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

Autoři: Laio da Costa Dutra aff001;  Larissa Chaves Morais de Lima aff001;  Érick Tássio Barbosa Neves aff001;  Monalisa Cesarino Gomes aff001;  Luíza Jordânia Serafim de Araújo aff001;  Franklin Delano Soares Forte aff002;  Saul Martins Paiva aff003;  Fernanda Morais Ferreira aff003;  Ana Flávia Granville-Garcia aff001
Působiště autorů: Graduate Program in Dentistry, State University of Paraiba (UEPB), Campina Grande, Paraiba, Brazil aff001;  Graduate Program in Dentistry, Federal University of Paraiba (UFPB), Joao Pessoa, Paraiba, Brazil aff002;  Graduate Program in Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225176


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.

Klíčová slova:

Adolescents – Caries – Dentition – Literacy – Oral health – Schools – Social stratification – Socioeconomic aspects of health


1. Antunes JL, Peres MA, Frias AC, Michel-Crosato E, Biazevic MHG. Gingival health of adolescents and the utilization of dental services, state of São Paulo, Brazil. 2008; 42 (2):191–9.

2. Sanders LM, Shaw JS, Guez G, Baur C, Rudd R. Health Literacy and Child Health Promotion: Implications for Research, Clinical Care, and Public Policy. Pediatrics. 2009; 124 (3): 306–14.

3. Macek MD, Haynes D, Wells W, Bauer-Leffler S, Cotton PA, Parker RM. Measuring conceptual health knowledge in the context of oral health literacy: Preliminary results. J Public Health Dent. 2010; 70 (3): 197–204. doi: 10.1111/j.1752-7325.2010.00165.x 20337901

4. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Secretaria de Vigilância em Saúde. SB Brasil 2010: Pesquisa Nacional de Saúde Bucal: resultados principais / Ministério da Saúde. Secretaria de Atenção à Saúde. Secretaria de Vigilância em Saúde.–Brasília: Ministério da Saúde; 2012. p. 116.

5. Silveira MF, Freire RS, Nepomuceno MO, Martins AM, Marcopito LF. Tooth decay and associated factors among adolescents in the north of the State of Minas Gerais, Brazil: a hierarchical analysis. Ciênc. saúde coletiva. 2015; 20 (11): 3351–3364

6. Davoglio RS, Aerts DR, Abegg C, Freddo SL, Monteiro L. Factors associated with oral health habits and use of dental services by adolescents. Cad Saude Publica. 2009; 25 (3): 655–667. doi: 10.1590/s0102-311x2009000300020 19300854

7. Gomes MC, Perazzo MF, Neves ÉT, Martins CC, Paiva SM, Granville-Garcia AF. Oral Problems and Self-Confidence in Preschool Children. Braz. Dent. J. 2017; 28 (4): 523–530. doi: 10.1590/0103-6440201601295 29160407

8. Cianetti S, Lombardo G, Lupatelli E, Rossi G, Abraha I, Pagano S, Paglia L. Dental caries, parents educational level, family income and dental servisse attendance among children in Italy. Eur J Paediatr Dent.2017; 18 (1): 15–18. doi: 10.23804/ejpd.2017.18.01.03 28494596

9. Engelmann JL, Tomazoni F, Oliveira M, Ardenghi TM. Association between Dental Caries and Socioeconomic Factors in Schoolchildren—A Multilevel Analysis. Braz. Dent. J. 2016; 27(1):72–78. doi: 10.1590/0103-6440201600435 27007350

10. Schiavo JH. Oral health literacy in the dental office: the unrecognized patient risk factor. J Dent Hyg. 2011; 85 (4): 248–55. 22309865

11. Peker K, Köse TE, Güray B, Uysal Ö, Erdem TL. Reliability and validity of the Turkish version of the Rapid Estimate of Adult Literacy in Dentistry (TREALD-30). Acta Odontol Scand. 2017; 75 (3): 198–207. doi: 10.1080/00016357.2016.1278079 28093024

12. Junkes MC, Fraiz FC, Sardenberg F, Lee JY, Paiva SM, Ferreira FM. Validity and reliability of the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry—BREALD-30. PLoS One; 2015; 10 (7): e0131600. doi: 10.1371/journal.pone.0131600 26158724

13. Lima LCM, Neves ETB, Dutra LC, Firmino RT, Araújo LJS, Paiva SM, Ferreira FM, Granville-Garcia AF. Psychometric properties of the Breald-30 for adolescents. Rev Saude Publica. 2019; 53:53. doi: 10.11606/S1518-8787.2019053000999 31432910

14. Sørensen k, Broucke SV, Fullan J, Doyle G, Pelikan J, Slonska Z, Brand H, HLS-EU. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012; 12:80. doi: 10.1186/1471-2458-12-80 22276600

15. Lee JY, Divaris K, Baker AD, Rozier RG, Vann WF Jr. The Relationship of oral health literacy and self-efficacy with oral health status and dental neglect. Am J Public Health. 2012; 102 (5): 923–29. doi: 10.2105/AJPH.2011.300291 22021320

16. Biazevic MGH, Rissotto RR, Michel-Crosato E, Mendes LA, Mendes MOA. Relationship between oral health and its impact on quality of life among adolescentes. Braz oral res. 2008; 22 (1): 36–42. doi: 10.1590/s1806-83242008000100007 18425243

