Impact of oral health literacy on oral conditions among different population groups( A systematic review and meta-analysis)

Document Type : Systematic Review


Department of Public Health Dentistry, Amrita Vishwa Vidyapeetham, Amrita School of Dentistry, Kerala, India.


Background and Objective: Literacy in oral health is essential for promoting and preventing oral health issues. Evaluating oral health literacy enables the identification of opportunities to implement interventions at both policy and practice levels, aiming to improve oral health outcomes for individuals and populations. This review aims to conduct a systematic review focused on the association between oral health literacy and oral conditions. 

Materials and Methods: The search strategy aimed to retrieve both published and unpublished literature. The databases searched include PubMed, Scopus, Google Scholar, Web of Science, CINAHL, ProQuest, EBSCO- APA PsycInfo, and Shodhganga. After the search, all retrieved citations were examined to determine whether they meet the inclusion requirements. When possible, quantitative data was combined and analysed through a meta-analysis. The methodological validity of the included studies was critically evaluated using the JBI critical evaluation tool. The effect size was provided as a risk ratio or odds ratio for dichotomous data, while standard mean differences was used to depict it for continuous data. Statistics were used to evaluate study heterogeneity. In cases where statistical pooling is not possible, the findings were reported descriptively.

Results: This review incorporated data from 9,044 participants across 22 cross-sectional studies. The results indicated an association between inadequate oral health literacy and  individuals experiencing dental caries [OR: 0.36(95% CI 0.15,0.89) Thirteen studies, 4857 participants], Periodontal pocket [OR: 0.38 (95% CI 0.24, 0.62) five studies, 2651 participants], and tooth loss [OR: 0.57(95% CI 0.45,0.72) 2 studies, 1281 participants]. However, it's important to note that the studies included in this review were identified as having a high risk of methodological bias. 

Conclusion: Oral health Literacy is associated with poor oral health conditions; however, the quality of evidence is low.


Acknowledgements: None

Availability of data and materials: Data sharing is not applicable to this article as no data sets were generated or analysed during the current study.

Conflicts of interests: The authors declared no potential conflicts of interest with respect to research, authorship, and/or publication of this article.

Consent for publication: Not applicable

Ethical approval and consent to participate: Not applicable. All procedure comply with the principles of the Declaration of Helsinki. Ethical issues (including plagiarism, data fabrication or falsification, double publication etc.) have been completely observed by the authors.

Funding: No financial support was received for this study.

Author contributions: All authors contributed to the study conception, design, interpretation of results and reviewing. Data extraction and data analysis were performed by V.S.V. (Vattiprolu Sujay Vivek) and A.J. (Anju James). The quality assessment was performed by V.S.V, C.J (Chandrashekar Janakiram), and V.S.K. (Vijay S Kumar). The first draft of the manuscript was written by V.S.V and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. 


