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Abstract Background Oral health literacy (OHL) might have an impact on oral health outcomes. Currently, relatively few related studies have been conducted among older people. The aim of this study was to explore the impacts of OHL on oral health outcomes in older adults in a cross-sectional design. Methods From November to December 2023, through the utilization of the cluster sampling approach, a questionnaire survey was carried out among elderly patients visiting the Prosthodontics Department of West China hospital of Stomatology. Data were collected through the general information questionnaire, the Chinese version of the Oral Health Literacy Scale, the Geriatric Oral Health Assessment Index, and oral examinations. Descriptive statistics, binary logistic regression, and poisson regression were used to analyse the data. Results A total of 407 valid questionnaires were recovered, with an effective retrieval rate of 98.79%. After adjustment for sociodemographic, economic and oral health behaviours, the results of the binary logistic regression indicated that the correlations between OHL and self-rated oral health were not statistically significant, while OHL was a predictor variable for dental expenditures within the past year (OR = 0.591; 95%CI: 0.371–0.939), and the poisson regression revealed that OHL was a predictor variable of the quality of life (PR = 1.062, 95%CI: 1.030–1.084) and the number of lost teeth (PR = 0.917, 95%CI: 0.865–0.972). Conclusions This study showed that OHL was closely associated with recent dental expenditure, oral health-related quality of life and the number of lost teeth. These findings could contribute to the planning and development of oral health education programs aimed at enhancing the OHL among the elderly population.

Abstract Objective This study aimed to investigate the current status of oral healthy literacy (OHL) among the elderly in Hangzhou and analyze its influencing factors. Methods A convenience sampling method was used to select 222 elderly people living in Hangzhou from August 2022 to January 2023. The General Information Questionnaire, the Simplified Version of the Oral Health Literacy Scale (HeLD-14), the Social Support Rating Scale (SSRS), and the General Self-Efficacy Scale (GSES) were employed to investigate and analyze the influencing factors of OHL in the elderly. Results The total OHL score of the elderly was 37 (31, 41) points, and the results of regression analysis showed that the monthly household income, place of residence, history of oral health education, and social support entered the regression equation as influencing factors of elderly OHL, which were the influencing factors of OHL in the elderly, explaining 24.4% of the variance. Conclusion The OHL of the elderly in Hangzhou is at a moderate level, and medical staff should implement targeted health education for the elderly with different family incomes and places of residence, publicize the role of oral health education, and improve the level of social support on oral health, to improve the OHL level of the elderly.

Abstract Background Understanding the interactions among predictors of dental trust in children is important for designing effective interventions in pediatric dental care. Aim This study aimed to develop and validate a conceptual model to evaluate factors influencing dental trust in children. Design This cross-sectional study included 267 parent-child dyads. Data collection tools included a sociodemographic data form, the Turkish Oral Health Literacy Assessment Task (TOHLAT-P), the Dental Trust Scale (DTS), the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), and the Early Childhood Oral Health Impact Scale (ECOHIS). The conceptual model explored the factors influencing dental trust in children by incorporating endogenous and exogenous variables. Path analysis was conducted to test model fit. Results Dental trust was significantly associated with parental oral health literacy (β = −0.20; P

Abstract Background Direct and indirect associations have been identified among health literacy, health behavior, and health status. Thus, we aimed to investigate the influence of oral health literacy and behaviors in parents on their children's oral health status. Moreover, we aimed to analyze the mentioned mediating effects through oral health behavior management. Methods Oral health information of 1,102 preschool children aged 3 to 6 years was collected from five primary schools in Jinjiang District, Chengdu City, Sichuan Province, China. The decay-missing-filled teeth (DMFT) index and soft scale plaque index (PI) were used by professional dentists aided by school teachers to assess caries and periodontal health among the children. Simultaneously, we conducted a questionnaire-based survey among the parents to determine their oral health literacy and health behavior and their children's oral health behavior. The probit model, instrumental variables, and mediation effect model were used to evaluate the association of parents' oral health literacy and behavior with their children's oral health status. Results The DFMT index was 1.58 among the children, with zero caries in 646 (58.6%) children. The PI was 0.68, with zero gum disease in 517 (46.9%). The univariate analysis suggested that the parents' health literacy and behavior were correlated with their children's oral health status (P