17. Gushi LL, Forni TIB, Vieira V, Wada RS, Sousa MLR. Dental caries in 15-to-19-year-old adolescents in São Paulo State, Brazil, 2002. Cad Saude Publica. 2005; 21 (5): 1383–91. doi: 10.1590/s0102-311x2005000500010 16158143

18. Newton JT, Bower EJ. The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol. 2005; 33 (1): 25–34. doi: 10.1111/j.1600-0528.2004.00190.x 15642044

19. Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CM: STROBE initiative: guidelines on reporting observational studies. Rev Saude Publica. 2010; 44 (3): 559–65. doi: 10.1590/s0034-89102010000300021 20549022

20. Nyvad B, Machiulskine V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res. 1999; 33 (4): 252–60. doi: 10.1159/000016526 10343087

21. Peres MA, Traebert J, Marcenes W. Calibration of examiners for dental caries epidemiology studies. Cad Saude Publica. 2001; 17 (1): 153–9. doi: 10.1590/s0102-311x2001000100016 11241938

22. Vilella KD, Assunção LRS, Junkes MC, Menezes JVNB, Fraiz FC, Ferreira FM. Training and calibration of interviewers for oral health literacy using the BREALD-30 in epidemiological studies. Braz. Oral Res. 2016; 30 (1):1–7.

23. Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de classificação econômica Brasil. 2016 [citado em 06 de fevereiro de 2019].

24. Blizniuk A, Ueno M, Zaitsu T, Kawaguchi Y. Association of oral health literacy with oral health behaviour and oral health status in Belarus. Community Dent Health. 2015; 32 (3): 148–152. 26513849

25. Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol. 2008; 8: 70. doi: 10.1186/1471-2288-8-70 18973665

26. Nyvad B, Baelum V. Nyvad Criteria for Caries Lesion Activity and Severity Assessment: A Validated Approach for Clinical Management and Research. Caries Res. 2018; 52 (5): 397–405. doi: 10.1159/000480522 29506010

27. Kim JA, Choi HM, Seo Y, Kang DR. Relations among obesity, Family socioeconomic status, oral health behaviors, and dental caries in adolescents: the 2010–2012 Korea National Health and nutrition examination survey. BMC Oral Health. 2018; 18 (1): 114–20.

28. Roncalli AG, Sheiham A, Tsakos G, Watt RG. Socially unequal improvements in dental caries levels in Brazilian adolescents between 2003 and 2010. Community Dent Oral Epidemiol. 2015; 43 (4): 317–24. doi: 10.1111/cdoe.12156 25660728

29. Marthaler T, Menghini G, Steiner M. Use of the Significant Caries Index in quantifying changes in caries in Switzerland from 1964 to 2000. Community Dent Oral Epidemiol. 2005; 33 (3):159–66. doi: 10.1111/j.1600-0528.2005.00196.x 15853838

30. Baskaradoss JK. The association between oral health literacy and missed dental appointments. J Am Dent Assoc. 2016; 147 (11): 867–74. doi: 10.1016/j.adaj.2016.05.011 27497866

31. DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009; 124 (3): 265–74.

32. Miller E, Lee JY, Dewalt DA, Vann WF Jr. Impact of caregiver literacy on children’s oral health outcomes. Pediatrics. 2010; 126 (1): 107–114. doi: 10.1542/peds.2009-2887 20547644

33. Sanzone LA, Lee JY, Divaris K, Dewalt D, Baker AD; Vann W Jr. A cross sectional study examining social desirability bias in caregivers reporting of children’s oral health behaviors. BMC Oral Health. 2013; 13 (24).

34. Vichayanrat T, Sittipasoppon T, Rujiraphan T, Meeprasert N, Kaveepansakol P, Atamasirikun Y. Oral health literacy among mothers of pre-school children. M Dent J. 2014; 34 (3): 243–52.

35. Perry EL. Health literacy in adolescents: integrative review. J for Spec Ped. 2014; 19: 210–18

36. Holtzman JS, Atchison KA, Gironda MW, Radbod R, Gornbein J. The association between oral health literacy and failed appointments in adults attending a university based general dental clinic. Community Dent Oral Epidemiol. 2014; 42 (3): 263–70. doi: 10.1111/cdoe.12089 24372282

37. Bridges SM, Parthasarathy DS, Wongb HM, Yiu CKY, Au TK, Mcgrath CPJ. Development of functional oral health literacy assessment instruments: application of literacy and cognitive theories. J Public Health Dent. 2014; 74 (2): 110–9. doi: 10.1111/jphd.12033 24015770

38. Macek MD, Atchison KA, Chen H, Wells W, Haynes D, Parker RM, Azzo S. Oral health conceptual knowledge and its relationship with oral health outcomes: findings from a multi-site health literacy study. Commun Dent Oral Epidemiol. 2017; 45 (4):323–9.

39. Haridas R, Supreetha S, 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. 25628486

40. Gong DA, Lee JY, Rozier RG, Pahel BT, Richman JA, Vann WF Jr. Development and testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD). J Public Health Dent. 2007; 67 (2): 105–12. doi: 10.1111/j.1752-7325.2007.00023.x 17557682

41. Peres MA, Liu P, Demarco FF, Silva AER, Wehrmeister FC, Menezes AM, Peres KG Income trajectories affect treatment of dental caries from childhood to Young adulthood: a birth cohort study. Braz. Oral Res. 2018; 32: e36. doi: 10.1590/1807-3107bor-2018.vol32.0036 29742233

Článek vyšel v časopise


2019 Číslo 11