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit

  1. Petersen PE, Kwan S. The 7th WHO Global Conference on Health Promotion - Towards Integration of Oral Health, Nairobi, Kenya, 26-30 October 2009. Community Dental Health. 2010;27(2 suppl. 1):129-36.
  2. Baskaradoss JK. Relationship between oral health literacy and oral health status. BMC Oral Health. 2018 Oct 24;18(1):172. PMid:30355347 PMCid:PMC6201552
  3. Berkman ND, Davis TC, McCormack L. Health literacy: what is it? J Health Commun. 2010;15 Suppl 2:9-19. PMid:20845189
  4. Kutner M. Literacy in Everyday Life: Results From the 2003 National Assessment of Adult Literacy. 2003
  5. Centers for Disease Control and Prevention [Internet]. 2023 [cited 2023 May 25]. What is health literacy? Take action. Find out. Available from:
  6. The Invisible Barrier: Literacy and Its Relationship with Oral Health. Journal of Public Health Dentistry. 2005;65(3):174-82. 7325.2005.tb02808.x PMid:16171263
  7. Horowitz AM, Kleinman DV. Oral health literacy: a pathway to reducing oral health disparities in Maryland: Oral health literacy: reducing disparities. Journal of Public Health Dentistry. 2012 Jan;72:S26-30.
  8. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005 Sep;83(9):661-9
  9. National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services. The invisible barrier: literacy and its relationship with oral health. A report of a workgroup sponsored by the National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services. J Public Health Dent. 2005;65(3):174-82. PMid:16171263
  10. 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 Dec 4;14:148. PMid:25472659 PMCid:PMC4417207
  11. Sabbahi DA, Lawrence HP, Limeback H, Rootman I. Development and evaluation of an oral health literacy instrument for adults. Community Dentistry and Oral Epidemiology. 2009;37(5):451-62. PMid:19740249
  12. Jones K. Development and psychometric validation of a Health Literacy in Dentistry scale (HeLD). Community Dental Health. 2014 Mar 1;37-43. PMid:25388410
  13. Miller E, Lee JY, DeWalt DA, Vann WF. Impact of caregiver literacy on children's oral health outcomes. Pediatrics. 2010 Jul;126(1):107-14. PMid:20547644 PMCid:PMC2896459
  14. Baskaradoss JK. The association between oral health literacy and missed dental appointments. J Am Dent Assoc. 2016 Nov;147(11):867-74. PMid:27497866
  15. Wigen TI, Skaret E, Wang NJ. Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children. Int J Paediatr Dent. 2009 Nov;19(6):431-7. PMid:19708863
  16. Wehmeyer MMH, Corwin CL, Guthmiller JM, Lee JY. The impact of oral health literacy on periodontal health status. J Public Health Dent. 2014;74(1):80-7. PMid:23121152 PMCid:PMC3800213
  17. Richman JA, Lee JY, Rozier RG, Gong DA, Pahel BT, Vann WF. Evaluation of a Word Recognition Instrument to Test Health Literacy in Dentistry: The REALD-99. J Public Health Dent. 2007 Mar;67(2):99-104. PMid:17557681
  18. Lee JY, Rozier RG, Lee SYD, Bender D, Ruiz RE. Development of a Word Recognition Instrument to Test Health Literacy in Dentistry: The REALD-30 - A Brief Communication. Journal of Public Health Dentistry. 2007;67(2):94-8. PMid:17557680
  19. Gong DA, Lee JY, Rozier RG, Pahel BT, Richman JA, Vann WF. Development and Testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD). J Public Health Dent. 2007 Mar;67(2):105-12. PMid:17557682
  20. Atchison KA, Gironda MW, Messadi D, Der-Martirosian C. Screening for oral health literacy in an urban dental clinic. J Public Health Dent. 2010;70(4):269-75. PMid:20545829 PMCid:PMC3661197
  21. Macek MD, Haynes D, Wells W, Bauer-Leffler S, Cotten PA, Parker RM. Measuring conceptual health knowledge in the context of oral health literacy: preliminary results. J Public Health Dent. 2010;70(3):197-204. PMid:20337901 PMCid:PMC3612930