Abstract Objective Oral health is a critical area in healthy aging. Oral health literacy (OHL) plays an important role in improving oral health behaviors and oral health status. However, few studies have investigated OHL among community-dwelling older adults and the influential mechanism of OHL on oral health behaviors has not been clarified. The aim of this study is to explore the interaction pathways through which OHL influences oral health behaviors among community-dwelling older adults. Methods This is a cross-sectional study. 429 community-dwelling older adults were recruited by a convenience sampling method from the activity service center in Zhenjiang, Southern China. The data were collected between September and November 2021 using the Oral Health Literacy Adult Questionnaire (OHL-AQ) and other sophisticated scale assessments. A theoretical model based on the information-motivation-behavioral skills model (IMB model) and previous research was developed and then validated using a structural equation model with AMOS v24.0. Results The proposed model revealed a good fit to the data (χ2/df = 3.349, goodness of fit index = 0.957, adjusted goodness of fit index = 0.921, root mean squared error of approximation = 0.074, comparative fit index = 0.955, normed fit index = 0.938). Oral health information (β = 0.23) and motivation (β = 0.56) positively affected OHL. OHL (β = 0.20) and motivation (β = 0.25) positively affected self-efficacy; self-efficacy (β = 0.98) had a direct effect on oral health behavior. OHL had an indirect effect on oral health behaviors through self-efficacy (β = 0.19). Motivation can both directly influence oral health behavior (β = 0.18) and indirectly influence oral health behavior through OHL and self-efficacy(β = 0.35). Conclusions The study findings make a valuable contribution to the influential mechanism of OHL on oral health behaviors. OHL improved oral health behaviors through self-efficacy among community-dwelling older adults. Oral health information directly affected OHL. Motivation directly affected oral health behaviors as well as influence oral health behaviors by changing OHL.

Abstract Background Oral Health Literacy (OHL), defined as an ability to obtain, understand, and apply information related to oral health, plays a crucial role in promoting effective oral health outcomes and behaviors. Given the pressing need to enhance oral health among older adults, this scoping review aims to summarize the impact of OHL on oral health behaviors and outcomes in this population. Methods The authors performed an electronic search up through July 22, 2024. Among the 2,226 articles identified, the authors included studies in which the investigators evaluated the association between OHL and oral health behaviors or outcomes restricted to individuals aged 60 years and older. Thematic analysis was used to develop the domain for oral health behaviors or outcomes. Results Among the 10 studies analyzed, significant correlations were identified between OHL and various oral health indicators, including periodontitis, the number of remaining teeth, dental prosthesis use, oral hygiene, oral health-related quality of life among men, as well as dissatisfaction with oral health (p

Abstract Background Pregnancy is a unique period of women’s lives, and oral health is an important public health indicator during this period. Pregnant women have increased vulnerability to oral health problems. The study aimed to describe oral health knowledge, literacy and behavior of pregnant women in a northeastern province of Thailand. Methods A descriptive study was used. Twenty pregnant women who attended antenatal care clinics of eight public hospitals in the province were recruited by use of purposive sampling. They participated voluntarily in individual interview. The Health Belief Model was used as conception framework. All data were transcribed and subjected to content analysis. Results Five categories emerged: Misbelief and lack of knowledge, Oral health problems and dental care seeking, Oral health information from different persons, Self-care management of oral health, and Fear of and anxiety towards dental treatment. The findings showed that low knowledge of need for treatment, little importance to oral health and low priority of dental needs affect the demand for dental care. Fear of and anxiety towards dental treatment were the results of negative past experiences of neglecting dental care. Some women perceived health benefits of practicing self-care of oral health during pregnancy. Conclusion The findings help to better understand the oral health issues of pregnant women and provide baseline information for oral health promotion. Such promotion and culturally appropriate care should be integrated in maternal health education classes.

