ORAL HEALTH RELATED QUALITY OF LIFE

Data about the impacts on people´s life caused by oral condition has been gathered recently in the last decades. It is accepted and recognized by dental community that oral health status can cause considerable pain and suffering, if oral symptoms remain untreated would be a major source of diminished quality of life; disturbing people´s food choices or their speech, or may lead to sleep deprivation, depression, and multiple adverse psychosocial out comes. Influencing how people grow, enjoy life, chew, taste food and socialize, as well as their feelings of social wellbeing. There are so many oral conditions that impact negatively on quality of life like caries, periodontal disease, tooth loss, cancer, dental injuries, dental fluorosis, and dental anomalies, craniofacial disorders among others. In fact, not only dental disease but also treatment experience can negatively affect the oral health related quality of life. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual‟s oral health, functional well-being, emotional wellbeing, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization(WHO) as an important segment of the Global Oral Health Program (2003). There are different approaches to measure OHRQOL; the most popular one is multiple item questionnaires. OHRQOL should be the basis for any oral health programme development. Moreover, research at the conceptual level is needed in countries where OHRQOL has not been previously assessed, including India.

are important, and affect overall welfare." HRQoL is an important subjective component so it will depend on the relationship that each individual has with his life. This concept will vary and depend largely on the perception that people has about their physical, mental, social and spiritual state, largely depending on their own values, convictions and beliefs, as well as their personal cultural context and history. [1] Oral Health Related Quality of Life (OHRQoL) Although oral health problems are rarely a matter of life and death they remain a major public health problem because of its prevalence and there are significant indications that oral health problems have social, economic and psychological consequences, this means that they haveimpact of quality of life. Oral healthrelated quality of life was defined as a "self-report specifically pertaining to oral health-capturing both the functional, social and psychological impacts of oral disease".
Oral health related quality of life (OHRQOL) is a relatively new, but rapidly growing phenomenon, which has emerged over the past 2 decades. It is evident from the literature that the notion of OHRQOL appeared only in the early 1980s in contrast to the general HRQOL notion that started to emerge in the late 1960s. One explanation for the delay in the development of OHRQOL could be the poor perception of the impact of oral diseases on QOL. The concept of "OHRQOL" captures the aim of new perspective i.e., the ultimate goal of dental care mainly good oral health. According to the US Surgeon General, oral disease and conditions can "…undermine self-image and self-esteem, discourage normal social interaction, and cause other health problems and lead to chronic stress and depressionas well as incur great financial cost.
QOL is a highly individual concept. Mount and Scot linkened the assessment of it to assessing the beauty of rose: No matter how many measurements are made (Ex-color, Smell, Height, etc.) the entire beauty of the rose is never captured. QOL that are important to an individual, although systems in which patient specify at least some of the qualities are likely to come closest. [3] Common dimensions in OHRQoL instruments are given in Fig  As HRQoL oral health related quality of life is highly subjective and has to be assessed within the framework of patients" conditions, sociocultural environments and own experiences and states of mind: because OHRQoL is related to daily life and is unique to each individual, even patients with severe conditions can report having nutritional level. It has been reported that wearing dentures may interfere with the ability to eat satisfactorily, talk clearly, and laugh freely.
Tooth loss is one of the worst types of damage to oral health, causing esthetic and functional problems. Some other common oral conditions, such as caries, periodontal disease, which are almostuniversal in prevalence, and which are chronic but with acute recurring episodes, also impacton QoL. Another alteration that affects quality of life is malocclusion.
There is an association between the presence of malocclusion with worse OHRoQL. Particularly the one related to lack of space, facial pain has adversely effects of body image, social interaction and daily behavior of the individual. Not only malocclusion but also its treatment has an effect on OHRQoL may also affect QoL through their effect on function and esthetics. [3] • Identifying and prioritizing problems

Instruments to assess OHRQoL
The clinical indexes do not evaluate these aspects, they only measure the presence and severity of illness, and givescarce consideration to the functionality of the oral cavity as a whole, or to the impact of the symptoms on the patients" quality of life. So the clinical indexes that are commonly used to establish the presence and severity of pathological conditions should be complemented with indicators of social and emotional aspects related to the individual experience and subjective perception of changes in the patients" physical, mental, and social health.

Geriatric Oral Health Assessment Index (GOHAI)
The GOHAI is one of the most commonly used scales in assessment of OHRQoL it was developed by Kathryn Atchison and Dolan in 1990 in the USA for use with elderly populations. It is compounded by 12-items developed with three months" time reference, with five (six in the original) Likert scale options, scoring as "often", always", "seldom "or "sometimes" and "never" reflecting the aspects that are considered to have an impact upon the quality of life of the older population as given in Table 1. [4] It was developed to evaluate threedimensions of OHRQoL including physical functions like eating, chewing, speech, swallowing psychosocial functions like worry, limitations and discomfort with social contacts, dissatisfaction with appearance; and self-consciousness about oral health, pain or discomfort including the use of medication or discomfort from the mouth. The GOHAI score is determined by summing the final score of each of the 12 items. [5] (Locker, 1988). The OHIP contains 49 assessing seven dimensions of impacts of oral conditions on people"s OHRQoL including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. [6] A short version, OHIP-14, was later developed based on a subset of 2 questions for each of the 7 dimensions. It is patient-centered, gives a greater weight to psychological and behavioral outcomes, is better at detecting psychosocial impacts among individuals and groups, and better meets the main criteria for the measurement of OHRQoL. The OHIP 14 responses, "never", "hardly ever", "occasionally", "fairly often", and "very often", were codified from 0 to 4, respectively [7] as mentioned in Table 2. The scores assigned to the responses to the 14 questions are added to obtain values between 0 and 14. [8]