The relationship between practice ownership and follow-up of comprehensive dental care. A Swedish register study.

AIMS: The aims of this register study were: 1. To study whether the type of ownership of the dental practice was correlated with the type of dental care provided, that is public versus private ownership and professional (dentist or dental hygienist) versus non-professional ownership. 2. To study the extent of follow-up of patients who have undergone two types of treatments.  Material and method: Two types of dental care were defined in the two groups studied, periodontitis/peri-implantitis and comprehensive restorative/rehabilitation. All relevant treatment codes that fall under these definitions are noted when they are performed. Also, the follow-up of each treatment code is noted. Differences in dental and socioeconomic status over time and between regions were adjusted for. A drop-out analysis was performed.  Results: Dental practices owned by dentists or dental hygienists schedule follow-up appointments for patients who have undergone comprehensive restorative or rehabilitation dentistry more often than practices with other types of ownership. Dental practices owned by dentists or dental hygienists follow up patients with periodontitis and peri-implantitis less frequently. CONCLUSION: Type of ownership of a dental business influences the extent to which periodontal, and comprehensive restorative or rehabilitation dentistry were followed up.

Exploring salutogenic factors supporting oral health in the elderly.

AIM: To explore associations between salutogenic factors and selected clinical outcome variables of oral health in the elderly, combining Antonovsky's salutogenic theory and the Lalonde Health Field concept. METHODS: The subjects comprised 146 individuals, aged 60 years and older, who had participated in a population-based epidemiological study in Sweden, 2011-2012, using questionnaire and oral examination data. A cross-sectional analysis used the selected outcome variables, such as number of remaining teeth, DMFT-index and risk assessment, and salutogenic factors from the questionnaire, clustered into domains and health fields, as artifactual-material, cognitive-emotional and valuative-attitudinal. This selection was based on findings from our previous analysis using a framework cross-tabulating two health models. The purpose was to facilitate analysis of associations not previously addressed in the literature on oral health. Bivariate and Multiple Linear Regression analyses were used. RESULTS: Numerous salutogenic factors were identified. Significant associations between outcome variables and salutogenic factors previously unreported could be added. Regression analysis identified three contributing independent factors for 'low DMFT'. CONCLUSIONS: This study supports the usefulness of a salutogenic approach for analysing oral health outcomes, identifying university education, the importance of dental health organization recall system and close social network, as important salutogenic factors. The large number of salutogenic factors found supporting oral health among the elderly indicates the complexity of salutogenesis and the need for robust analysing tools. Combining two current health models was considered useful for exploring these covariations. These findings have implications for future investigations, identifying important research questions to be explored in qualitative analyses.

Prevalence of Facial Pain and Headache in Sweden.

AIMS: To compare the prevalence of facial pain and headache across various regions in Sweden. METHODS: This study involved a comparison of cross-sectional questionnaire studies over a period of 10 years including 128,193 individuals and assessed facial pain, pain on function, and headache. Participants included (1) all Public Dental Service patients aged 16 to 90 years in Västerbotten (n = 57,283) and Gävleborg (n = 60,900); and (2) random samples of residents in Kalmar (n = 3,560) and Skåne (n = 6,450). Facial pain and pain on function were assessed for all participants, and headache was also assessed for participants in Kalmar and Skåne. Descriptive statistics were used to estimate unadjusted prevalence estimates and demographic characteristics. Prevalence estimates were adjusted for age and sex using weighted distributions from the 2015 data in the Swedish population registry before comparisons across the regions. RESULTS: Overall, the prevalence of facial pain and headache were significantly higher in female than in male participants (P < .01). The standardized prevalence of facial pain was 4.9% in Västerbotten, 1.4% in Gävleborg, 4.6% in Kalmar, and 7.6% in Skåne. For headache, the standardized prevalence was 18.9% in Kalmar and 21.3% in Skåne. In Skåne, individuals with facial pain had a 15-fold higher odds of headache than those without. CONCLUSION: In the present Swedish epidemiologic study, the prevalence of facial pain ranged from 1.4% in Gävleborg to 7.6% in Skåne. Besides different sampling frames and other population characteristics, the presence of a high number of immigrants in Skåne may account for some differences in pain prevalence across the Swedish regions.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde.

OBJECTIVE: The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde. MATERIAL AND METHODS: This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated. RESULTS: The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m2' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors. CONCLUSIONS: The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists.

