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19-04-2020 | Uitgave 9/2020

Quality of Life Research 9/2020

The association of socio-economic status, dental anxiety, and behavioral and clinical variables with adolescents’ oral health-related quality of life

Quality of Life Research > Uitgave 9/2020
Bilu Xiang, Hai Ming Wong, Antonio P. Perfecto, Colman P. J. McGrath
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The online version of this article (https://​doi.​org/​10.​1007/​s11136-020-02504-7) contains supplementary material, which is available to authorized users.

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It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents’ OHRQoL.


Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents’ educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents’ OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis.


1207 adolescents (46.6% females) participated in this study. The mean total CPQ11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p < 0.05). In addition, gingival bleeding was a predictor of the oral symptom domain (β = 0.7, p = 0.027); the emotional well-being of adolescents whose father went to college had a better OHRQoL (β =  − 0.9, p = 0.014) and adolescents from the higher-income family had a statistically better social well-being (p = 0.015).


Our study indicates that adolescents with poorer oral health knowledge, higher dental anxiety levels, brushing their teeth less than once a day, or having a daily consumption of chocolate or biscuits had statistically worse OHRQoL. These findings can provide guidance for future oral health promotion in improving OHRQoL among adolescents.

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