Adolescents with worse levels of oral health literacy have more cavitated carious lesions

Abstract

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.

Association of Oral Health Literacy and School Factors with Untreated Dental Caries among 12-Year-Olds: A Multilevel Approach

“…This result suggests that each 1-point increase in OHL scores (independent variable) reduced the number of surfaces with untreated dental caries (outcome) by about 5% among adolescents. Other studies have demonstrated similar results in children, adults, and late adolescence [Firmino et al, 2017[Firmino et al, , 2018Dutra et al, 2019]. However, the results are still inconclusive due to methodological differences.…”

“…This tool also considers aspects such as the reading pace and sound repetition during speaking which may suggest that people do not understand the words even when they finish reading them. A low functional OHL has been associated with dental caries in later adolescence and among children considering parents' proxy measures [Firmino et al, 2018;Dutra et al, 2019]. Although schooling and OHL are related, the latter is a determinant of oral health that performs better in supporting the capacity to identify and use oral health-related information [Batista et al, 2017].…”

“…Health literacy is defined as "the ability to obtain, process, and understand basic health and services needed to make appropriate health decisions" [Ratzan and Parker, 2000]. Previous studies conducted with older adolescents [Dutra et al, 2019] and guardians of younger children [Firmino et al, 2018] have observed a high prevalence of dental caries in those with a low level of OHL. In contrast, little attention has been paid to the early phase of adolescence, especially in studies with a multilevel approach that includes school environmentrelated factors.…”

Family Cohesion Is Associated with the Self-Perceived Need for Dental Treatment among Adolescents

“…Previous studies have shown that aspects such as lower quality of life related to oral health, sociodemographic factors, searching dental services for treatment, dental pain, dissatisfaction with teeth and mouth, and dental caries were associated with the self-perceived need for dental treatment in adolescents [ 3 , 14 ]. Another factor that has been associated with oral health outcomes in adolescents is oral health literacy (OHL) [ 15 , 16 ], which is the ability to identify, understand. and apply oral health information and influences health decision-making [ 17 , 18 ].…”

Do Parents’ Oral Health Literacy Levels Influence Their Response to Interventions to Improve Their Knowledge of Traumatic Dental Injuries?

“…Low caregiver education is associated with worse health conditions and is a risk factor for dental caries in children [6][7][8][9]. Similarly, inadequate oral health literacy (OHL) is related to worse oral health conditions in adults and adolescents, less retention of health information, and, in parents and caregivers, is a risk factor for increased caries in their children [10][11][12][13][14][15][16][17][18][19].…”