OBJECTIVE: To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. BACKGROUND: Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. MATERIALS AND METHODS: A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. RESULTS: From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. CONCLUSION: Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.

S100A12 Expression Is Modulated During Monocyte Differentiation and Reflects Periodontitis Severity.

S100A12 is a calcium-binding protein of the S100 subfamily of myeloid-related proteins that acts as an alarmin to induce a pro-inflammatory innate immune response. It has been linked to several chronic inflammatory diseases, however its role in the common oral immunopathology periodontitis is largely unknown. Previous in vitro monoculture experiments indicate that S100A12 production decreases during monocyte differentiation stages, while the regulation within tissue is poorly defined. This study evaluated S100A12 expression in monocyte subsets, during monocyte-to-macrophage differentiation and following polarization, both in monoculture and in a tissue context, utilizing a three-dimensional co-culture oral tissue model. Further, we explored the involvement of S100A12 in periodontitis by analyzing its expression in peripheral circulation and gingival tissue, as well as in saliva. We found that S100A12 expression was higher in classical than in non-classical monocytes. S100A12 expression and protein secretion declined significantly during monocyte-to-macrophage differentiation, while polarization of monocyte-derived macrophages had no effect on either. Peripheral monocytes from periodontitis patients had higher S100A12 expression than monocytes from controls, a difference particularly observed in the intermediate and non-classical monocyte subsets. Further, monocytes from periodontitis patients displayed an increased secretion of S100A12 compared with monocytes from controls. In oral tissue cultures, monocyte differentiation resulted in increased S100A12 secretion over time, which further increased after inflammatory stimuli. Likewise, S100A12 expression was higher in gingival tissue from periodontitis patients where monocyte-derived cells exhibited higher expression of S100A12 in comparison to non-periodontitis tissue. In line with our findings, patients with severe periodontitis had significantly higher levels of S100A12 in saliva compared to non-periodontitis patients, and the levels correlated to clinical periodontal parameters. Taken together, S100A12 is predominantly secreted by monocytes rather than by monocyte-derived cells. Moreover, S100A12 is increased in inflamed tissue cultures, potentially as a result of enhanced production by monocyte-derived cells. This study implicates the involvement of S100A12 in periodontitis pathogenesis, as evidenced by increased S100A12 expression in inflamed gingival tissue, which may be due to altered circulatory monocytes in periodontitis.

Threshold values affect predictive accuracy of caries risk assessment.

OBJECTIVE: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment. MATERIAL AND METHODS: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists' risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds. RESULTS: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk. CONCLUSIONS: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

Dentistry as a free market in the context of leading policymaking.

The purpose of this study was to disclose the psychological meaning structure of dentistry as a free market within the context of leading Swedish policymaking. Following the criteria for the descriptive phenomenological psychological method data was collected from leading policy makers about the experiential aspects of dentistry as a free market within the context of a welfare state. The analysis showed that dentistry as a free market was experienced as a complex business relationship between buyers and sellers that transcended the traditional dentist and patient roles. The lived experience of the proposed business transaction was based on two inherently conflicting views: the belief in the individual's ability to make a free choice versus the understanding that all individuals in a society do not have the ability or the means necessary to make a free choice. Dentistry as a free market within a welfare state, such as Sweden, can thus be seen as a persistent attempt to hold on to a compromise between two very distinctive political ideologies.

Dental politics and subsidy systems for adults in Sweden from 1974 until 2016.

AIMS: The dental health sector, as part of the Swedish welfare system, originated in 1974. Since then, the dental insurance has undergone three major changes. The aim of this archive study was to study where in the legislative process the dental politics concerning national dental insurance and subsidies were formed. MATERIALS AND METHODS: The material, such as Commission of inquiry proposals and Government Bills from four major dental reforms, was collected from the library at the Sveriges Riksdag (Swedish Parliament) and was analysed and structured using a modified version of the Health Field Model. RESULTS: The views on the fundamental ideas, such as the connection between general and dental health, preventive dentistry, rehabilitation of the mouth and promotion of dental health, were the same over the years. The views on dentistry as a market, when it comes to freedom of prices, have undergone a major change since 1974, but the view on the welfare state remains the same. CONCLUSIONS: The Swedish dental subsidy systems and how dentistry has been treated politically are the results of a chain of events ranging from care for the population's dental health, political doctrines, 'zeitgeist', dental policy, to state finances.

