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General discussion and future perspectives1679Quality of life (QoL), or “individuals’ perceptions of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns” is now recognized as a valid parameter in patient assessment in nearly every area of physical and mental health care, including oral health. Oral health–related quality of life (OHRQoL) has important implications for the clinical practice of oral maxillofacial surgery and research. It includes a subjective evaluation of the individuals’ oral health, functional well-being, emotional well-being, expectations of and satisfaction with care, and sense of self. Assessment of OHRQoL allows for a shift from traditional medical/dental criteria to assessment and care that focus on a person’s social and emotional experience and physical functioning in defining appropriate treatment goals and outcomes.1 Medical and dental research on HRQoL has flourished because of (1) the patient’s more active role as a member of the treatment team; (2) the need for evidence-based approaches in health practices; and (3) the fact that many treatments for chronic diseases fail to cure the health condition, thereby elevating the importance of HRQoL as a valuable health outcome variable.2 This has created a need for a range of instruments with which to measure oral health–related quality of life. The Oral Health Impact Profile (OHIP-49) questionnaire contains 49 questions, assessing 7 dimensions of impacts of oral conditions on people’s OHRQoL, including functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap.3, 4 A short version, the Oral Health Impact Profile-14 (OHIP-14) was later developed and is based on a subset of 2 questions for each of the 7 dimensions. 4 It is patient centered, gives a greater weight to psychological and behavioral outcomes, is better at detecting psychosocial impacts among individuals and groups, and better meets the main criteria for the measurement of OHRQoL. 4 The OHIP responses, “never”, “hardly ever”, “occasionally”, “fairly often”, and “very often”, are codified from 0 to 4, respectively. In 2011, a study showed that the Dutch version of the OHIP-14NL questionnaire is a reliable and valid tool with which to measure the impact of oral health on quality of life in the Dutch population.5, 6The use of questionnaires as used in this thesis also has drawbacks. The data are self-reported and there are concerns regarding patient bias that might distort the results. The motivations and accuracy of the patients in filling out the questionnaires can be debated. They may be driven to fill out the forms just to