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Association between oral health and quality of life

Research

15 May 2012

Oral health as a concept has evolved. Today it not only involves issues that are directly related to the oral cavity, like chewing or swallowing, but also entails other social and psychologically-related aspects that affect an individual’s self esteem, communication, expression and even physical appearance. 

The quality of life associated with oral health relates to the impact that oral changes can have on daily life and that are important to people. 

Dental hypersensitivity 

Dental hypersensitivity (DH) is defined as a dental pain caused by a seemingly normal stimulus (1). Some studies have shown that the loss of dental health can reduce quality of life by up to 3 times with respect to the general population, with DH being the most common complaint (50.7%)(2)

DH can directly affect patients’ quality of life, forcing them at times to change their social, nutritional and hygiene habits. 

This decrease in quality of life occurs because of the pain or discomfort experienced with the intake of certain foods or drinks. As a consequence, patients reduce their consumption of these foods and may even stop consuming their favourite foods and drinks all together. 


DH can also have serious repercussions on the rest of oral health. In order to avoid pain, patients are at times unmotivated and tend to stop brushing as long or as efficiently as they normally do, which can cause the accumulation of bacterial plaque (oral biofilm) and increase the risk for cervical caries(3), gingivitis and periodontitis. 

Xerostomia 

Xerostomia is the most common clinical manifestation of salivary dysfunction(4) and involves the reduction or absence of salivary secretion. It is also known as dry mouth. 

Proper oral hygiene with the right products can boost the quality of life of these patients. 

A lack of humectation in the oral cavity can cause a variety of clinical signs that may negatively alter a patient’s quality of life. Xerostomia makes oral functions difficult, including chewing, swallowing and phonation, among others. It can also affect soft tissues, since the lack or reduction of saliva makes them more susceptible to dryness, burning, irritation and inflammation: of the mucosa (mucositis), of the mucous membrane that supports prostheses (subprosthesis stomatitis) and of the gums (gingivitis); as well as the presence of painful ulcers and local infections (candidiasis)(5). The main effects on dental tissues are an increase in caries (6) and dental sensitivity (7). Another complication that might occur is halitosis. 

Halitosis 

Halitosis is expressed as a set of unpleasant or offensive odours coming from the oral cavity. 

It can seriously affect the quality of life of those who suffer from it, since it tends to have psychological, personal behavioural and even professional implications


Psychological implications: increases anxiety and stress levels. Causes loss of confidence and low self esteem.


Social implications: affects relationships with others and interferes with intimate relationships. 


Professional implications: it can negatively affect one’s image and even influence aspects as important as professional success. 


Behavioural implications: limits oral communication and can even make a person with halitosis cover their mouth or use more non-verbal communication. Increases interpersonal distance. 


Halitosis is also directly related to caries, gingivitis and periodontitis from oral biofilm build-up(9,10)

Orthodontics 

Orthodontics is the area of dentistry that studies, prevents and corrects alterations in development, the shape of dental arches and the position of maxillaries, in order to restore morphological and functional balance in the mouth and face, thus improving dental and facial aesthetics, leading to an increase in a patient’s quality of life.

Despite advances in orthodontics, reducing the discomforts that commonly occur throughout treatment, and that can negatively affect its outcome and the quality of patients’ lives, continues to be a great challenge. 

The difficulty to remove oral biofilm from highly retentive areas, such as orthodontic appliances, can cause gingival inflammation, caries and halitosis. 


After insertion and activation of orthodontic appliances, pain and discomfort may appear because of the great pressure on teeth from chewing or clenching. Ulcers caused by the rubbing of orthodontic appliances against soft tissues are also very common. All of this makes eating and even talking quite difficult (11)

Prostheses 

A dental prosthesis is an artificial element used to repair the anatomy of one or of several missing teeth, in order to restore the relation between maxillaries and gain back aesthetics and the ability to chew and swallow. 

Therefore, the use of a prosthesis increases a patient’s quality of life. 

But even so, some inconveniences exist, such as the possible development of sub-prosthesis stomatitis and lesions of the mucous membrane during the integration process, due to poor adjustment or displacement of the prosthesis that can cause pain, speech difficulty, reduced chewing force, increase in the growth of bacteria that cause bad odour, etc. 


The use of high quality adhesives can prevent dentures from moving and rubbing gums. But when the adhesive used does not secure dentures, they can bring back pain, psychological problems such as insecurity while talking, problems chewing, eating, etc., which can represent a significant limitation to quality of life. In all of these cases, proper oral hygiene with specific products for each condition, along with regular check-ups with a specialist, can increase these patients’ quality of life.

Bibliography

  1. Curro FA. “Hipersensibilidad dental en la variedad del dolor”. Dent Clin N Am 1990; 34 (3): 393-402.
  2. Bekes K, John MT, Schaller HG ,Hirsch C. “Oral health-related quality of life in patients seeking care for dentin hypersensitivity”. J Oral Rehabil 2009; 36: 45-51.
  3. Dababneh RH, Khouri AT, Addy M. “Dentine hypersensitivity an enigma. A review of terminology, epidemiology, mechanisms, etiology and management”. Br Dent J 1999 (Dec): 187 (11): 606-611.
  4. M, Escalona LA. “Manejo terapéutico del paciente con xerostomía”. Acta Odontol. 2001; 39: 70-9.
  5. Valdez I Fox P. “Diagnosis and management of salivary dysfunction”. Oral Biol and Med 1993,4: 271-277.
  6. Mandel I. “Impact of saliva on dental caries”. Compend Cotin Educ Dent 1989; 13: 476-481
  7. Javier Jiménez Duarte. “Aspectos clínicos y tratamiento de la xerostomía”. Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello. Volumen 33. Número 1, marzo de 2005.
  8. Widdop F. “Caring for the dentate elderly”. Int Dent J. 1989; 39:85-94.
  9. Rosenberg M, Leib E. “Experiences of an Israeli malodor clinic”. In: Rosenberg M, editor. Bad breath: research perspectives. Tel Aviv, Israel: Ramot Publishing; 1995: 137– 48.
  10. Messadi DV. “Oral and nonoral sources of halitosis”. Calif Dental Assoc 1997; 25: 127– 31.
  11. Estudio de higiene oral en portadores de ortodoncia realizado en 211 clínicas odontológicas. Laboratorios Dentaid. 2009.

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