Diagnoses and treatment proposals in periodontal treatment. A comparison between dentists, dental hygienists and undergraduate students.

The aim of this study is to find out how professionals in Swedish dental care perform diagnostic procedures in general. Is there a common ground between dentists and dental hygienists concerning sharing different job assignments in an effective way? Are the methods of treatment used in accordance with degree of severity of the disease and to what extent is proposed treatment in accordance with the National Guidelines? A questionnaire consisting of three different patient cases with periodontal disease was sent to 804 private practitioners, 809 dentists in Dental Public Service, 802 dental hygienists and 40 dental students on their final semester at the Dental School in Malmö. The questionnaire was completed by 1,103 respondents (47%). A majority of all practitioner groups (94%) found that a relatively healthy patient had disease, the risk for developing further disease was deemed none too low by 97%, but 91% wanted to give preventive care. A vast majority suggested more dental care to healthy patients as compared to patients with severe periodontal disease. In Conclusion the two groups, i.e. dentists and dental hygienists, did not to a sufficiently high degree share views on diagnosis and treatment, in order to optimize the resources in dentistry. The delivery of dental care was not in line with the severity of disease and too much attention was paid to the needs of relatively healthy persons. To change this pattern, the incentives in and structure of the national assurance system could be adapted. Furthermore, the knowledge basis for periodontal diagnosis and treatment needs, with special reference to the National Guidelines, should to a higher degree be shared by all caregivers.

A multivariable analysis of patient dental satisfaction and oral health-related quality-of-life. A cross-sectional study based on DVSS and OHIP-14.

OBJECTIVE: The aim of this paper was to study the association between dental satisfaction and oral health-related quality-of-life (OHRQoL) when controlling for individual, clinical and psychological factors. MATERIALS: Secondary analysis was conducted using data from a large study carried out in the Swedish region of Värmland in 2004. The questionnaire included demographic variables, clinical assessment and the following instruments: the Dental Visit Satisfaction Scale (DVSS), the short version of Oral Health Impact Profile (OHIP-14) and a modified version of the revised helping alliance questionnaire. Internal consistency analysis was undertaken on the instruments to assess reliability; bivariate comparisons were assessed to compare DVSS scores with individual factors (age, gender and education). In addition, a three step hierarchical multiple regression analysis was performed with DVSS as a dependent variable. RESULTS: Data were completed for 485 randomly selected patients. The mean age of participants was 43.5 years, 54.6% were women,and 41.2% had high education. The median DVSS score was 48 (range 10-50) and the median OHIP was 3.0 (range 0-56). All the instruments showed good reliability. Bivariate analysis showed that females were more satisfied than males (p ≤ 0.01) and patients of 50 years or older were more satisfied than the younger ones (p ≤ 0.05). Finally, the following variables explained 31% of the variance of being very satisfied with dental visit: a good OHRQoL and patients' positive perceptions of the relationship with their care provider. CONCLUSION: This study showed positive associations between dental satisfaction and OHRQoL when controlling for related factors. The result suggests that care providers should take into account the various dimensions of OHRQoL rather than use only clinical measurements when they evaluate patient satisfaction.

Knowledge of periodontitis and self-perceived oral health: a survey of periodontal specialist patients.

The aim of this study was to investigate changes in knowledge of periodontal disease among patients referred to periodontal specialist clinics. A further aim was to investigate the patients' self- perceived oral health before the treatment. Patients referred to five specialist clinics in periodontology for comprehensive periodontal treatment were consecutive sampled. The study was based on a questionnaire in a before and after design. The first questionnaire was sent to the patients before visiting the specialist clinic and the second was sent after six months. Four questions were analysed, two to measure knowledge about periodontitis and two to measure the patients self- perceived oral health. The first questionnaire was sent by post to 273 patients with a response rate of 31%. The second questionnaire was sent to 85 patients with a response rate of 73%. The results of the study showed a statistically significant improvement of correct answers on the knowledge questions after six months was found for scaling (p = 0.006), X-ray examination (p = 0.001) and increased space between the teeth (p = 0.001). The most frequent self-perceived trouble from the mouth was bleeding gum (70%) and sensitive teeth (51%). In conclusion knowledge of periodontitis improved after visiting the specialist clinic of periodontology. Many of the patients experienced some problems of the mouth.

