Until the turn of the century, oral health had been primarily assessed with objective indicators of caries such as the number of decayed, filled or missing teeth due to caries or with periodontal health indicators such as probing pocket depth or bone loss. Similarly, outcomes of dental treatment were primarily determined by considering clinical parameters. Following a powerful movement in medicine, clinicians and researchers in the oral health arena have begun to realize the value of considering patient-centered outcomes (PCO) and subjective indicators of oral health. The objectives of this general introduction to the relevance of PCOs in dental medicine are (a) to describe their importance for dental clinicians, researchers, and educators; (b) to specifically consider their role over the course of a patient’s treatment from the time of diagnosis and treatment decision-making to the actual treatment phase and the post-treatment period; and (c) to discuss the relevance of PCOs for future research and clinical practice. PCOs such as patients’ oral health-related quality of life and treatment satisfaction complement clinicians’ understanding of patients’ oral health-related experiences and treatment outcomes and thus can support their efforts to provide the best care possible. PCOs offer researchers an opportunity to comprehensively assess outcomes in basic science, translational, clinical, and behavioral research. Assuring that dental educators prepare future clinicians and researchers to understand the value of PCOs and to embrace their importance is therefore crucial. One ultimate benefit of PCOs is their value when communicating oral health-related concerns inter-professionally and to persons outside of the health professions.
Oral health professionals live in interesting times: On one hand, oral diseases affect the lives of billions of individuals worldwide. For example, more than 3 billion people suffer from the most common chronic disease in our world that can lead to tooth loss: untreated dental caries (Marcenes et al. 2013). On the other hand, technological advancements in the way we can treat patients with oral diseases are becoming increasingly more sophisticated and elegant. One might argue that the constant in this situation is the patient suffering from poor oral health. While this argument holds up nicely when considering the biological aspects of oral diseases, sociologists would most likely disagree. They would look at people, especially in Western industrialized nations, and argue that a “silent revolution” in value priorities from materialistic to post-materialistic values is occurring and resulting in quite significant changes in personal choices, lifestyles, and behaviors, including health-related behaviors (Inglehart 1977). In medicine, this shift from valuing “survival” above all to a post-materialistic value priority of having a life with dignity, autonomy, and a positive quality of life was first documented in patients undergoing cancer treatment who refused treatment that might have prolonged their life but severely impacted their quality of life (Cimprich & Paterson 2002). A movement to consider treatment outcomes more comprehensively and in their entire complexity developed as a consequence and led to the consideration of patient-centered outcomes (PCOs) in medicine, such as health-related quality of life and treatment satisfaction.
In dentistry, oral health-related PCOs began to be considered following these developments in medicine (Inglehart & Bagramian 2002; Inglehart 2006). It very quickly became clear that oral health could no longer be assessed using only objective indicators of oral disease such as the number of decayed, missing and filled teeth due to caries, periodontal probing depth, or bone loss measures. Complementing these disease indicators with subjective, patient-centered indicators became a priority. Clinicians and researchers in the oral health sciences alike began to consider the significance of including oral health-related quality of life measures in their work. For example, in 2002, the current director of the US National Institute for Dental and Craniofacial Research, Dr. Martha Somerman, already advocated the inclusion of oral health-related quality of life measures in oral-health research activities (Somerman 2002). Even earlier in 1995, the Institute of Medicine Report entitled “Dental Education at the Crossroads: Challenges and Change” had argued for a patient-centered approach to oral health and oral healthcare in all dental education efforts (Fields 1995). More recently, the US Food and Drug Administration (FDA) began to expand the usage of PCOs to demonstrate the value of new drugs or devices for clinical use (Basch 2013). A recent workshop on periodontal regeneration also emphasized the call to action to include PCOs for clinical trials in regenerative therapy (Giannobile & McClain 2015). Patient-centered considerations were thus clearly introduced into the discussion of oral health-related clinical practice, research, and education starting about two decades ago (Fig. 1).