Impact of Oral Conditions and Subjective Factors on Academic Performance


  • Fernanda Ruffo Ortiz
  • Thiago Machado Ardenghi
  • Saul Martins Paiva
  • Marília Cunha Maroneze
  • Isabela Almeida Pordeus


Adolescent, Academic Performance, Bullying, Oral Health


Objective: To evaluate the influence of oral health clinical and non-clinical indicators on adolescents’ academic performance. Material and Methods: A longitudinal design was performed with a random sample of 1,134 12-year-old Brazilian adolescents. In 2012, the adolescents were clinically assessed by calibrated dentists and investigated about demographics, socioeconomic factors, dental service use, toothache, and verbal bullying related to oral condition via structured questionnaires. The contextual variable was obtained from the city’s official database. After two years, 771 adolescents were reassessed. The outcome adolescent’s academic performance (good or poor) was collected through official school’s register. Multilevel logistic regression analyses were performed to assess associated factors for adolescents’ academic performance. Results: Adolescents with toothache (OR 1.74; CI 95%: 1.05-2.89), who have been a victim of bullying (OR 2.23; CI 95%: 1.21-4.09), and were male (OR 1.92; CI 95%: 1.19-3.09) had a lower academic performance. On the other hand, adolescents whose mothers had higher educational levels (OR 1.79; CI 95%: 1.08-2.97) and belonged to higher-income households (OR 1.95; CI 95%: 1.18-3.23) had higher academic performance when compared to their peers. Conclusion: Adverse oral conditions, as well as subjective and socioeconomic factors, impacted on adolescents’ academic performance.


World Health Organization. Global Accelerated Action for the Health of Adolescents (‎AA-HA!)‎: Guidance to Support Country Implementation. Geneva: World Health Organization; 2017.

Blum RW, Nelson-Mmari K. The health of young people in a global context. J Adolesc Health 2004; 35(5):402-18.

Thomson WM, Poulton R, Milne BJ, Caspi A, Broughton JR, Ayers KMS. Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort. Community Dent Oral Epidemiol 2004; 32(5):345-53.

Haas SA. Health selection and the process of social stratification: the effect of childhood health on socioeconomic attainment. J Health Soc Behav 2006; 47(4):339-54.

Ruijsbroek A, Wijga AH, Gehring U, Kerkhof M, Droomers M. School performance: a matter of health or socio-economic background? Findings from the PIAMA birth cohort study. PloS ONE 2015; 10(8):e0134780.

Frenz P, Kaufman JS, Nazzal C, Cavada G, Cerecera F, Silva N. Mediation of the effect of childhood socioeconomic position by educational attainment on adult chronic disease in Chile. Int J Public Health 2017; 62(9):1007-17.

Koivusilta L, Arja R, Andres V. Health behaviours and health in adolescence as predictors of educational level in adulthood: a follow-up study from Finland. Soc Sci Med 2003; 57(4):577-93.

Haas SA, Fosse NE. Health and the educational attainment of adolescents: Evidence from the NLSY97. J Health Soc Behavior 2008; 49(2):178-92.

Guarnizo-Herreño CC, Lyu W, Wehby GL. Children's oral health and academic performance: evidence of a persisting relationship over the last decade in the United States. J Pediatric 2019; 209:183-9.

Ribeiro APAD, Almeida RF, Mendonça JGA, Leal SC. Oral health and its effect on the academic performance of children and adolescents. Pediatr Dent 2018; 40(1):12-7.

United Nations International Children's Emergency Fund. Hidden in Plain Sight: A Statistical Analysis of Violence Against Children. New York: UNICEF, 2014.

Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry 2013; 70(4):419-26.

Hanish LD, Guerra NG. A longitudinal analysis of patterns of adjustment following peer victimization. Dev Psychopathol 2002; 14(1):69-89.

Rebelo MAB, Rebelo Vieira JM, Pereira JV, Quadros LN, Vettore MV. Does oral health influence school performance and school attendance? A systematic review and meta-analysis. Int J Paediatr Dent 2019; 29(2):138-48.

World Health Organization. Oral Health Surveys: Basic Methods. 4th ed. Geneva: World Health Organization; 1997.

Instituto Brasileiro de geografia e Estatística. Censo Demográfico, 2010. Available from: [Accessed on July 15, 2020]. [In Portuguese].

Tomazoni F, Vettore MV, Zanatta FB, Tuchtenhagen S, Moreira CHC, Ardenghi TM. The associations of socioeconomic status and social capital with gingival bleeding among schoolchildren. J Public Health Dent 2017; 77(1):21-9.

Piovesan C, Antunes JLF, Mendes FM, Guedes RS, Ardenghi TM. Influence of children's oral health-related quality of life on school performance and school absenteeism. J Public Health Dent 2012; 72(2):156-63.

Barasuol JC, Soares JP, Castro RG, Giacomin A, Gonçalves BM, Klein D, et al. Untreated dental caries is associated with reports of verbal bullying in children 8-10 years old. Caries Res 2017; 51(5):482-8.

Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Portal Ideb. 2013. Available from: [Accessed on August 23, 2020]. [In Portuguese].

Perazzo MF, Gomes MC, Neves ÉTB, Firmino RT, Barros AA, Silva LC, et al. Self-perceptions of the impact of oral problems on the social behavior of preschoolers. JDR Clin Trans Res 2019; 17:2380084419894576.

Jackson SL, Vann JrWF, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health 2011; 101(10):1900-6.

Maharani DA, Adiatman M, Rahardjo A, Burnside G, Pine C. An assessment of the impacts of child oral health in Indonesia and associations with self-esteem, school performance and perceived employability. BMC Oral Health 2017; 17(1):65.

Maroneze MC, Ardenghi DM, Brondani M, Unfer B, Ardenghi TM. Dental treatment improves oral health-related quality of life of adolescents: a mixed methods approach. Int J Paed Dent 2019; 29(6):765-74.

Busch V, Laninga-Wijnen L, Schrijvers AJP, De Leeuw JRJ. Associations of health behaviors, school performance and psychosocial problems in adolescents in The Netherlands. Health Promot Int 2015; 32(2):280-91.

Reijntjes A, Stegge H, Terwogt MM, Kamphuis JH, Telch MJ. Children’s coping with in vivo peer rejection: An experimental investigation. J Abnormal Child Psychol 2006; 34(6):873-85.

Almeida RF, Leal SC, Medonca JGA, Hilgert LA, Ribeiro APD. Oral health and school performance in a group of schoolchildren from the Federal District, Brazil. J Public Health Dent 2018; 78(4):306-12.

Kaewkamnerdpong I, Krisdapong S. The associations of school oral health-related environments with oral health behaviours and dental caries in children. Caries Res 2018; 52(1-2):166-75.

Courtenay WH. Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Soc Sci Med 2000; 50(10):1385-1401.

Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 2). J Epidemiol Community Health 2006; 60(2):95-101.

Salama F, Alwohaibi A, Alabdullatif A, Alnasser A, Hafiz Z. Knowledge, behaviours and beliefs of parents regarding the oral health of their children. Eur J Paediatr Dent 2020; 21(2):103-9.




How to Cite

Ortiz, F. R. ., Ardenghi, T. M. ., Paiva, S. M. ., Maroneze, M. C., & Pordeus, I. A. . (2021). Impact of Oral Conditions and Subjective Factors on Academic Performance. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 21, e0233. Retrieved from



Original Articles