The effect of oral health literacy of adolescents on their oral health status: A cross-sectional study from Southwestern Iran

Document Type : Original Article


1 Associate Professor, Department of Pediatric Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Associate Professor, Department of Health Education and Promotion, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Associate Professor, Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Dentist, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran



BACKGROUND AND AIM: Oral health literacy (OHL) has proved to be important in diminishing oral health inequalities and in promoting oral health. The aim of this study was to evaluate the correlation between OHL and dental indices of 12- to 15-year-old students in Ahvaz, Iran.
METHODS: In this cross-sectional study, a sample of 254 middle school students was selected by cluster random sampling method. The data were gathered using a previously-validated questionnaire, Oral Health Literacy Instrument (OHLI). Oral health status was evaluated using the Simplified Oral Hygiene Index (OHI-S) and the Decayed, Missing, and Filled Teeth (DMFT) index. Data were analyzed using SPSS software with a significance level of P < 0.05.
RESULTS: From a total of254 students (mean age = 13.65 years, 51.57% male),24.4% were caries-free. The OHL level of 50.2% of the students was inadequate and it was in positive correlation with the OHI-S, students’ gender, grade, and their fathers’ educational level (P < 0.05). The mean DMFT of the sample was 3.35 ± 2.72 and it was significantly higher among girls (P = 0.004). The mean OHI-S was 1.24 ± 0.91.
CONCLUSION: According to our findings, students with higher OHL had better oral hygiene status and belonged to higher educated families. OHL-promoting programs for the students should be considered to improve their oral health and prevent future dental caries.


