Factors Associated with Oral Health Literacy among Patients with Type 2 Diabetes Mellitus Attending Hospital Universiti Sains Malaysia


  • Norkhafizah Saddki
  • Muhamad Izaat bin Mohd Hashim
  • Noraini Mohamad


Diabetes Mellitus, Oral Health, Health Literacy, Health Education


Objective: To determine the oral health literacy (OHL) level and its associated factors among patients with type 2 diabetes mellitus attending Hospital Universiti Sains Malaysia (USM). Material and Methods: This cross-sectional study involved 135 diabetic patients with a mean age of 62.6 years old (SD=9.05) who attended the Diabetes Outpatient Clinic at Hospital USM, a teaching hospital in the north-eastern corner of Peninsular Malaysia. The Malay version of the Oral Health Literacy Instrument (OHLI-M) was used to assess the level of OHL among respondents. An additional self-administered questionnaire was used to obtain other variables of interest. Systematic random sampling was applied in this study. The data were analyzed using an independent t-test and ANOVA to determine factors associated with oral health literacy among respondents. Results: Most respondents have at least one oral health problem (62.2%). The most common problem was cavitated tooth (42.2%). Other problems include toothache (17.8%), mobile tooth (17.8%), and swollen gums (16.3%). OHL level for most respondents (40.7%) was inadequate. The mean total OHLI-M score was 67.9 (SD=17.74). The OHL score was significantly lower in respondents with the following characteristics: female, no formal education or had primary education, unemployed, lower income group, never visited a dentist, and had swollen gums. Conclusion: The OHL of most patients with type 2 diabetes mellitus attending the Diabetes Outpatient Clinic, Hospital USM still need to be improved. Oral health problems were common in patients with type 2 diabetes mellitus in this study. This study also highlighted the link between OHL and socio-demographic factors. Improving the OHL of patients may increase their capability to obtain and understand oral health messages needed to take appropriate actions that will eventually prevent oral diseases associated with diabetes mellitus.


American Dental Association. Health Literacy in Dentistry.2021. Available from: https://www.ada.org/en/public-programs/health-literacy-in-dentistry#:~:text=ADA%%20defines%20oral%20health,make%20appropriate%20oral%20health%20decisions. [Accessed on January 26, 2021].

Sorensen K, Van den Broucke S, Fullam J, Doyle G., Pelikan J, SlonskaZ, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012; 12(1):1-13. https://doi.org/10.1186/1471-2458-12-80

Bress LE. Improving Oral health literacy – the new standard in dental hygiene practice. J Dent Hyg 2013; 87(6):322-9.

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(1):148-61. https://doi.org/10.1186/1472-6831-14-148

Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone M. Literacy and health outcomes. J Gen Intern Med 2004; 19(12):1228-39. https://doi.org/10.1111/j.1525-1497.2004.40153.x

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):923-9. https://doi.org/10.2105/AJPH.2011.300291

Mahmud SZ, Amin MS, Tarafder MA, Hossain SM. Measurement of oral health literacy level among Bangladeshi adults seeking dental care and its relationship with socio-demographic characteristics. Anwer Khan Mod Med Coll J 2016; 7(1):34-9. https://doi.org/10.3329/akmmcj.v7i1.31611

Henderson E, Dalawari P, Fitzgerald J, Hinyard L. Association of oral health literacy and dental visitation in an inner-city emergency department population. Int J Environ Res Public Health 2018;15(8):1748-58. https://doi.org/10.3390/ijerph15081748

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care 2014; 37(1):81-90. https://doi.org/10.2337/dc14-S081

Institute for Public Health, National Institutes of Health. Ministry of Health, Malaysia. National Health and Morbidity Survey 2019. Technical report. Volume 1. Non-Communicable Diseases: Diabetes, Hypertension and Hypercholesterolaemia. Available from: http://ikumohgovmy/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-NCD_v2pdf. 2020. [Accessed on January 27, 2021].

Wild S, Roglic G, Green A., Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes care 2004; 27(5):1047-53. https://doi.org/10.2337/diacare.27.10.2568

Nanditha A, Ronald CW, Ramachandran A, Snehalatha C, Chan JC, Chia K, et al. Diabetes in Asia and the Pacific: implications for the global epidemic. Diabetes Care 2016; 39(3):472-85. https://doi.org/10.2337/dc15-1536

Kane SF. The effects of oral health on systemic health. Gen Dent 2017; 65(6):30-4.

