Banner Portal
Can oral health have an impact on academic performance and school absenteeism?


Oral health
Academic performance

How to Cite

Karam SA, Costa F dos S, Chisini LA, Darley R, Demarco FF, Correa MB. Can oral health have an impact on academic performance and school absenteeism? : a systematic review and meta-analysis. Braz. J. Oral Sci. [Internet]. 2024 May 2 [cited 2024 Jun. 14];23(00):e240322. Available from:


Aim: The study aimed to evaluate the association between oral health and academic performance and/or school absenteeism. Methods: Electronic searches were performed of the PubMed, Web of Science, SCOPUS and LILACS/BVS databases. We included observational studies that evaluated the association between dental caries, tooth loss, dental pain or oral health status with school absenteeism or academic performance. The studies had to contain a representative sample of the population: schoolchildren, children or adolescents. After the removal of duplicates, the electronic searches produced 3,789 articles. Of these, 25 studies were included in the systematic review and 13 in the meta-analysis. Results: Considering all the studies evaluated in the meta-analysis, seven articles satisfied 100% of the Joanna Briggs Institute Critical Appraisal checklist, and six contained between 90% and 75% positive answers. The pooled effects showed that the chances of school absenteeism were 31% higher in subjects with dental caries (OR 1.31; 95%CI 1.12-1.54). Students with fair/poor dental health had a 50% higher chance of suffering poor academic performance (OR 1.50; 95%CI 1.22-1.84) and 34% higher chance of having problems at school (OR 1.34; 95%CI 1.06-1.70). Students with a history of toothache had a 3.7 higher chance of being absent from school (OR 6.65; 95%CI 1.60-8.32) and 71% higher chance of missing class due to toothache (OR 1.71; 95%CI 1.15-2.56). Subjects with a history of toothache had a 2.5 times higher chance of suffering poor academic performance (OR 2.58; 95% CI 2.04-3.27). Conclusion: Therefore, students with oral problems were more likely to take time off school and present inferior academic performance.


Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017 Apr;96(4):380-387. doi: 10.1177/0022034517693566.

Dutra ER, Chisini LA, Cademartori MG, Oliveira LJC, Demarco FF, Correa MB. Accuracy of partial protocol to assess prevalence and factors associated with dental caries in schoolchildren between 8-12 years of age. Cad Saude Publica. 2018;34(4):e00077217. doi: 10.1590/0102-311x00077217. .

Costa F, Wendt A, Costa C, Chisini LA, Agostini B, Neves R, et al. Racial and regional inequalities of dental pain in adolescents: Brazilian National Survey of School Health (PeNSE), 2009 to 2015. Cad Saude Publica. 2021 Jun 25;37(6):e00108620. doi: 10.1590/0102-311X00108620.

Chisini LA, Collares K, Cademartori MG, de Oliveira LJC, Conde MCM, Demarco FF, et al. Restorations in primary teeth: a systematic review on survival and reasons for failures. Int J Paediatr Dent. 2018 Mar;28(2):123-139. doi: 10.1111/ipd.12346.

Chisini LA, Sarmento HR, Collares K, Horta BL, Demarco FF, Correa MB. Determinants of dental prosthetic treatment need: A birth cohort study. Community Dent Oral Epidemiol. 2021 Oct;49(5):394-400. doi: 10.1111/cdoe.12608.

Chisini LA, Sarmento HR, Horta BL, Demarco FF, Correa MB. Normative and subjective need for dental prosthesis: accuracy and agreement in a population based-study. Cad Saude Publica. 2021 Feb 10;37(2):e0052720. doi: 10.1590/0102-311X0052720.

Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015 May;94(5):650-8. doi: 10.1177/0022034515573272.

Bernabé E, Flores-Mir C, Sheiham A. Prevalence, intensity and extent of Oral Impacts on Daily Performances associated with self-perceived malocclusion in 11-12-year-old children. BMC Oral Health. 2007 May 16;7:6. doi: 10.1186/1472-6831-7-6.

Biazevic MG, Rissotto RR, Michel-Crosato E, Mendes LA, Mendes MO. Relationship between oral health and its impact on quality of life among adolescents. Braz Oral Res. 2008 Jan-Mar;22(1):36-42. doi: 10.1590/s1806-83242008000100007.

