linking general medical status and clinical care to quality of life. 5
iii
