Oral health-related quality of life and condition-specific daily performance impacts in dental fluorosis: a narrative synthesis

Abstract

Introduction. Dental fluorosis is an oral condition with aesthetic, psychosocial, and, in some contexts, functional implications that may extend beyond the clinical appearance of enamel. Interest in patient-reported outcome measures has increased because clinical severity alone does not explain how children and adolescents experience fluorosis in daily life. This manuscript aims to synthesize the evidence on oral health-related quality of life and to assess the relevance of a condition-specific Oral Impacts on Daily Performance approach for dental fluorosis. Materials and methods. A narrative synthesis was prepared according to PRISMA-ScR guidance [REF]. The search framework was designed for PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and the institutional repository of Nicolae Testemițanu State University of Medicine and Pharmacy. Core studies addressing dental fluorosis and oral health-related quality of life were extracted together with methodological papers on condition-specific OIDP, instrument adaptation, and Moldova-generated contextual literature. The methodological premises from the attached doctoral thesis on the Romanian adaptation of dental questionnaires were also integrated. Results. The evidence is heterogeneous. Mild dental fluorosis is often associated with no deterioration in oral health-related quality of life, while moderate to severe fluorosis is more consistently linked to worse quality-of-life outcomes. The most direct condition-specific OIDP evidence comes from a cross-sectional study in India showing significant correlations between fluorosis, CS-OIDP, and OHRQoL. A recent systematic review confirmed the mixed direction of results across 16 studies. Local Moldovan publications support the public health relevance of endemic fluoride exposure and the need for Romanian-language instruments adapted to this context. Conclusions. The current evidence supports the methodological relevance of a fluorosis-adapted CS-OIDP instrument. A future Romanian adaptation should combine rigorous translation procedures, cognitive testing, and psychometric validation, while retaining clinical measures of fluorosis severity for discriminative analysis.