Bulgareli JV, Faria ET, Cortellazzi KL, Guerra LM, Meneghim MC, Ambrosano GMB, et al. Factors influencing the impact of oral health on the daily activities of adolescents, adults and older adults. Rev Saude Publica. 2018;52:44. doi: 10.11606/s1518-8787.2018052000042.

Freire Mdo C, Reis SC, Figueiredo N, Peres KG, Moreira Rda S, Antunes JL. Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010 [Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010]. Rev Saude Publica. 2013 Dec;47 Suppl 3:40-9. Portuguese. doi: 10.1590/s0034-8910.2013047004322.

Peres MA, Latorre MdRDO, Sheiham A, Peres KG, Barros FC, Hernandez PG, et al. [Effects of Social and biological factors on dental caries in 6-year-old children: a cross sectional study nested in a birth cohort in Southern Brazil]. Rev Bras Epidemiol. 2003;6(4):293-306. Portuguese. doi: 10.1590/S1415-790X2003000400004.

Reisine ST. The impact of dental conditions on social functioning and the quality of life. Annu Rev Public Health. 1988;9:1-19. doi: 10.1146/annurev.pu.09.050188.000245.

Silva JVd, Machado FCdA, Ferreira MAF. Social Inequalities and the Oral health in Brazilian Capitals. Cienc Saude Colet. 2015;20(8):2539-48. doi: 10.1590/1413-81232015208.12052014.

Jaggi A, Marya CM, Nagpal R, Oberoi SS, Kataria S, Taneja P. Impact of Early Childhood Caries on Oral Health-related Quality of Life Among 4-6-year-old Children Attending Delhi Schools: A Cross-sectional Study. Int J Clin Pediatr Dent. 2019 May-Jun;12(3):215-221. doi: 10.5005/jp-journals-10005-1626.

Blumenshine SL, Vann WF Jr, Gizlice Z, Lee JY. Children's school performance: impact of general and oral health. J Public Health Dent. 2008 Spring;68(2):82-7. doi: 10.1111/j.1752-7325.2007.00062.x.

Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health. 2011 Oct;101(10):1900-6. doi: 10.2105/AJPH.2010.200915.

Vasconcellos SS, Mattos CLG. [School absenteeism and its regulation]. In: Mattos CLG, Castro PA, organizers. [Ethnography and education: concepts and uses]. Campina Grande: EDUEPB; 2011. p.271-94. Available from: Portuguese.

Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health. 1992 Dec;82(12):1663-8. doi: 10.2105/ajph.82.12.1663.

Costa FDS, Costa CDS, Chisini LA, Wendt A, Santos IDSD, Matijasevich A, et al. Socio-economic inequalities in dental pain in children: A birth cohort study. Community Dent Oral Epidemiol. 2022 Oct;50(5):360-366. doi: 10.1111/cdoe.12660.

Piovesan C, Antunes JL, 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 Spring;72(2):156-63. doi: 10.1111/j.1752-7325.2011.00301.x.

Vasileva O, Balyasnikova N. (Re)Introducing Vygotsky's Thought: From Historical Overview to Contemporary Psychology. Front Psychol. 2019 Aug 7;10:1515. doi: 10.3389/fpsyg.2019.01515.

Esteban-Guitart M. The biosocial foundation of the early Vygotsky: Educational psychology before the zone of proximal development. Hist Psychol. 2018;21(4):384-401. doi: 10.1037/hop0000092.

Yasnitsky A. Vygotsky circle as a personal network of scholars: restoring connections between people and ideas. Integr Psychol Behav Sci. 2011 Dec;45(4):422-57. doi: 10.1007/s12124-011-9168-5.

Gradella CM, Bernabé E, Bönecker M, Oliveira LB. Caries prevalence and severity, and quality of life in Brazilian 2- to 4-year-old children. Community Dent Oral Epidemiol. 2011 Dec;39(6):498-504. doi: 10.1111/j.1600-0528.2011.00625.x.

Neves ETB, Firmino RT, Perazzo MD, Gomes MC, Martins CC, Paiva SM, et al. Absenteeism among preschool children due to oral problems. J Public Health-Heidelberg. 2015;24(1):65-72. doi: 10.1007/s10389-015-0697-0.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71. PMID: 33782057; PMCID: PMC8005924.

Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al.: Systematic reviews of etiology and risk 2017. In: Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute; 2020. Chapter 7. doi: 10.46658/JBIMES-20-08.

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta‐Analysis. New York, NY: JohnWiley & Sons; 2009.

Chisini LA, Cademartori MG, Francia A, Mederos M, Grazioli G, Conde MCM, et al. Is the use of Cannabis associated with periodontitis? A systematic review and meta-analysis. J Periodontal Res. 2019 Aug;54(4):311-317. doi: 10.1111/jre.12639.

Chisini LA, Cademartori MG, Conde MCM, Costa FDS, Tovo-Rodrigues L, Carvalho RV, et al. Genes and SNPs in the pathway of immune response and caries risk: a systematic review and meta-analysis. Biofouling. 2020 Oct;36(9):1100-1116. doi: 10.1080/08927014.2020.1856821.

Chisini LA, Cademartori MG, Conde MCM, Tovo-Rodrigues L, Correa MB. Genes in the pathway of tooth mineral tissues and dental caries risk: a systematic review and meta-analysis. Clin Oral Investig. 2020 Nov;24(11):3723-3738. doi: 10.1007/s00784-019-03146-x.

Chisini LA, Cademartori MG, Conde MCM, Costa FDS, Salvi LC, Tovo-Rodrigues L, Correa MB. Single nucleotide polymorphisms of taste genes and caries: a systematic review and meta-analysis. Acta Odontol Scand. 2021 Mar;79(2):147-155. doi: 10.1080/00016357.2020.1832253.

DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177-88. doi: 10.1016/0197-2456(86)90046-2.

Astrøm AN, Okullo I. Validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross-sectional study of adolescents in Uganda. BMC Oral Health. 2003 Aug 28;3(1):5. doi: 10.1186/1472-6831-3-5.

de Paula JS, Ambrosano GM, Mialhe FL. Oral Disorders, Socioenvironmental Factors and Subjective Perception Impact on Children's School Performance. Oral Health Prev Dent. 2015;13(3):219-26. doi: 10.3290/j.ohpd.a32672.

de Paula JS, Lisboa CM, Meneghim Mde C, Pereira AC, Ambrosano GM, Mialhe FL. School performance and oral health conditions: analysis of the impact mediated by socio-economic factors. Int J Paediatr Dent. 2016 Jan;26(1):52-9. doi: 10.1111/ipd.12158.

Mohamed SAS, Baker SR, Deery C, Vettore MV. Are oral health conditions associated with schoolchildren's performance and school attendance in the Kingdom of Bahrain? A life-course perspective. Int J Paediatr Dent. 2022 Mar;32(2):127-143. doi: 10.1111/ipd.12803.

Darley RM, Karam SA, Costa FDS, Correa MB, Demarco FF. Association between dental pain, use of dental services and school absenteeism: 2015 National School Health Survey, Brazil. Epidemiol Serv Saude. 2021 Mar 12;30(1):e2020108. English, Portuguese. doi: 10.1590/S1679-49742021000100011.

Bernabé E, Tsakos G, Sheiham A. Intensity and extent of oral impacts on daily performances by type of self-perceived oral problems. Eur J Oral Sci. 2007 Apr;115(2):111-6. doi: 10.1111/j.1600-0722.2007.00440.x.

Jürgensen N, Petersen PE. Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos. BMC Oral Health. 2009 Nov 16;9:29. doi: 10.1186/1472-6831-9-29.

Kaewkamnerdpong I, Krisdapong S. Oral diseases associated with condition-specific oral health-related quality of life and school performance of Thai primary school children: A hierarchical approach. Community Dent Oral Epidemiol. 2018 Jun;46(3):270-279. doi: 10.1111/cdoe.12361.

Naidoo S, Chikte UM, Sheiham A. Prevalence and impact of dental pain in 8-10-year-olds in the western Cape. SADJ. 2001 Nov;56(11):521-3.

