Objectives The aim of this study was to evaluate the association between the prevalence of cavitated dental caries and oral health literacy (OHL), family characteristics and sociodemographic factors in early adolescence. Methods A cross‐sectional study was conducted with 740 twelve‐year‐old students. The students' guardians provided information on sociodemographic data, and the students provided information on family characteristics and OHL. Two trained dentists examined the participants for dental caries and administered the Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry (BREALD‐30). Control variables were selected using a directed acyclic graph. Descriptive analysis was performed; this was followed by robust Poisson regression analysis for complex samples to evaluate the association between dental caries and socioeconomic and family predictors (α = 5%). Results The following variables were associated with a greater number of cavitated caries lesions: low level of education completed by the mother (RR = 1.58; 95% CI: 1.12‐2.24), less privileged social class (RR = 1.89; 95% CI: 1.28‐2.80), non‐White ethnicity (RR = 1.64; 95% CI: 1.0‐2.48), larger number of residents in the home (RR = 1.87; 95% CI: 1.25‐2.81), low level of OHL (RR = 2.02; 95% CI: 1.28‐3.18), and the ‘connected’ (RR = 4.72; 95% CI: 1.17‐18.90), ‘separated’ (RR = 4.09; 95% CI: 1.05‐15.86) and ‘disengaged’ (RR = 4.20; 95% CI: 1.09‐16.18) types of family cohesion. Conclusions A low level of oral health literacy, sociodemographic factors, and a low level of family cohesion are predictors of cavitated caries lesions in early adolescence.

OBJECTIVE: To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS: The study included 750 adolescents: 375 aged 12 years and 375 aged 15–19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS: BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach’s alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48–3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24–3.11]. CONCLUSIONS: BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.

The aim of the present study was to investigate whether the ability to recognize and read oral health terms is associated with the number of teeth with cavitated carious lesions in adolescents. A population-based cross-sectional study was conducted involving a sample of 746 adolescents representative of students aged 15 to 19 years at the public and private school systems in a city in northeast Brazil. Two examiners who had undergone a training and calibration exercise (inter-examiner and intra-examiner Kappa coefficient: 0.87 to 0.93) performed the diagnosis of caries using the Nyvad Index and evaluated the level of OHL (BREALD-30) of the adolescents. The participants answered questions regarding their history of visits to the dentist and the parents/caregivers answered a questionnaire addressing socioeconomic characteristics. A directed acyclic graph was created to direct the selection of covariables for adjustments in the Poisson multiple regression analysis to test the association between dental caries and OHL (α = 5%). Cavitated carious lesions (codes 3 to 6 on the Nyvad index) were found in 41.6% of the adolescents. Only 29.4% had a high level of OHL (BREALD-30 scores between 23 and 30); 42.3% of the families belonged to the A-B social class and 93% of the adolescents had been to the dentist at least once in their lifetimes. In the multivariate analysis, adolescents with inadequate (PR: 1.69; 95% CI: 1.18–2.41; p = 0.004) and marginal (PR; 1.42; 95% CI: 1.01–1.99; p = 0.042) OHL and those in the lower social classes (C-D-E) (PR: 1.85; 95% CI: 1.39–2.47; p<0.001) had more teeth with cavitated carious lesions. In conclusion, adolescents aged 15 to 19 years with poorer levels of OHL had a larger number of teeth with cavitated carious lesions, independently of their socioeconomic status and history of visiting a dentist.

OBJECTIVE: Evaluate socio-demographic, family and behavioral factors associated with oral health literacy (OHL) in adolescents. METHODS: Cross-sectional study conducted with adolescents aged 15 to 19 years in Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing socio-demographic data. The adolescents answered validated instruments on family cohesion and adaptability (family adaptability and cohesion evaluation scale), drug use (alcohol, smoking and substance involvement screening test), type of dental service used for last appointment and OHL (Brazilian version of the Rapid Estimate of Oral Health Literacy in Dentistry). Two dentists were trained to evaluate OHL (K = 0.87–0.88). Descriptive analysis was performed, followed by Poisson regression analysis (α = 5%). A directed acyclic graph was used to select independent variables in the study. RESULTS: The following variables remained associated with better OHL: high mother’s schooling level (RR = 1.07; 95%CI: 1.03–1.12), high income (RR = 1.04; 95%CI: 1.01–1.09), white ethnicity/skin color (RR = 1.05; 95%CI: 1.01–1.10), married parents (RR = 1.04; 95%CI: 1.01–1.09), “enmeshed” family cohesion (RR = 1.21; 95%CI: 1.12–1.30), “structured” (RR = 1.06; 95%CI: 1.01–1.12) or “rigid” (RR = 1.11; 95%CI: 1.04–1.19) family adaptability, having more than five residents in the home (RR = 1.07; 95%CI: 1.01–1.14) and having used a private dental service during the last appointment (RR = 1.08; 95%CI: 1.03–1.13). CONCLUSION: Family functioning and socio-demographic factors influence the level of oral health literacy among adolescents.

Background The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments. Aim To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents. Design A cross‐sectional study was conducted with 740 12‐year‐old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD‐30), levels of family adaptability and cohesion (FACES III), and visits to the dentist sometime in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed. Results A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01‐1.03), high social class (PR = 1.28; 95% CI: 1.09‐1.50), higher mother's schooling (PR = 1.58; 95% CI: 1.37‐1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19‐2.02) and connected (PR = 1.22; 95% CI: 1.02‐1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01‐1.38) remained associated with having visited a dentist. Conclusions Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.