Abstract Background The Arabic version of the short form of the Health Literacy in Dentistry scale (HeLD) had not yet been developed in previously published studies. This study aims to test the reliability and validity of an Arabic version of the short form of the HeLD questionnaire. Methods The short version of HeLD was translated into Arabic and the psychometric properties were evaluated in a sample of 1,889 female students in their first year of secondary school. Test–retest reliability was assessed using the intra-class correlation coefficient (ICC), and internal consistency reliability was assessed using Cronbach’s alpha. Content validity was investigated by creating a correlation matrix between the individual items of the HeLD-14, and criterion validity was determined using Pearson’s correlation between the HeLD-14 score and an overall oral health rating. Sensitivity analysis was assessed by testing the associations of the HeLD-14 score with oral health-related behaviours and residential area. Results The Arabic version of HeLD-14 (A-HeLD-14) had acceptable ICC (0.54) and excellent internal consistency (Cronbach’s alpha: 0.92). The correlations between the items of the A-HeLD-14 varied from 0.3 to 0.9. The A-HeLD-14 showed a statistically significant correlation with the overall oral health rating (r = 0.37, p

Abstract Background The need for online adaptations of research instruments became more pronounced amidst the COVID-19 pandemic. This study sought to modify the REALD-30 for online application (eREALD-30) and evaluate its content validity and internal reliability among medical and dental students in Nigeria. Methods The eREALD-30 required participants to identify if each of the listed words were related to dentistry by ticking either a ‘yes’ or ‘no’ response with the option to mark ‘don’t know’ for words they were unsure about. Scores ranged from 0 to 30. Five oral health experts reviewed the eREALD-30 for cultural appropriateness, while content validity was evaluated by 10 medical and dental students. Internal reliability was assessed with 320 students recruited from 15 medical and dental schools spanning the country’s six geopolitical zones. These students also completed an oral health status assessment tool. Data collection utilized an online survey platform. Validity of the eREALD-30 was determined through correlation analysis between eREALD-30 scores and the oral health status assessment tool. Furthermore, binary logistic regression analysis was employed to explore the assocations between participants’ oral health status and their oral health literacy, adjusting for age, sex, and level of medical and dental education. Results Out of the respondents, 178 (55.6%) exhibited poor oral health literacy, while 205 (64.1%) reported having good oral health status. Those with good oral health literacy demonstrated significantly higher odds of having good oral health status (OR: 1.61; 95% CI: 1.02–2.54; p = 0.04). However, individuals with good oral health literacy had increased odds of good oral health status after adjusting for confounding factors,, though this association did not retain statistical significance (AOR: 1.39; 95% CI: 0.86–2.24; p = 0.17). The eREALD-30 displayed strong internal consistency (Cronbach alpha = 0.933), indicating its reliability in assessing oral health literacy levels, alongside a high content validity score of 0.90. Conclusion The study finding suggests that the e-version of the REALD-30 was reliable and valid for use among medical and dental students in Nigeria.

Abstract Background Diabetic patients’ oral health concerns are a reality for every diabetic patient in China. The attitudes of diabetic patients toward early identification of oral literacy influence oral literacy in diabetes patients. Diabetes patients' oral health literacy is critical for providing focused education and therapies. However, no instrument exists to measure oral health literacy in Chinese diabetic patients. In this study, the English version of the oral health literacy among people living with diabetes (OHLD) scale was cross-culturally validated to provide a reliable tool for assessing the oral health literacy of diabetic patients in China. Objective The oral literacy among people living with diabetes (OHLD) scale was Chineseized and its reliability and validity tested, and the OHLD scale was revised to test the reliability and validity of the Chinese version of the OHLD scale and to provide a tool for assessing the oral health literacy of diabetic patients in China. Methods A modified version of the Brislin translation model was used, cross-cultural adaptation was performed through expert consultation and pre-survey, and expert opinion was used to assess content validity to form the Chinese version of the Oral Health Literacy Scale for Diabetic Patients, which was administered to 420 diabetic patients in two tertiary hospitals in Liaoning Province from March to August 2023. The reliability of the scale was tested. SPSS 25.0 and AMOS 23.0 were used to analyze the data. Results The Chinese version of the OHLD scale consisted of three dimensions and 10 entries. Structure of the validity analysis: three factors were extracted from the exploratory factors with a cumulative variance contribution of 79.794%; Content validity results:An item’s content validity index (I-CVI) was 0.857 to 1 at the entry level, and the content validity index of the scale (S-CVI) was 0.928 at the scale level. The results of the reliability analyses were: the Cronbach's alpha coefficient for the total scale was 0.908; the Cronbach's alpha coefficients for the factors and dimensions were 0.853 to 0.922; the split-half reliability was 0.827; and the test–retest reliability was 0.848. The results of the validation factor analysis showed that (χ2/df) was 1.430, the root mean square of the error of approximation (RMSEA) was 0.045, the comparative fit index (CFI) was 0.989, and the Tucker Lewis index (TLI) was 0.985, which showed that the model had an overall good fit. Conclusion The Chinese version of the OHLD scale has good reliability and validity and can be used as a valid tool for assessing diabetes mellitus patients in China.