Expectations and satisfaction with care for periodontal specialist patients.

OBJECTIVE: The aim of this study was to investigate expectations on and satisfaction with treatment among patients referred for comprehensive treatment to specialist clinics in periodontology and to explore factors associated with satisfaction in regression analysis. MATERIALS AND METHODS: Patients referred for comprehensive periodontal treatment were sampled for the study. The study was based on a questionnaire in a before-and-after design. The first questionnaire was sent to the patients before their first appointment at the specialist clinic. The second questionnaire was sent after ≈ 6 months. Three questions were used to measure expectations and four questions to measure satisfaction. The first questionnaire was sent to 273 patients with a response rate of 31% and the second questionnaire was sent to 85 patients with a response rate of 73%. In non-response analysis, no difference between respondents and non-respondents were detected as to age and gender. RESULTS: Many of the patients viewed it as important or very important to have healthy teeth (98%) and improved well-being (93%) after periodontal treatment. More than 50% of the patients were satisfied with the relation to the caregiver. When measuring the satisfaction in general, 42% indicated the highest score on the summarized Dental Visit Satisfaction Scale. Having confidence (p ≤ 0.001) and a good relation (p = 0.001) to the caregiver indicated higher satisfaction. CONCLUSION: Having a good relation to the caregiver and having confidence in the caregiver seems to indicate satisfied patients receiving periodontal treatment at periodontal clinics.

Oral health in the adult population of Skåne, Sweden: a clinical study.

OBJECTIVE: The aim of this study was to describe the oral health in the adult population of Skåne by clinical factors with special reference to age, gender, ethnicity and education. MATERIALS AND METHODS: Clinical examinations were performed on 451 randomly selected individuals, 20-89 years old, living in Skåne, Sweden. The clinical examination included a radiographic examination and a questionnaire. Clinical variables were put into cross-tabulations along with age, gender, educational level and ethnicity. RESULTS: For all of the described clinical variables, except caries, the frequency increased with age. There were no differences in the clinical variables due to gender. The frequencies of missing teeth, caries, periodontal conditions and DMFT were higher among those with a lower educational level. More missing teeth, worse periodontal conditions, more apical destructions and less dental fillings were found in individuals who were not born in Sweden. CONCLUSIONS: The oral health in the adult population of Skåne was overall good, with low frequencies of oral disease and a large number of remaining teeth up to a high age. The patients' oral health status, as determined by a dentist's clinical examination, differed due to age, educational level and ethnicity, but not due to gender.

Self perceived oral health, oral treatment need and the use of oral health care of the adult population in Skåne, Sweden.

UNLABELLED: The aim was to describe how the adult population in Skåne, Sweden, perceived their oral health, dental status, oral treatment need and use of oral health care. A questionnaire was sent to a randomly selected sample of 10 000 persons in Skåne, Sweden. The individuals were between 20 and 89 years old and registered as residents of the region during 2006. After excluding those no longer living in the region, 9 690 individuals remained. The response rate to the questionnaire was 63%, of which 57% were women and 43% men.A majority was satisfied with their teeth and with their teeth's appearance, 65% and 62% respectively. Of the respondents, 35% considered their dental health to be better than others in their age group. Symptoms associated with periodontitis were experienced by 40%. 7% were missing more than ten teeth while 7% had no dental fillings. 30% rated their need of dental treatment as high and most expected their treatment need to increase in the future. Most of the respondents, 60%, received their oral care at a private practice, whereas 13% did not see a dentist regularly for check-ups. More women than men perceived a high dental treatment need, 32% compared to 28%. CONCLUSIONS: A majority of the adult population in Skåne have a positive attitude towards their oral health. Most individuals had lost few teeth and removable dentures were uncommon.A third rated their dental treatment need as high and most expected their treatment need to increase in the future..

Comparison of patients' and providers' severity evaluation of oral mucosal conditions.

