Al-Assmi, Zainab Mohammed; (2022) The association between dental caries and school performance and attendance in 13-15-year-old schoolchildren in Saudi Arabia. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Dental caries is a highly prevalent global disease that impacts quality of life and affects daily activities. Different studies aimed to test the association between oral health or dental caries and school performance and attendance (school outcomes), however, the results were inconclusive. Most studies indicated that poor oral health or the presence of dental caries was associated with poor school performance and frequent absence from schools, whilst fewer studies indicated no association. No studies about the association between dental caries and school outcomes were carried out in Saudi Arabia. Moreover, the available studies were not free from conceptual and methodological limitations. These limitations included using non-validated measures of school outcomes and not accounting for covariate variables. This study aimed to examine the association between dental caries and dental sepsis with school performance and attendance. The second aim was to test the potential role of oral health related quality of life (OHRQoL) related to caries in the aforementioned association. Methods: This is a cross-sectional study of 13-15-year-old schoolchildren who attend public intermediate schools in Riyadh, Saudi Arabia. Ethical approval was obtained from UCL Research Ethics Committee and King Saud University Institutional Review Board, and parental consent was obtained prior to data collection. Information about dental caries and sepsis (main independent variables), demographics, socioeconomic position and OHRQoL was collected from schoolchildren. School performance and attendance (study outcomes) information were collected from schools and the Saudi Ministry of Education (SME). Multivariable linear regression analysis was carried out to explore the associations of interest while sequentially adjusting for demographic characteristics, socioeconomic position, dental visits and caries-specific OHRQoL. Results: In the unadjusted model, dental caries and sepsis were negatively associated with GPA scores (GPA) and students marks in mathematics (MathM), Science (SciM) and English language (EngM). Schoolchildren with extensive caries (4 or more carious teeth) and those with dental sepsis had significantly lower GPA, MathM, SciM and EngM than their peers though the differences were generally negligible or small in terms of magnitude. However, children with moderate caries (1-3 carious teeth) were not significantly different in school performance outcomes than children with no caries. Adjusting for caries-specific OHRQoL hardly attenuated the estimates between extensive caries and school performance, but it slightly attenuated the estimates between dental sepsis and school performance. No association was observed between dental caries and sepsis with school attendance. Conclusion: Extensive dental caries and the presence of dental sepsis were associated with worse school performance among 13-15-year-old schoolchildren in Saudi Arabia. Caries-specific OHRQoL did not contribute much to explaining the associations above, but it slightly attenuated some of the associations. On the contrary, dental caries and sepsis were not associated with school attendance.

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