Abstract Background Oral health literacy has gained importance in dental literature, and its relationship with oral health status and association with health status (HL) has been reported. Then, an association between the levels of HL and OHL could be expected. This study aimed to assess the levels of HL and OHL according to sociodemographic factors and to explore a possible association between HL and OHL. Methods The European Health Literacy Survey and Oral Health Literacy Adults Questionnaire were applied to a convenience sample from Portuguese individuals. Also, sociodemographic factors such as sex, age, schooling level of the participants and their parents, and if the participants were professionals or students of the health field were assessed. To analyze the data, the Kruskal–Wallis and Mann–Whitney U tests were used to compared sociodemographic variables and the levels of literacy in general and oral health. The Spearman correlation test assessed the correlation between the levels of HL and OHL. Results HL results showed that 45.1% of the volunteers were considered in a “problematic level” and 10.3% in “excellent level”. However, 75% presented an adequate level of OHL. Regarding the levels of HL in each sociodemographic variable, significant higher levels of “excellent level” were found in health professionals and students when compared with participants not related to health area (p

Abstract Background Poor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse population of Australian adults visiting a public dental clinic in Western Sydney. Methods A mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach. Results A sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL. Conclusions Strategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.

Abstract Background To accomplish the purpose of health education and health promotion programs, schools are the most effective place for delivering health information to children. The main purpose of our research was to inform, gather evidence and contribute to developing knowledge regarding the OHL, knowledge, and attitude among school teachers towards oral health in Najran region of Saudi Arabia. Methods A questionnaire-based cross-sectional study was conducted in Najran region of Saudi Arabia for 6 months. A stratified cluster random sampling of 252 teachers was taken to represent all the teachers of Najran region of Saudi Arabia. The questionnaire contains 2 parts, sociodemographic part that include age, gender, education, teaching level, and income of the participants. The second part contains 25 items that assess the OHL (HelD-14 questions), knowledge (6 questions), and attitude (5 questions) of the participants. SPSS software version 26 was used to enter and analyze the data (IBM SPSS, Chicago, IL, USA software version 26.0). Multiple Logistic regression was applied to check the relationship between OHL and the associated factors. The Chi-square test was applied to evaluate knowledge of study participants. The level of significance was set up at p

Abstract Background Low oral health literacy levels and deficient oral health knowledge jeopardize the communication between dentists and patients in different communities. This study aimed to examine the impact and association of oral health literacy with patients’ levels of dental anxiety and their utilization of dental health services. Methods This cross-sectional study was conducted at the Misr International University (MIU) dental clinics. The study utilized a structured, interview led questionnaire that was administered by second year dental students, over the period of two successive academic years 2018–2019 and 2019–2020. A total of 440 student interviewed a convenience sample of 440 dental patients: including 269 females (61.1%) and 171 males (38.9%). The questionnaire consisted of four sections; a demographic section, a modified Arabic Rapid Estimate of Adult Literacy (ARELAD-30) Tool that measures the ability of the participants to read 30 commonly used dental terms. This questionnaire was modified by the authors to measure the participants’ knowledge by asking them to choose the most accurate meaning for each word based on their previous knowledge. Scoring was dependent on the participant’s immediate correct pronunciation, as well as comprehension of each word. The Arabic Modified Dental Anxiety Scale (AMDAS) was used to measure the level of dental anxiety, and the dental health service utilization was measured using the Utilization of oral health services questionnaire. Results One quarter (24.1%) of the participants read the 30 items of the A-REALD correctly. The average percentage of correct responses to the meaning of the dental terms was 71.2%. There was no statistically significant association between A-REALD and knowledge scores (Spearman’s Correlation coefficient ρ = -0.008, p-value = 0.872). There was a statistically significant inverse correlation between age and MDAS (Correlation coefficient ρ = -0.146, p-value = 0.002). A-REALD scores were inversely correlated with time since last visit (Regression coefficient = -0.027, p-value = 0.036, with 95% CI: -0.052 – -0.002). Conclusion Within the limitations of this study, it can be concluded that oral health literacy is significantly associated to dental health services utilization, while, dental anxiety is related to other variables, such as age and gender.

Abstract Purpose Oral health is important for general health; nurses are expected to possess good oral health awareness and work together for public oral health promotion. The purpose of this study is to investigate oral health literacy (OHL)and oral health behaviors of nurses, and explore the association between oral health literacy with demographic variables and oral health behaviors. Methods A cross-sectional study in a tertiary hospital was conducted using a short-form Health Literacy in Dentistry-14 (HeLD-14) and a 16-items oral health behaviors questionnaire. Information about the subjects’ demographic details including age, gender, place of residence, marital status, marital status, education level, monthly household income, working experience, etc. were collected. Independent sample t- test, One- way ANOVA, and multivariable regression were used to identify the association of oral health literacy with demographic variables and oral health behaviors. Results A total number of 317 nursing nurses participated in the survey, with a mean OHL score of 36.72, SD10.531, 21.8% were categorized as good, 34.1% medium and 44.2% poor oral health literacy; monthly household income, self-rated oral health, brushing time, use of fluoride toothpaste, and regular oral examination were signficantly associated with OHL scores. Conclusion The overall oral health literacy of the nurse population is at a moderate to low level. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nurses, especially nurses with low monthly household income and poor self-assessed oral health status. Nursing administrators and nursing educators should pay more attention to the oral health status of the nurse population.

Abstract Background Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children’s oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL). Methods This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI). Results Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p

Abstract Background Health literacy is a main factor in health for its improvement, allowing the individuals to have a greater capacity to engage and participate in collective health promotion actions. The evaluation of functional health literacy is essential to determine the ability that each individual has to understand basic health information. The present study aimed to perform the translation and cross-cultural adaptation of the Rapid Estimate of Adult Literacy in Dentistry-30 to the Portuguese language and test the reliability and validity of this version. Methods After translation and cultural adaptation, the instrument was applied to a group of individuals that participate in the program Atividade Senior, developed by the municipality of Viseu, Portugal. The final sample was composed by 206 participants that accepted responding to the translated version of the instrument. Statistical validation was accomplished to complete the process and obtain the final instrument. One question was removed for the creation of the final instrument with 29 questions, therefore being named Rapid Estimate of Adult Literacy in Dentistry-29 PT. Results The Rapid Estimate of Adult Literacy in Dentistry-29 PT presented good internal reliability. Cronbach’s alpha ranged from 0.89 to 0.90 when words were deleted individually. The analysis of test–retest reliability revealed excellent reproducibility. We can verify that the Rapid Estimate of Adult Literacy in Dentistry-29 PT scale for assessment of oral health literacy among older adults presents an acceptable internal consistency, with a global Cronbach´s alpha of 0.894. Conclusions The new scale can be applied to assess oral health literacy among older Portuguese adults, presenting an acceptable internal consistency and is validated to assess oral health literacy and is crucial in epidemiological studies.

Abstract Background Poor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan. Methods A cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL. Results A total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men. Conclusions The relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women’s oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

Abstract Background It has been widely accepted that oral health status is related to oral health literacy. The need to measure oral health literacy has led to the development of measurement instruments. This study aimed to develop a comprehensive instrument for adults and to examine its reliability and validity in China. Methods A three-step design process was used. First, a literature review and expert panel discussion were used to draw up a 37-item pool covering oral health knowledge, belief, practice, skill, and functional oral health literacy. The Delphi method was used to delete and modify questions in the item pool. The draft instrument was evaluated by nine experts and the consensus among them was calculated using the content validity index. The scale was then used to conduct a psychometric study among 370 participants from community health centers in Beijing. Construct validity, discriminant validity and concurrent validity were examined. The Cronbach’s alpha coefficient, and test–retest methods were used to assess reliability. Results The final scale included 30 items across four dimensions. The item–level content validity index was 0.90. Exploratory factor analysis extracted four fixed factors, and the result of the Kaiser–Meyer–Olkin and Bartlett’s tests was 0.752, with the model explaining 35.21% of the total variance. The four dimensions were associated with oral health knowledge, perceptions of oral health issues, oral health practice and skills, and functional oral health literacy. The mean score of the lowest 27% was significantly lower than the highest 27% (P

Abstract Background This article aims to provide a description of conceptual dimensions and psychometric properties of the tools of oral and dental health literacy. Methods Two authors in this study conducted electronic searches in the Medline (via PubMed), and Embase databases to find relevant articles from 1990 to present day. Evaluation of the tools was carried out in two parts; general evaluation of the tools using skills introduced by Sørensen et al., and qualitative assessment of psychometric properties using COSMIN checklist. Results After reviewing 1839 articles on oral and dental health literacy and evaluating 33 full text articles for eligibility, 21 articles entered the study. The sample size varied from 20 to 1405 subjects and the items of each tool ranged from 11 to 99 items. Of the 21 tools examined, 16 tools were evaluated for word recognition. For the studies examined, the evaluation of COSMIN scores was often fair or good. Of the 21 tools examined, 9 tools at least in one dimension were in the category of “poor”, 19 tools were in the category of “fair”, 20 tools were in the category of “good”, and 4 tools were in the category of “excellent” in at least one dimension. Conclusion The findings of this study showed that some aspects of oral and dental health literacy are being ignored in the existing tools. Therefore, the authors of present study emphasize on the necessity to design and develop a comprehensive tool and take into account two characteristics of simplicity and briefness for international use.

Abstract Background The present study aimed to investigate the association between oral health literacy and oral health behaviors among North Korean defectors. Methods This study involved the collection of self-reported questionnaires from 123 North Korean defectors visited a dental clinic that offered complimentary services, to receive dental treatment in a metropolitan area of South Korea from December 2017 to April 2018. Oral health literacy was measured with the Test of Korean Functional Health Literacy in Dentistry (TOKFHLiD), which consists of 30 items concerning verbal oral health literacy and 42 items concerning functional oral health literacy (28 items for reading comprehension and 14 items for numeracy). In addition, the questionnaire contains 15 and 14 items related to demographic characteristics and oral health behaviors (interest, lifestyle, diet, prevention), respectively, for a total of 101 items. Results The mean oral health literacy score was 44 (out of a maximum possible score of 72). Oral health literacy and oral health behaviors were positively correlated (r = 0.526, P

Abstract Background Oral health literacy is an important construct for both clinical and public health outcomes research. The need to quantify and test OHL has led to the development of measurement instruments and has generated a substantial body of recent literature. A commonly used OHL instrument is REALD-30, a word recognition scale that has been adapted for use in several languages. The objective of this study was the development and testing of the Greek language oral health literacy measurement instrument (GROHL). Methods Data from 282 adult patients of two private dental clinics in Athens, Greece were collected via in-person interviews. Forty-four words were initially considered and tested for inclusion. Item response theory analysis (IRT) and 2-parameter logistic models assessing difficulty and discriminatory ability were used to identify an optimal scale composition. Internal consistency was examined using Cronbach’s alpha and test-retest reliability was measured using intraclass correlation coefficient (ICC) in a subset of 20 participants over a two-week period. Convergent validity was tested against functional health literacy screening (HLS) items, dental knowledge (DK), oral health behaviors (OHBs), oral health-related quality of life (OHRQoL; OHIP-14 index), as well as self-reported oral and general health status. Results From an initial item pool of 44 items that were carried forward to IRT, 12 were excluded due to no or little variance, 10 were excluded due to low item-test correlation, and 2 due to insignificant contribution to the scale, i.e., difficulty parameter estimate with p > 0.05. The twenty remaining items composed the final index which showed favorable internal consistency (alpha = 0.80) and test-retest reliability (ICC = 0.95). The summary score distribution did not depart from normality (p = 0.32; mean = 11.5; median = 12; range = 1–20). GROHL scores were positively correlated with favorable oral hygiene behaviors and dental attendance, as well as HLS, DK and education level. Conclusion The GROHL demonstrated good psychometric properties and can be used for outcomes research in clinical and public health settings.

Abstract Background This study evaluated the impact of anticipatory guidance on the caries incidence of 2–3-year-old preschool children and their 4–6-year-old siblings, as well as on their mothers’ oral health literacy, as compared to the conventional Ministry of Health (MOH) programme. Methods This quasi-experimental study was conducted at two government dental clinics in Batu Pahat District, Malaysia. The samples comprised of 478 mother-child-sibling trios (233 families in the intervention group, and 245 families in the control group). An oral health package named the Family Dental Wellness Programme (FDWP) was designed to provide dental examinations and oral health education through anticipatory guidance technique to the intervention group at six-month intervals over 3 years. The control group received the standard MOH oral health education activities. The impact of FDWP on net caries increment, caries prevented fraction, and mother’s oral health literacy was assessed after 3 years of intervention. Results Children and siblings in the intervention group had a significantly lower net caries increment (0.24 ± SD0.8; 0.20 ± SD0.7) compared to the control group (0.75 ± SD1.2; 0.55 ± SD0.9). The caries prevented fraction for FDWP was 68% for the younger siblings and 63.6% for the older children. The 2–3-year-old children in the intervention group had a significantly lower incidence of white spot lesions than their counterpart (12% vs 25%, p

Abstract Background To investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants. Methods Participants (N = 1,405) enrolled in the Carolina Oral Health Literacy (COHL) study completed the short form of the Oral Health Impact Profile Index (OHIP-14, a measure of OHRQoL) and REALD-30 (a word recognition literacy test). Socio-demographic and self-reported dental attendance data were collected via structured interviews. Severity (cumulative OHIP-14 score) and extent of impact (number of items reported fairly/very often) scores were calculated as measures of OHRQoL. OHL was assessed by the cumulative REALD-30 score. The association of OHL with OHRQoL was examined using descriptive and visual methods, and was quantified using Spearman's rho and zero-inflated negative binomial modeling. Results The study group included a substantial number of African Americans (AA = 41%) and American Indians (AI = 20%). The sample majority had a high school education or less and a mean age of 26.6 years. One-third of the participants reported at least one oral health impact. The OHIP-14 mean severity and extent scores were 10.6 [95% confidence limits (CL) = 10.0, 11.2] and 1.35 (95% CL = 1.21, 1.50), respectively. OHL scores were distributed normally with mean (standard deviation, SD) REALD-30 of 15.8 (5.3). OHL was weakly associated with OHRQoL: prevalence rho = -0.14 (95% CL = -0.20, -0.08); extent rho = -0.14 (95% CL = -0.19, -0.09); severity rho = -0.10 (95% CL = -0.16, -0.05). "Low" OHL (defined as < 13 REALD-30 score) was associated with worse OHRQoL, with increases in the prevalence of OHIP-14 impacts ranging from 11% for severity to 34% for extent. The inverse association of OHL with OHIP-14 impacts persisted in multivariate analysis: Problem Rate Ratio (PRR) = 0.91 (95% CL = 0.86, 0.98) for one SD change in OHL. Stratification by race revealed effect-measure modification: Whites--PRR = 1.01 (95% CL = 0.91, 1.11); AA--PRR = 0.86 (95% CL = 0.77, 0.96). Conclusions Although the inverse association between OHL and OHRQoL across the entire sample was weak, subjects in the "low" OHL group reported significantly more OHRQoL impacts versus those with higher literacy. Our findings indicate that the association between OHL and OHRQoL may be modified by race.