FDI World Dental Federation Develops A New Definition For Oral Health.

In The Journal of the American Dental Association’s December editorial, Drs. Michael Glick, David M. Williams, Dushanka V. Kleinman, Marko Vujicic, Richard G. Watt, and Robert J. Weyant discuss how the FDI World Dental Federation’s new definition for oral health creates an opportunity for the dentistry profession.

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. 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?

Read the rest of the editorial in the December JADA.

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 2020.1 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 2020,1 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.
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The new definition acknowledges the multifaceted nature and attributes of oral health.

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 (Figure) . (A powerpoint version of the new definition of oral health and its accompanying framework can be downloaded at http://www.fdiworldental.org/oral-health...ral-health.aspx.)
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Box

Definition of oral health.
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Figure

Framework for the oral health definition. The core elements of oral health are as follows: disease and condition status refers to a threshold of severity or a level of progression of disease, which also includes pain and discomfort; physiological function refers to the capacity to perform a set of actions that include, but are not limited to, the ability to speak, smile, chew, and swallow; and psychosocial function refers to the relationship between oral health and mental state that includes, but is not limited to, the capacity to speak, smile, and interact in social and work situations without feeling uncomfortable or embarrassed. Driving determinants are factors that affect oral health and cover 5 main domains: genetic and biological factors, social environment, physical environment, health behaviors, and access to care. In turn, driving determinants nest within systems that can support or serve as a barrier to maintaining and promoting oral health and managing oral diseases and conditions. Moderating factors are elements that determine or affect how a person scores his or her oral health and include, but are not limited to, age, culture, income, experience, expectations, and adaptability.

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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

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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;
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moves dentistry from treating disease to providing care and support for oral health;
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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;
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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.2 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.3 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.4 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.
References

Glick, M., Monteiro da Silva, M., Seeberger, G.K. et al. FDI Vision 2020: shaping the future of oral health. Int Dent J. 2012; 62: 278–291
View in Article | Crossref | PubMed | Scopus (32)
World Dental Federation. FDI in brief. Available at: http://www.fdiworldental.org/about-fdi/f...i-in-brief.aspx. Accessed October 1, 2016.
World Health Organization. Commission on Social Determinants of Health: final report. Available at: http://www.who.int/social_determinants/t...finalreport/en/. Accessed October 2, 2016.
American Dental Association Health Policy Institute. Oral health and well-being in the United States. Available at: http://www.ada.org/en/science-research/h...-and-well-being. Accessed October 2, 2016.

Biography

Dr. Glick is a professor and the William M. Feagans Chair, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY. He also is the editor of The Journal of the American Dental Association.

Dr. Williams is a professor, Global Oral Health, Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom.

Dr. Kleinman is a professor, School of Public Health, University of Maryland, College Park, MD.

Dr. Vujicic is the chief economist and vice president, Health Policy Institute, American Dental Association, Chicago, IL.

Dr. Watt is a professor and the chair, Department of Epidemiology and Public Health, University College London, London, United Kingdom.

Dr. Weyant is a professor and the chair, Department of Dental Public Health, University of Pittsburgh, Pittsburgh, PA.

Disclosure. The authors did not report any disclosures.

ORCID Number. Michael Glick: http://orcid.org/0000-0003-4236-5385.

Editorials represent the opinions of the authors and not necessarily those of the American Dental Association.
Copyright © 2016 American Dental Association. All rights reserved.

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