Main Subjects

Horowitz AM, Kleinman DV. Oral health literacy: The new imperative to better oral health. Dent Clin North Am 2008; 52(2): 333-44.
Baskaradoss JK. Relationship between oral health literacy and oral health status. BMC Oral Health 2018; 18(1): 172.
Lima LCM, Neves ETB, Dutra LDC, Firmino RT, Araujo LJS, Paiva SM, et al. Psychometric properties of BREALD-30 for assessing adolescents' oral health literacy. Rev Saude Publica 2019; 53: 53.
Batista MJ, Lawrence HP, Sousa MDLR. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health 2017; 18(1): 60.
Haerian Ardakani A, Morowati Sharifabad MA, Rezapour Y, Pourghayumi Ardakani A. Investigation of the relationship of oral health literacy and oral hygiene self-efficacy with DMFT and Gingival index in students of Ardakan University. Payesh 2015; 14(3): 351-62. [In Persian].
Kesavan R, Prabhakar R, Chaly P, Saravanan R, Mary AV. Assessment of oral health literacy and its relationship with oral health related behaviour and socioeconomic status among students of a university in Chennai City. Biomed Pharmacol J 2019; 12(2): 739-46.
Firmino RT, Ferreira FM, Paiva SM, Granville-Garcia AF, Fraiz FC, Martins CC. Oral health literacy and associated oral conditions: A systematic review. J Am Dent Assoc 2017; 148(8): 604-13.
Manganello JA. Health literacy and adolescents: A framework and agenda for future research. Health Educ Res 2008; 23(5): 840-7.
Lopes RT, Neves ETB, Dutra LDC, Gomes MC, Paiva SM, Abreu MHNG, et al. Socioeconomic status and family functioning influence oral health literacy among adolescents. Rev Saude Publica 2020; 54: 30.
10. Dutra LDC, de Lima LCM, Neves ETB, Gomes MC, de Araujo LJS, Forte FDS, et al. Adolescents with worse levels of oral health literacy have more cavitated carious lesions. PLoS One 2019; 14(11): e0225176.
11. Nowak AJ, Christensen JR, Mabry TR, Townsend JA, Wells MH. Pediatric dentistry: Infancy through adolescence. Philadelphia, PA: Elsevier; 2019.
12. Silk H, Kwok A. Addressing adolescent oral health: A review. Pediatr Rev 2017; 38(2): 61-8.
13. Dickson-Swift V, Kenny A, Farmer J, Gussy M, Larkins S. Measuring oral health literacy: A scoping review of existing tools. BMC Oral Health 2014; 14: 148.
14. Sabbahi DA, Lawrence HP, Limeback H, Rootman I. Development and evaluation of an oral health literacy instrument for adults. Community Dent Oral Epidemiol 2009; 37(5): 451-62.
15. World Health Organization. Oral health surveys: Basic methods. 5th ed. Geneva, Switzerland: WHO; 2013.
16. Basir L, Hashemi E, Khataminia M, Ansarifar S. Evaluation of correlation between DMFT index and social factors in 3-6 years old children of Ahvaz kindergartens. Jundishapur Sci Med J 2014; Suppl: 17-29. [In Persian].
17. Basir L, Khaneh Masjedi MA, Dasht Bozorgi B. Evaluation of the effect of repetition of oral health education in 9-10 years old students’ plaque index. Jundishapur Sci Med J 2009; 8(2): 219-29. [In Persian].
18. Senthil A, Kirk R. Oral health literacy of parents of pre-schoolers in New Zealand. J Theory Pract Dent Public Health 2013; 1(4): 20-9.
19. Kanupuru KK, Fareed N, Sudhir KM. Relationship between oral health literacy and oral health status among college students. Oral Health Prev Dent 2015; 13(4): 323-30.
20. Alm A, Wendt LK, Koch G, Birkhed D. Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age. Caries Res 2008; 42(1): 28-36.
21. Abdelhamid N, Bahta H, Raja S, Dhanni C, Hamida ME. Prevalence of dental caries and evaluation of mean DMFT index among secondary school students in Asmara, Eritrea. Afr J Oral Health 2019; 8(2): 1-7.
22. Babaei Hatkehlouei M, Tari H, Goudarzian AH, Hali H. Decayed, missing, and filled teeth (DMFT) index among first-grade elementary students in Mazandaran Province, northern Iran. Int J Pediatr 2017; 5(6): 5069-77.
23. Gorgi Z, Abbasi A, Mohsenzadeh A, Damankeshan A, Sheikh Fathollahi M. A survey on DMFT index of the first permanent molar in 12-year-old students of Larestan, Iran, in 2014. J Occu Health Epidemiol 2017; 6(1): 32-9.
24. Ghasemianpour M, Bakhshandeh S, Shirvani A, Emadi N, Samadzadeh H, Moosavi Fatemi N, et al. Dental caries experience and socio-economic status among Iranian children: a multilevel analysis. BMC Public Health 2019; 19(1): 1569.
25. Lukacs JR, Largaespada LL. Explaining sex differences in dental caries prevalence: saliva, hormones, and "life-history" etiologies. Am J Hum Biol 2006; 18(4): 540-55.
26. Obregon-Rodriguez N, Fernandez-Riveiro P, Pineiro-Lamas M, Smyth-Chamosa E, Montes-Martinez A, Suarez-Cunqueiro MM. Prevalence and caries-related risk factors in schoolchildren of 12- and 15-year-old: a cross-sectional study. BMC Oral Health 2019; 19(1): 120.
27. Al Nuaimi M, Ferguson DJ, Al-Mulla A. Oral hygiene status in school adolescents: A study of 20,000 school-age adolescents in 66 public and private schools comparing oral hygiene status by gender and ethnicity. Oral Health Dent Manag 2014; 13(2): 474-85.
28. Rachmawati E, Setiawan AS, Hayati AT, Saptarini RP, Carolina DN, Rusmina N. Determination of oral hygiene status (OHI-S) and dental health status (DEF-T) of elementary school age children in Bandung City. J Int Dent Med Res 2020; 12(4): 1447-51.
29. Haridas R, SS, Ajagannanavar SL, Tikare S, Maliyil MJ, Kalappa AA. Oral health literacy and oral health status among adults attending dental college hospital in India. J Int Oral Health 2014; 6(6): 61-6.
30. Albohassan J, Almaydani A, Alhammadi A, Almurayhil A. The association between perception of esthetic and oral hygiene practice: A cross sectional study among Saudi adolescent. Saudi Dent J 2019; 31: S75.
31. Eigbobo JO, Nzomiwu CL, Obiajunwa CC. Oral hygiene practices among adolescents in Port Harcourt – a school-based study. Niger Q J Hosp Med 2017; 27(2): 719-25.
32. Lee YH, Choi JO. Study on DMFT related factors in some adolescents. Curr Pediatr Res 2017; 21(4): 640-5.
33. Santha B, Sudheer H, Saxena V, Jain M, Tiwari V. The impact of body mass index on oral hygiene practices of adolescents in Bhopal City, India. J Coll Physicians Surg Pak 2016; 26(2): 125-9.