Alpert PT. Oral health: the oral-systemic health connection. Home Health Care Manag Pract 2017; 29(1):56-9. https://doi.org/10.1177/1084822316651658

Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. The Lancet 2005; 366(9499):1809-20. https://doi.org/10.1016/S0140-6736(05)67728-8

Casanova L, Hughes F, Preshaw P. Diabetes and periodontal disease: a two-way relationship. Br Dent J 2014; 217(8):433-7. https://doi.org/10.1038/sj.bdj.2014.907

Al-Maskari AY, Al-Maskari MY, Al-Sudairy S. Oral manifestations and complications of diabetes mellitus: a review. Sultan Qaboos Univ Med J 2011; 11(2):179-86.

Aggarwal A, Panat SR, Oral health behavior and HbA1c in Indian adults with type 2 diabetes. J Oral Sci 2012; 54(4):293-301. https://doi.org/10.2334/josnusd.54.293

Ramlay MZ, Saddki N, Tin-Oo M, Arifin WN. Cross-cultural adaptation and validation of Oral Health Literacy Instrument (OHLI) for Malaysian adults. Int J Environ Res Public Health 2020; 17(15):1-11. https://doi.org/10.3390/ijerph17155407

Fabillah NS, Mustapa N, Rohani M, Esa R. Oral health literacy among carers of special needs children in Kuala Terengganu, Malaysia. Ann Dent UM 2015; 22(1):15-20. https://doi.org/10.22452/adum.vol22no1.3

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):148-52.

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. https://doi.org/10.1111/j.1600-0528.2009.00490.x

Ministry of Health Malaysia. National Oral Health Survey of Adults 2010; Oral Health Division, Ministry of Health Malaysia: Kuala Lumpur, Malaysia. Available from: https://ohdmohgovmy/images/pdf/annual_rpt/annual_rpt13pdf. 2013. [Accessed on Jun 27, 2021].

Preshaw PM, Bissett SM. Periodontitis and diabetes. Br Dent J 2019; 227(7):577-84. https://doi.org/10.1038/s41415-019-0794-5

Blizniuk A, Ueno M, Furukawa S, Kawaguchi Y. Evaluation of a Russian version of the oral health literacy instrument (OHLI). BMC Oral Health 2014; 14(1):1-7. https://doi.org/10.1186/1472-6831-14-141

Llena Puy MC. The role of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Patol Oral Cir Bucal 2006; 11(5):449-45.

Kodama Y, Matsuura M, Sano T, Nakahara Y, Ozaki K, Narama I, et al. Diabetes enhances dental caries and apical periodontitis in caries-susceptible WBN/KobSlc rats. Comp Med 2011; 61(1):53-9.

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. https://doi.org/10.1016/j.adaj.2017.04.012.

Baskaradoss JK. Relationship between oral health literacy and oral health status. BMC Oral Health 2018; 18(1):172-8. https://doi.org/10.1186/s12903-018-0640-1

Doak CC DL, Root JH. Teaching Patients with Low Literacy Skills. 2nd. ed. Philadelphia: JB Lippincott; 1996.

Mbanda N, Dada S, Bastable K, Ingalill GB, Ralf WS. A scoping review of the use of visual aids in health education materials for persons with low-literacy levels. Patient Educ Couns 2020; 104(5):998-1017. https://doi.org/10.1016/j.pec.2020.11.034

Perazzo MF, Serra Negra JM, Firmino RT, Pordeus IA, Martins-Júnior PA, Paiva SM. Patient-centered assessments: how can they be used in dental clinical trials? Braz Oral Res 2020; 34(5):1-7. https://doi.org/10.1590/1807-3107bor




How to Cite

Saddki, N., Hashim, M. I. bin M., & Mohamad, N. (2022). Factors Associated with Oral Health Literacy among Patients with Type 2 Diabetes Mellitus Attending Hospital Universiti Sains Malaysia. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 22, e210143. Retrieved from https://revista.uepb.edu.br/PBOCI/article/view/1487



Original Articles