An empirical investigation of oral health literacy and its relationship with dental anxiety among university students.

Abstract

BACKGROUND: Oral health literacy (OHL) refers to an individual’s capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions. It is a multi-dimensional construct that has steadily gained prominence in dental research as a factor possibly associated with oral health behaviours, oral health outcomes and dental care access. Dental anxiety (DA) is a widespread issue in everyday dental practice; it poses a challenge for patients and dentists alike and is considered a major driving force behind poor dental attendance. Oral health literacy and dental anxiety both affect the patient-dentist relationship and are associated with a social gradient that may exacerbate oral health disparities. Only a few studies have explored the relationship between these two constructs in any population. AIM: The purpose of this cross-sectional study was a) to assess the oral health literacy of University of Macedonia students through a newly translated and validated oral health literacy instrument, b) to provide insights on the relationship between oral health literacy and dental anxiety and c) to explore the associations between these two constructs and several sociodemographic and oral health-related factors. MATERIALS AND METHODS: Data were collected from 278 University of Macedonia students via a questionnaire survey. Oral health literacy was measured with the OHL–AQ tool, which was translated into Greek following a forward-backward translation process. Dental anxiety was measured with the Modified Dental Anxiety Scale (MDAS). Sociodemographic characteristics and data pertaining to dental anamnesis and oral health-related behaviours were also recorded. OHL–AQ’s internal consistency was assessed with Cronbach’s alpha coefficient. Bivariate analyses were employed to explore the associations between the two constructs (OHL and DA) and the sociodemographic and oral health-related variables. The association between oral health literacy and dental anxiety was evaluated with Spearman’s correlation coefficient. A multiple linear regression model with dental anxiety (MDAS score) as the dependent variable was developed to investigate further the relationship between oral health literacy and dental anxiety on a multivariable level. RESULTS: The Greek version of OHL–AQ had a Cronbach’s alpha value of 0.721, indicating adequate internal consistency. The face, content and construct validity of the instrument were also favourable. The average age of the participants was 20.7 (SD = 3.9) and 52.9% were female (n = 147). A departure from normality was observed for the OHL-AQ (p <0.001, mean (SD) = 10.9 (3.2), Md = 11, IQR = 4, range = 1–17) and MDAS (p <0.001, mean (SD) = 11.4 (4.6), Md = 10, IQR = 6, range = 5–25) sum scores. Overall, 28.8% of the participating students had inadequate, 22.7% had marginal, and 48.5% had adequate oral health literacy. The OHL–AQ scores were significantly associated on a bivariate level with sex, mother’s education, the financial situation of the household, self-perceived oral health status, tooth brushing frequency and frequency of dental visits. The estimated proportion of participants with extreme dental anxiety was 8.6%. OHL–AQ and MDAS scores had a negative but weak correlation (ρ = -0.295, p < 0.001). According to the multiple linear regression model, the MDAS score had a significant multivariate association with OHL–AQ score (β = -0.42, p < 0.001), after adjusting for sex, mother’s education level, previous traumatic dental experience, tooth brushing frequency and frequency of dental visits. CONCLUSIONS: The Greek version of OHL–AQ seems to be a reliable and valid instrument for the assessment of oral health literacy. The prevalence of inadequate oral health literacy is significant (28.8%), even among highly educated young adults. Potentially dental phobic individuals comprised 8.6% of the sample. Oral health literacy and dental anxiety are negatively correlated and their association remains significant even after adjusting for other variables. Both constructs are associated with sociodemographic determinants and oral health-related factors. Further research should elucidate the specific pathways of this complex relationship and explore the potential use of oral health literacy interventions for the management of dental anxiety.