BACKGROUND: In dental diseases, significant discrepancies were observed in the oral health-related quality of life evaluation between patients and providers. Few studies have been performed specifically on the impact of oral mucosal diseases on patients' health. OBJECTIVE: We sought to compare the evaluation of the severity of oral mucosal conditions in providers and patients. METHODS: Patients with an oral mucosal condition were recruited at the oral health care unit of a dermatologic hospital. Severity was evaluated both by the physician and by the patient, using a global severity assessment score on a 5-point scale. The 14-item Oral Health Impact Profile was used to evaluate oral health-related quality of life, the 12-item General Health Questionnaire for psychologic problems, and the 20-item Toronto Alexithymia Scale for alexithymia (ie, the difficulty in identifying and expressing feelings). RESULTS: Data were complete for 206 patients. The agreement between patients' and providers' evaluation was very low (Cohen κ = 0.18). Severity was particularly underestimated by the physician in patients with alexithymia (43% compared with 25% of patients with no alexithymia) and with psychologic problems (44% vs 25%). LIMITATIONS: Because of the high number of different conditions, and thus the small figures in each group, it was not possible to analyze the concordance between patient and provider in each single condition. CONCLUSION: Even in the severity assessment of his or her own disease, it is plausible that a patient does not provide a simple clinical evaluation, but includes subjective aspects. It is important for the physician to take into account the severity the patient perceives in making treatment decisions, and in evaluating clinical improvement.

Multivariate analyses of patient financial systems and oral health-related quality of life.

OBJECTIVES: Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co-existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee-for-service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health-related quality of life (OHRQoL). METHODS: A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee-for-service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP-14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF-36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self-esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis. RESULTS: When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee-for-service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL. CONCLUSIONS: Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee-for-service care.

Oral health-related quality of life and dental status in an outpatient psychiatric population: a multivariate approach.

Research related to oral health in people with mental health problems may deepen our understanding of the quality of life of such individuals. This study aimed to investigate the relationship between oral status, health perceptions and life satisfaction, and their impacts on oral health-related quality of life (OHQoL). Data were collected from 113 patients in outpatient psychiatric care using a structured interview and an oral examination. Six multivariate models (one comprising the total population, three separate diagnostic groups, and two sex groups) investigated the variance in OHQoL. In the total population, the number of teeth, subjective life satisfaction, perception of physical health, sex, and relying on chance accounted for 40% of the variance. In the group consisting of patients diagnosed with schizophrenia 41% of the variance was explained by the variables 'number of teeth' and 'perception of physical health'. In the group diagnosed with mood disorders, the variable 'number of teeth' accounted for 58% of the variance. The variance in the remaining group of diagnoses was explained, up to 38%, by life satisfaction and reliance on chance. The sex models revealed significant differences: men considered the responsibility of caring for their oral health as a health matter, while women saw oral health as a more subjective issue. The perception of OHQoL was found to be dependent on the particular psychiatric diagnosis and sex. Such findings can be of use in the development of rehabilitation, as well as preventive strategies that could be individually tailored to maintain OHQoL and oral health.

Association of perceived quality of life and oral health among psychiatric outpatients.

OBJECTIVES: The relationship between oral health and various aspects of quality of life has gone uninvestigated in psychiatric populations. The aim of this study was to investigate the correlation between the Oral Health Impact Profile-14 and subjective quality of life, perceptions about general health, and self-related variables. METHODS: A structured interview constructed from validated instruments was administered to 113 consumers attending outpatient psychiatric care. RESULTS: A lower perceived oral health-related quality of life had a correlation with decreased ratings of subjective quality of life, general health disabilities, and chance and internal locus of control. CONCLUSIONS: Correlations between subjective and general health-related quality of life and oral health-related quality of life had not been detected in this group before. In order to improve mental health consumers' total perceived quality of life, oral health problems should be regularly addressed in the course of psychiatric care.

Measuring oral health from a public health perspective.

The paper aims to analyse measures of oral health-related quality of life (OHQOL) from a Public Health perspective. Twenty-two measures were analysed conceptually as to their mirroring of the Public Health principles: empowerment, participation, holism and equity. Elements of empowerment were found in connection with application of the measures. Participation was found in using lay opinions during development in 12 measures. All measures analysed had elements of a holistic approach so far that they were not wholly biological. Two measures captured positive health effects. Measures were available for all ages, various languages and populations, an element of equity. No measure was wholly compatible with Public Health. They were based on a utilitarian theory not in full accordance with modern health promotion. There is a need to develop measures that more obviously capture the positive aspects of health and health as a process, as well as the personal perspective of oral health.