  22. Lee J, Stucky B, Rozier G, Lee SY, Zeldin LP. Oral Health Literacy Assessment: development of an oral health literacy instrument for Spanish speakers. J Public Health Dent. 2013;73(1):1-8. PMid:23215757 PMCid:PMC4082329
  23. DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009 Nov;124 Suppl 3:S265-274. PMid:19861480
  24. Firmino RT, Ferreira FM, Martins CC, Granville-Garcia AF, Fraiz FC, Paiva SM. Is parental oral health literacy a predictor of children's oral health outcomes? Systematic review of the literature. Int J Paediatr Dent. 2018 Jul 8; PMid:29984431
  25. Firmino RT, Ferreira FM, Paiva SM, Granville-Garcia AF, Fraiz FC, Martins CC. Oral health literacy and associated oral conditions. The Journal of the American Dental Association. 2017 Aug;148(8):604-13. PMid:28477838
  26. Firmino RT, Martins CC, Faria L dos S, Martins Paiva S, Granville-Garcia AF, Fraiz FC, et al. Association of oral health literacy with oral health behaviors, perception, knowledge, and dental treatment related outcomes: a systematic review and meta-analysis. Journal of Public Health Dentistry. 2018;78(3):231-45. PMid:29498754
  27. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul 21;6(7):e1000097. PMid:19621072 PMCid:PMC2707599
  28. JBI Manual for Evidence Synthesis - JBI Global Wiki [Internet]. [cited 2023 Feb 20]. Available from:
  29. Peres KG, Cascaes AM, Nascimento GG, Victora CG. Effect of breastfeeding on malocclusions: a systematic review and meta-analysis. Acta Paediatrica. 2015;104(S467):54-61. PMid:26140303
  30. Iorio A, Spencer FA, Falavigna M, Alba C, Lang E, Burnand B, et al. Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients. BMJ. 2015 Mar 16;350:h870. PMid:25775931
  31. Barasuol JC. Caregiver oral health literacy: relationship with socioeconomic factors, oral health behaviors and perceived child dental status. Community Dental Health. 2020 Jun 1;37(2):110-4.
  32. Baskaradoss JK. Relationship between Caregivers' Oral Health Literacy and their Child's Caries Experience. Community Dental Health. 2019;(36):111-7.
  33. Chaichit R, Deeraksa S. The association between functional oral health literacy and periodontal disease among adults with type 2 diabetes mellitus in the northeast region of Thailand. Journal of International Oral Health. 2020 Oct 21;12:432-8.
  34. Das D, Menon I, Gupta R, Arora V, Ashraf A, Ahsan I. Oral health literacy: A practical strategy towards better oral health status among adult population of Ghaziabad district. J Family Med Prim Care. 2020;9(2):764. PMid:32318417 PMCid:PMC7113944
  35. Adil AH, Eusufzai SZ, Kamruddin A, Wan Ahmad WMA, Jamayet NB, Karobari MI, et al. Assessment of Parents' Oral Health Literacy and Its Association with Caries Experience of Their Preschool Children. Children (Basel). 2020 Aug 18;7(8):101. PMid:32824693 PMCid:PMC7464453
  36. Montes GR, Bonotto DV, Ferreira FM, Menezes JVNB, Fraiz FC. Caregiver's oral health literacy is associated with prevalence of untreated dental caries in preschool children. Ciênc saúde coletiva. 2019 Jul;24(7):2737-44. PMid:31340290
  37. Vyas S, Nagarajappa S, Dasar PL, Mishra P. Linguistic adaptation and psychometric evaluation of original Oral Health Literacy-Adult Questionnaire (OHL-AQ). J Adv Med Educ Prof. 2016 Oct;4(4):163-9.
  38. Neves ÉTB, Dutra LDC, Gomes MC, Paiva SM, Abreu MHNG, Ferreira FM, et al. The impact of oral health literacy and family cohesion on dental caries in early adolescence. Community Dent Oral Epidemiol. 2020 Jun;48(3):232-9. PMid:32009250
  39. Ueno M, Takeuchi S, Oshiro A, Kawaguchi Y. Relationship between oral health literacy and oral health behaviors and clinical status in Japanese adults. Journal of Dental Sciences. 2013 Jun 1;8(2):170-6.
