From the Journals

Poor oral health predicts children’s school problems

View on the News

Integrate oral health care to mitigate academic impact

“Dental caries remains the most common chronic disease of childhood in the United States and is known to affect multiple domains of health and well-being. Academic success is an important predictor of future employment and economic performance, as well as life and health outcomes. Therefore, it is important that we understand the impact oral disease has on academic performance,” Melinda Clark, MD, said in an interview. “This study demonstrated that middle schoolers are at greatest risk of dental disease impacting school performance, with poor dental health doubling the risk of having problems at school and missing school days in children 12-14 years of age.

Dr. Melinda Clark

“Several previous studies, including the Jackson study published in the American Journal of Public Health in 2011, have documented an association between poor oral health, missed school days, and diminished academic performance. The new study by Dr. Guarnizo-Herreno and associates in the Journal of Pediatrics confirms these data.

“Pediatricians care a great deal about the overall health and academic success of children, and the science informs us that poor oral health adversely impacts both of those domains. Pediatric primary care providers can adopt the Department of Health and Human Services Oral Health Framework to combat dental caries by integrating oral health services into practice and advocating for community water fluoridation. Application of fluoride varnish in the primary care office for all children from tooth eruption to age 6 years is recommended by the U.S. Preventive Services Task Force, the American Academy of Pediatrics, and is on the Bright Futures Periodicity schedule.

“Now is the time for action. The majority of dental disease in children is preventable with timely risk assessment, healthy diet choices, oral hygiene, and relatively simple office interventions. Future research should examine the effects of oral health changes on children’s academic outcomes to capture the full impact on children’s well-being.”

Dr. Clark is an associate professor of pediatrics at the Albany Medical Center, New York, and a member of the Pediatric News editorial advisory board. She was asked to comment on the article by Dr. Guarnizo-Herreño and associates. She has no relevant financial disclosures.



Poor oral health was significantly associated with poor academic performance in children aged 6-17 years, based on data from more than 45,000 children in the United States.

Boy with head in hands, children with rucksacks sitting on the stairs near school AGrigorjeva/Thinkstock

The study, published in the Journal of Pediatrics, updates an assessment from 2007 of a similarly representative sample of U.S. children.

“Providing an updated analysis is especially important to understand the dynamics between children’s oral health status and academic performance, given reported improvements in dental care use among children and dental treatment quality and the implementation or expansion of some state-level preventive strategies,” wrote Carol Cristina Guarnizo-Herreño, DDS, PhD, of Universidad Nacional de Colombia, Bogotá, and her colleagues.

The researchers analyzed data from the 2016 and 2017 versions of National Survey of Children’s Health that included 45,711 children aged 6-17 years. Survey data were collected from parents or other primary caregivers. In the study population, 16% of the children had a least one dental problem, defined as toothache, tooth decay or cavities, or bleeding gums, and 25% of the children had school problems: 67% missed any school, 23% missed more than 3 days of school, and 10% missed more than 6 days of school.

Overall, children with at least 1 dental problem were significantly more likely than those without dental problems to have problems at school (odds ratio, 1.56) or miss at least 1 school day (OR, 1.54) – more than 50% more likely. In addition, children with at least one dental problem were approximately 40% more likely to miss more than 3 days or more than 6 days of school (OR, 1.39 for both).

The association increased when the investigators used children’s oral health ratings; those with oral health rated as poor/fair were approximately 80% more likely to have school problems (OR, 1.77), almost 60% more likely to miss more than 3 days of school (OR, 1.56), and 90% more likely to miss more than 6 days of school, compared with children with oral health rankings of good, very good, or excellent.

Despite some variations in subgroups when the population was stratified by age, sex, race, household income, and health insurance, the associations between oral health problems and academic problems showed “remarkable stability,” across demographic and socioeconomic categories, the researchers said.

The study results were limited by several factors including the inability to identify the mechanisms behind the oral health and academic outcomes relationship, as well as the potential errors in parent or caregiver reports of children’s oral health and school performance, Dr. Guarnizo-Herreño and her associates said. However, the findings support those from an earlier study using 2007 data, and suggest that the link between poor oral health and poor academic performance has lasted for the past decade.

“The relationship between oral health and academic achievement is complex and likely involves multiple and intertwined pathways,” such as the impact of oral pain or discomfort on eating and sleeping that may affect academic performance, they said.

“These findings highlight the need for broad population-wide policies and integrated approaches to promote children’s development and reduce academic deficits that include among other components initiatives to improve oral health through prevention and treatment access strategies,” Dr. Guarnizo-Herreño and her associates concluded.

The study was supported by the National Institute of Dental and Craniofacial Research. The researchers had no financial conflicts to disclose.

SOURCE: Guarnizo-Herreño C et al. J Pediatr. 2019. doi: 10.1016/j.jpeds.2019.01.045.

Next Article: