Defining health is a metaphysical concern because health is an abstract idea or concept. We explore metaphysical questions such as what is health by using the dialectical method. This post is an initial attempt at defining oral health using the dialectical method. We will first explore some common sense conceptions of health to better our understanding. We will continue to explore health as the function or mechanism of the body by which one is able to achieve well-being according to his or her own life goals.
1. Oral Health is the Absence of Oral Disease
The idea that health is the absence of disease is prima facie appealing. If one has periodontal disease, one would obviously not be in oral health. Health and disease are mutually exclusive. Either one is healthy or unhealthy. Knowing that one does not have disease logically entails that one is in health.
On the other hand, formulating oral health as a negative definition inadequately tells us what oral health actually is. If I only told a patient she should not have gingivitis to have a healthy mouth, I haven’t really told the patient how to be healthy. Patients should brush correctly to have healthy pink gums. Oral health cannot merely be the absence of oral disease but some positive definition.
2. Oral Health Alines With Physiology and Disease Alines With Pathology
There is extensive study on human physiology and pathology. It is clear in cases of infection that a pathological process disrupts normal homeostasis of the body. One can claim that a person is in oral health when the mouth works physiologically and unhealthy when there is pathology.
We thereby have a positive definition of oral health. While this definition works well in cases of infection, we get convoluted answers in other areas of dentistry. Take for example extraction of infected teeth. The patient is left with less teeth then what the anatomical standard. The physiological conception says the patient is not in health but the surgical procedure removed disease. Where there is no disease, there is health (see previous section). The patient is both healthy and not healthy, a logical contradiction.
Since dentists claim that routine dental extractions of infected teeth promotes oral health (we certainly do), we must find a different definition of health.
3. Societal Norms set Oral Health Standards
Societal norms are not always based on what is most common or average. Most worldwide are infected with HSV-1, but having herpes is not considered healthy. The average adult has an average of 3.28 decayed or missing permanent teeth, but having cavities is also not considered healthy.
Health norms correspond to what society takes to be healthy. Though not a pathology, the midline diastema is considered improper occlusion (even by some orthodontics) in western culture and is often corrected with braces or veneers.
It must be acknowledged that norms vary by culture and change over time. Even in the dental field, what was once thought as routine pathology (e.g., first molar position or group function) is no longer a concern upon new evidence. If a health norm is based in certain truth, then saying that health is what society tells us would actually answer what oral health is, only indirectly. If, however, a health norm is based in non-rational opinion, we cannot meaningful understand the nature of health nor know what oral health is.
Many societal norms are based on superstition and lack any evidence. Luckily, healthcare is evidence-based, and there are many rational definitions of health for us to explore and better our understanding.
4. Health as Function
The World Health Organization maintains that health is not merely the absence of disease but physical, mental, and social well-being. Health is a necessary condition for living life well.
In virtue ethics, a thing is good when it performs its purpose (what the thing does) according to its proper function (how the thing does it). A dull knife cannot cut well, a lame horse cannot run fast, etc. Health is function because it is how humans do the things they do. A properly working arm can move well, a properly taught mind reasons well, and a properly developed personality allows us to socialize well.
Unlike knives and horses, humans are autonomous agents that direct action through a rational will. They determine their own purpose in life (even if one is given to them). This means, in part, that health requirements for an individual are determined by that person’s goals in life. If a patient does not require correction of a gummy smile to live her life by how she wills, then she has no disease and is perfectly healthy.
We do not run into the same metaphysical indeterminacy as in the previous section. Everyone or another needs a mouth with functioning teeth to eat food, structures to speak with, cosmetics to attract partners, etc. Oral functions are needed by all humans to live so oral health is an objective good generally. Even if a patient (as mentioned above) finds maxillary bone excess not relevant to her personal oral health, we still can determine what is healthy for her based on the requirements of her life goals. Maybe she wants to be a bodybuilder and has to chew on vegetables all day. Oral health for her would be adequate chewing structures as described by medical science.
Conceiving health as function gives us a positive definition of oral health and does not seem to run into obvious metaphysical or detrimental epistemic problems.
Oral Health and Cosmetics
Many insurance companies reject cosmetic claims because cosmetics is considered supplemental to health. Proper smile design restores a smile physically, improves mental-image of self, and allows us to better participate in social activities. It is obvious when we consider the WHO’s definition of health, cosmetics is relevant to healthcare because health professionals should strive to improve the patient’s physical, mental, and social well-being.
Cosmetics are important in certain jobs and most of the time crucial in searching for a life partner. Face it, to live life well we need a functioning, esthetic smile. Since proper function is determined by your goals, individualized smile design is a healthcare issue.
You can see some of the techniques of dialectal reasoning through the exploration of the concept of health. Negative definitions do not tell us what oral health is like a positive definition does. However, some positive definitions leave us with problematic judgements about health. These must be disregarded for better definitions that encapsulate our better understanding form past mistakes.
Conceiving health as what is physiological gives us objective answers in many areas of healthcare based on the strength of medical science, but falls short in accounting for health in other areas. Thinking about health in terms of societal norms provides a individualized conception of health but since societal norms are often non-rational and lack evidence, we cannot answer the question what is oral health meaningfully or with certainty.
Opinion cannot define health. Opinion only corresponds to true and meaningful thought when it is based on independent rational inquiry. Health is only adequately definable using rational inquiry. The functional conception of health gives us a meaningful and rational understanding of oral health without the discussed metaphysical and epistemological problems. Thus, heath professionals should stay away from too rigid diagnostic rules and learn to listen to the patient’s goals to determine what is health for them according to the best available medical science.
The dialectical method betters our understanding but not necessity gives us complete answers. I encourage readers to make a comment or submit an article to this blog exploring other definitions of health.