  40. Bado FMR, Barbosa TDS, Soares GH, Mialhe FL. Oral Health Literacy and Periodontal Disease in Primary Health Care Users. International Dental Journal. 2022 Oct;72(5):654-8. PMid:35065796 PMCid:PMC9485508
  41. Baskaradoss JK. Relationship between oral health literacy and oral health status. BMC Oral Health. 2018 Oct 24;18(1):172. PMid:30355347 PMCid:PMC6201552
  42. Batista MJ, Lawrence HP, Sousa M da LR de. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health. 2017 Jul 26;18(1):60. PMid:28747157 PMCid:PMC5530456
  43. 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 Sep;32(3):148-52.
  44. Dutra L da C, de Lima LCM, Neves ÉTB, Gomes MC, de Araújo LJS, Forte FDS, et al. Adolescents with worse levels of oral health literacy have more cavitated carious lesions. PLoS One. 2019 Nov 27;14(11):e0225176. PMid:31774850 PMCid:PMC6880994
  45. Kesavan R, Prabhakar R, Chaly P, Saravanan R, Mary AV. The Impact of Oral Health Literacy on Oral Hygiene, Gingival Status and Dental caries among Young Adults in a South Indian city. Ind Jour of Publ Health Rese & Develop. 2019;10(5):161.
  46. Khodadadi E, Niknahad A, Naghibi Sistani MM, Motallebnejad M. Parents' Oral Health Literacy and its Impact on their Children's Dental Health Status. Electronic physician. 2016 Dec 25;8:3421-5. PMid:28163858 PMCid:PMC5279976
  47. Mialhe FL, Santos BL, Bado FMR, Oliveira Júnior AJD, Soares GH. Association between oral health literacy and dental outcomes among users of primary healthcare services. Braz oral res. 2022;36:e004. PMid:35081222
  48. Wehmeyer MMH, Corwin CL, Guthmiller JM, Lee JY. The impact of oral health literacy on periodontal health status. J Public Health Dent. 2014;74(1):80-7. PMid:23121152 PMCid:PMC3800213
  49. Sukhabogi JR, Doshi D, Vadlamani M, Rahul V. Association of oral health literacy with oral health behavior and oral health outcomes among adult dental patients. Indian J Dent Res. 2020;31(6):835-9. PMid:33753650
  50. Singh P, Singh R, Kumari S, Kumari S, Singh S, Singh JP. Impact of Oral Health Literacy on Periodontal Health among Low-income-group Workers of Dental Institutes in Patna, Bihar, India. J Contemp Dent Pract. 2020 Jul 1;21(7):787-91. PMid:33020364
  51. Silva-Junior MF, Rosário de Sousa M da L, Batista MJ. Health literacy on oral health practice and condition in an adult and elderly population. Health Promot Int. 2021 Aug 30;36(4):933-42. PMid:33277894
  52. Sermsuti-anuwat N, Piyakhunakorn P. Association Between Oral Health Literacy and Number of Remaining Teeth Among the Thai Elderly: A Cross-Sectional Study. CCIDE. 2021 Apr;Volume 13:113-9. PMid:33880067 PMCid:PMC8051955
  53. Kleinman DV, Horowitz AM, Atchison KA. A Framework to Foster Oral Health Literacy and Oral/General Health Integration. Frontiers in Dental Medicine [Internet]. 2021 [cited 2024 Feb 9];2. Available from:
  54. Berkman ND, Davis TC, McCormack L. Health literacy: what is it? J Health Commun. 2010;15 Suppl 2:9-19. PMid:20845189
  55. Wolf MS, Feinglass J, Thompson J, Baker DW. In search of 'low health literacy': Threshold vs. gradient effect of literacy on health status and mortality. Social Science & Medicine. 2010 May;70(9):1335-41. PMid:20167411
  56. Naghibi Sistani MM, Yazdani R, Virtanen J, Pakdaman A, Murtomaa H. Determinants of Oral Health: Does Oral Health Literacy Matter? ISRN Dentistry. 2013 Mar 13;2013:1-6. PMid:23577262 PMCid:PMC3610341
  57. Schisterman E, Cole S, Platt R. Overadjustment Bias and Unnecessary Adjustment in Epidemiologic Studies. Epidemiology (Cambridge, Mass). 2009 Aug 1;20:488-95. PMid:19525685 PMCid:PMC2744485
  58. Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health Literacy and Health Outcomes in Diabetes: A Systematic Review. J GEN INTERN MED. 2013 Mar 1;28(3):444-52. PMid:23065575 PMCid:PMC3579965