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Oral epidemiology and development of oral health-related quality-of-life measures

14 December 2014

The UCL Dental Public Health Group has led the international field in the development of quality of life measures for oral health. These measures have been employed in epidemiological surveys nationally and internationally, influencing health policies and resulting in enhanced use of resources, improved patient care and health care access.

Understanding the quality of life of individuals is cardinal in the delivery of healthcare, as it provides a means to evaluate the personal and social impact of disease and its treatment, and thus provides a more rounded appreciation of disease than clinically derived markers alone.

Led by Dr Georgios Tsakos and Professor Aubrey Sheiham, the UCL Dental Public Health (DPH) Group developed the Oral Impacts on Daily Performances (OIDP) measure in 1996, followed by the Child Oral Impacts on Daily Life (Child-OIDP) in 2004, to assess to what extent oral conditions affect the quality of life of adults and children respectively.

The OIDP and the Child-OIDP have since been employed in epidemiological surveys in the UK and more than 25 other countries. The UCL DPH group's work has facilitated the practical application of oral health-related quality of life (OHRQoL) measures for assessing oral health needs and planning services, and also their application to evaluate clinical interventions. In addition, Dr Tsakos has led work to set recommended standards for reporting and interpreting OHRQoL measures. The impact of this research on oral epidemiology and OHRQoL measures is evidenced locally, nationally and internationally.

In 2009, Camden and Islington Primary Care Trust (PCT) used the OIDP to undertake a survey of the dental needs of elderly people in nursing homes. As a result, in 2012 the PCT established oral health measures as a key component of their local standards for residential homes in Islington. Homes must now ensure that all new residents receive an oral health assessment to identify and arrange urgent treatment; the oral hygiene practice of all residents should be recorded daily; a referral system for attendance to the dentist must be put in place for those in need; nursing home staff are trained to undertake these oral health related tasks. In practical terms, care has been improved and existing resources more effectively employed. Increased numbers of residents have been referred to the Community Dental Services to receive treatment, while NHS commissioned the provision of high concentration fluoride toothpaste for residents at risk of dental caries.

In 2010, the OIDP was a major component of a survey carried out at Holloway Prison, London. This has led to the London Borough of Islington/NHS North Central London to commission an enhanced oral health promotion service in Holloway Prison for 2013-14.

As a result of UCL epidemiological research, Islington carried out a pilot community-based fluoride varnish programme in 2010. The success of this project led to Islington Clinical Commissioning Group investing in a community-based fluoride varnish scheme. In the scheme fluoride varnish is applied, twice a year, to the teeth of 6,000 children attending children's centres, community nurseries and schools in the most deprived areas of Islington.

The survey is pivotal to our planning oral health services. Our services and workforce continues to develop to address the needs that arise in the knowledge of what we expect to see. - Chief Dental Officer, NHS England

The survey is pivotal to our planning oral health services. Our services and workforce continues to develop to address the needs that arise in the knowledge of what we expect to see. - Chief Dental Officer, NHS England

At national level, the UCL DPH Group helped conduct the 2009 Adult Dental Health Survey for England, Wales and Northern Ireland. The OIDP was included in this survey for the first time, to assess how severely oral health problems affected the ability of people to carry out basic functions of their daily life. The results have been used by the NHS to shape the planning and commissioning of the NHS dental services. The Child-OIDP has also been used to assess OHRQoL in the Children's Dental Health Survey 2013 for England, Wales and Northern Ireland; the results are expected in early 2015.

The OIDP and Child-OIDP have been part of national dental health surveys in different countries. Following a survey of children in Thailand, the Dental Health Division of the Thailand Department of Health set new national oral health goals based on OHRQoL aspects.

Through his involvement in the European Association of Dental Public Health, Tsakos has been instrumental in the Platform for Better Oral Health in Europe, a European-wide initiative that engages with key stakeholders and non-clinical audiences in terms of policy development and priority setting for the EU. His epidemiological and OHRQoL expertise have influenced the oral health policy in Europe through recommendations to key policymakers, such as European Commission officials and European Parliament members, and the formulation of 2020 targets for improved oral health in Europe.