Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 7;25(1):1300.
doi: 10.1186/s12903-025-06613-y.

Oral health literacy: its impact on oral health outcomes and associated factors in sixth-grade primary school students - a cross-sectional study

Kirana Kamolchaiwanich  1 , Pinpinut Wanichsaithong  2
Affiliations

Oral health literacy: its impact on oral health outcomes and associated factors in sixth-grade primary school students - a cross-sectional study

Kirana Kamolchaiwanich et al. BMC Oral Health. .

Abstract

Background: Low oral health literacy (OHL) plays a crucial role in contributing to poor oral health outcomes. However, limited studies have focused on school-age children. This study aims to investigate the association between OHL among sixth-grade primary school students and oral health outcomes, and to identify factors related to inadequate OHL.

Methods: A cross-sectional study was conducted among 408 Thai sixth-grade primary school students (aged 12 years) in Pathum Thani Province, Thailand. Participants completed the Test of Functional Health Literacy in Dentistry for Primary School Children (P-TOFHLiD) to assess OHL and underwent oral examinations. Oral health behaviors were collected through participant interviews and caregiver questionnaires, while demographic data were obtained from caregiver questionnaires. Chi-square tests, Spearman's correlation, and logistic regression were used to assess associations between OHL and oral health outcomes, and to identify risk factors for inadequate OHL.

Results: The mean P-TOFHLiD score was 19.4 (SD = 4.7), with a median of 21 (IQR: 17-23). 59.6% had inadequate OHL (score < 21). Chi-square tests showed that participants with inadequate OHL were more likely to have untreated caries in permanent teeth (p < 0.001), first permanent molars with disease-related pulp exposure (p = 0.001), poorer oral hygiene (p < 0.001), and consumption of cariogenic snacks (p < 0.001), while no associations were found with missing or filled permanent teeth, brushing frequency, fluoridated toothpaste use, or dental service utilization. Logistic regression showed that inadequate OHL increased the odds of having untreated caries in permanent teeth (AOR = 8.30, 95% CI: 4.89-14.11), first permanent molars with disease-related pulp exposure (AOR = 20.63, 95% CI: 4.84-87.91), and poor oral hygiene (AOR = 2.08, 95% CI: 1.20-3.59). Lower Grade Point Average (GPA) (AOR = 0.01, 95% CI: 0.00-0.02) and low family income (< 10,000 Baht) (AOR = 3.56, 95% CI: 1.62-7.82) were associated with increased risk of inadequate OHL.

Conclusions: Inadequate OHL was linked to adverse oral health outcomes. Lower GPA and low family income were identified as risk factors for inadequate OHL. These findings emphasize the need for targeted interventions to strengthen OHL and improve children's oral health.

Trial registration: Not applicable.

Keywords: Dental caries; Oral health literacy; Oral health promotion in school; Oral health status; P-TOFHLiD; Primary school-aged children; TOFHLiD.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Human Research Ethics Committee of Thammasat University (Science), Thailand (HREC-TU COA No. 027/2567), which considered the protocol in accordance with the Declaration of Helsinki, the Belmont Report, CIOMS guidelines, and international practice (ICH-GCP). Informed consent was obtained from all participants and their primary caregivers. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participants enrolled in the study (n = 408)
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Bramantoro T, Santoso CMA, Hariyani N, Setyowati D, Zulfiana AA, Nor NAM, Nagy A, Pratamawari DNP, Irmalia WR. Effectiveness of the school-based oral health promotion programmes from preschool to high school: a systematic review. PLoS ONE. 2021;16(8):e0256007. - PMC - PubMed
    1. Chakraborty T, Munigala A, Kala T, Yedla R, Shankar KS, Bennadi D, Tiwari HD, Patel P. Assessment of oral health promotion programs in schools and their long-term effects. J Pharm Bioallied Sci. 2024;16(Suppl 3):S2543–5. - PMC - PubMed
    1. Thai Bureau of Dental Health. The 9th National Oral Health Survey in Thailand. Department of Health, Ministry of Public Health. 2024. https://dental.anamai.moph.go.th/th/national-oral-health-survey-report/4952. Accessed 14 Jun 2024.
    1. Krisdapong S, Sheiham A, Tsakos G. Oral health-related quality of life of 12- and 15-year-old Thai children: findings from a National survey. Community Dent Oral Epidemiol. 2009;37(6):509–17. - PubMed
    1. Thai Bureau of Dental Health. Draft Thailand National Oral Health Plan 2023–2037. Department of Health, Ministry of Public Health. 2024. https://dental.anamai.moph.go.th/th/oral-health-plan/download?id=115982%.... Accessed 14 August 2024.

LinkOut - more resources