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A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health

2017; Elsevier BV; Volume: 151; Issue: 2 Linguagem: Inglês

10.1016/j.ajodo.2016.11.010

1097-6752

Michael Glick, David M. Williams, Dushanka V. Kleinman, Marko Vujicic, Richard G. Watt, Robert J. Weyant,

Healthcare cost, quality, practices

On September 6, 2016, a new definition of oral health was overwhelmingly approved by the FDI World Dental Federation General Assembly. This was a key part of the organization's advocacy and strategic plan—Vision 2020.1Glick M. Monteiro da Silva M. Seeberger G.K. et al.FDI Vision 2020: shaping the future of oral health.Int Dent J. 2012; 62: 278-291Crossref PubMed Scopus (117) Google Scholar The definition, together with a companion framework, creates an opportunity for the profession to reflect on what oral health encompasses and what the implications are of this definition for clinical practice and oral health policy. But why was a new definition needed? Although oral health has been recognized for millennia to be an essential component of overall health and well-being, it has not been clear whether oral health has meant the same thing for different components of our profession and for our stakeholders. And if we are uncertain as a profession what we mean, how can we explain ourselves clearly to our patients, other health care professionals, policy makers, and those others we seek to collaborate with and inform? A common definition can bring stakeholders together to advocate for the importance of oral health; to influence and shape parameters of care, health policies, research, education, and reimbursement models; and to shape the future of our profession. During the creation of FDI's Vision 2020,1Glick M. Monteiro da Silva M. Seeberger G.K. et al.FDI Vision 2020: shaping the future of oral health.Int Dent J. 2012; 62: 278-291Crossref PubMed Scopus (117) Google Scholar it became evident that there was a need for a universally accepted definition of oral health, one that conveys that oral health is a fundamental human right and that facilitates the inclusion of oral health in all policies. To accomplish this goal, the FDI charged a newly created Think Tank with producing such a definition. A definition was needed that included the full scope of health and well-being and, ultimately, one that could be agreed on by all. Traditionally, oral health has been defined as the absence of disease. This definition fails to account for a person's values, perceptions, and expectations. Furthermore, existing definitions of oral health mostly lack a theoretical framework that can be used to address all of the domains and elements that are part of oral health. The new definition acknowledges the multifaceted nature and attributes of oral health (Box) . Alongside the proposed concise definition, a companion framework was developed to describe the complex interactions among the 3 core elements of oral health (disease and condition status, physiological function, and psychosocial function), a range of driving determinants (elements that influence and determine oral health), moderating factors (factors that determine or affect how a person scores his or her oral health), and, finally, overall health and well-being (Fig) . (A powerpoint version of the new definition of oral health and its accompanying framework can be downloaded at http://www.fdiworldental.org/oral-health/vision-2020/a-new-definition-of-oral-health.aspx.)Definition of oral healthTabled 1Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.Further attributes of oral health:— It is a fundamental component of health and physical and mental well-being. It exists along a continuum influenced by the values and attitudes of people and communities.— It reflects the physiological, social, and psychological attributes that are essential to the quality of life.— It is influenced by the person's changing experiences, perceptions, expectations, and ability to adapt to circumstances. Open table in a new tab Tabled 1Oral health is multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.Further attributes of oral health:— It is a fundamental component of health and physical and mental well-being. It exists along a continuum influenced by the values and attitudes of people and communities.— It reflects the physiological, social, and psychological attributes that are essential to the quality of life.— It is influenced by the person's changing experiences, perceptions, expectations, and ability to adapt to circumstances. Open table in a new tab In addition to the creation of a theoretical framework, there are several other advantages associated with adoption of this new definition of oral health. The new definition—echoes definitions used by the World Health Organization (WHO), national dental associations worldwide, and many other organizations and is, therefore, not a revolution but an evolution of existing definitions;—moves dentistry from treating disease to providing care and support for oral health;—uses language that resonates with language commonly used in the health care realm—words and concepts that health care professionals across disciplines can understand and use;—raises awareness of the different dimensions of oral health and emphasizes that oral health does not occur in isolation but is embedded in the wider framework of overall health. FDI represents more than 1 million dentists through its more than 200 national dental associations in more than 130 countries; it represents dentistry at WHO and is a member of the World Health Professions Alliance and the Supporters Consultation Group of the Non-Communicable Disease Alliance.2World Dental Federation. FDI in brief. Available at: http://www.fdiworldental.org/about-fdi/fdi-in-brief/fdi-in-brief.aspx. Accessed October 1, 2016.Google Scholar The creation of this new definition of oral health and the accompanying framework is intended to be used by all stakeholders and builds on the WHO's Commission on Social Determinants of Health report.3World Health Organization. Commission on Social Determinants of Health: final report. Available at: http://www.who.int/social_determinants/thecommission/finalreport/en/. Accessed October 2, 2016.Google Scholar Accordingly, patients, practicing dentists, academicians, researchers, politicians, third-party payers, industry partners, and medical providers were consulted and included in the creation of the definition. Efforts are under way to assess and measure this new definition of oral health, and work in the United States has started, as demonstrated by the American Dental Association Health Policy Institute.4American Dental Association Health Policy Institute. Oral health and well-being in the United States. Available at: http://www.ada.org/en/science-research/health-policy-institute/oral-health-and-well-being. Accessed October 2, 2016.Google Scholar We now have a definition of oral health that will enable a conversation that creates a common understanding when addressing the needs of people and communities and when making the case for the importance of optimal oral health for all. Let's get started.