Pongpichit B, Sheiham A, Pikhart H, Tsakos G. Time absent from school due to dental conditions and dental care in Thai schoolchildren. J Public Health Dent. 2008 Spring;68(2):76-81. doi: 10.1111/j.1752-7325.2007.00051.x.

Mialhe FL, de Oliveira Júnior AJ, Junior MFS, Jamieson L, Neiva A, Soares GH. Oral Health Literacy, Sense of Coherence and Associations With Poor School Performance. J Sch Health. 2022 Nov;92(11):1106-1113. doi: 10.1111/josh.13223.

Gopalan T, Asokan S, John JB, Geetha Priya PR. School absenteeism, academic performance, and self-esteem as proxy measures of oral health status: A cross-sectional study. J Indian Soc Pedod Prev Dent. 2018 Oct-Dec;36(4):339-346. doi: 10.4103/JISPPD.JISPPD_217_18.

Karki S, Päkkilä J, Laitala ML, Humagain M, Anttonen V. Influence of dental caries on oral health-related quality of life, school absenteeism and school performance among Nepalese schoolchildren. Community Dent Oral Epidemiol. 2019 Dec;47(6):461-469. doi: 10.1111/cdoe.12485.

Pourhashemi SJ, Paryab M, Kheirandish K, Kharazi-Fard MJ. Oral health and school performance in elementary students: A cross-sectional study in a group of Iranian students, Tehran, Iran. J Oral Health Oral Epidemiol. 2015;4(2):64-70.

Guskuma RC, Lages VA, Hafner MB, Rando-Meirelles MPM, Cypriano S, Sousa MDLR, et al. Factors associated with the prevalence and intensity of dental pain in children in the municipalities of the Campinas region, São Paulo. Rev Paul Pediatr. 2017 Jul-Sep;35(3):322-330. doi: 10.1590/1984-0462/;2017;35;3;00001.

Jiang H, Petersen PE, Peng B, Tai B, Bian Z. Self-assessed dental health, oral health practices, and general health behaviors in Chinese urban adolescents. Acta Odontol Scand. 2005 Nov;63(6):343-52. doi: 10.1080/00016350500216982.

Krisdapong S, Prasertsom P, Rattanarangsima K, Sheiham A. School absence due to toothache associated with sociodemographic factors, dental caries status, and oral health-related quality of life in 12- and 15-year-old Thai children. J Public Health Dent. 2013 Fall;73(4):321-8. doi: 10.1111/jphd.12030.

Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012 Sep;102(9):1729-34. doi: 10.2105/AJPH.2011.300478.

Guarnizo-Herreño CC, Wehby GL. Children's dental health, school performance, and psychosocial well-being. J Pediatr. 2012 Dec;161(6):1153-9. doi: 10.1016/j.jpeds.2012.05.025.

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 Pediatr. 2019 Jun;209:183-189.e2. doi: 10.1016/j.jpeds.2019.01.045.

Agaku IT, Olutola BG, Adisa AO, Obadan EM, Vardavas CI. Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6-17 years, 2011-2012. Prev Med. 2015 Mar;72:83-8. doi: 10.1016/j.ypmed.2014.12.037.

Baños García R, Leyva Madrigal A, Quintana Galende ML, de Armas Águila Y. [Ethnography and education: concepts and uses]. Educ Med Super. 2001;15(3):284-92. Spanish.

Besseling S, Ngonephady S, van Wijk AJ. Pilot survey on dental health in 5-12-year-old school children in Laos. J Investig Clin Dent. 2013 Feb;4(1):44-8. doi: 10.1111/j.2041-1626.2012.00136.x.

Brown RM, Canham D, Cureton VY. An oral health education program for Latino immigrant parents. J Sch Nurs. 2005 Oct;21(5):266-71. doi: 10.1177/10598405050210050401.

Butani Y, Gansky SA, Weintraub JA. Parental perception of oral health status of children in mainstream and special education classrooms. Spec Care Dentist. 2009 Jul-Aug;29(4):156-62. doi: 10.1111/j.1754-4505.2009.00086.x.

Colares V, Feitosa S. School performance of pre-school children with severe caries. Acta Scient Health Sci. 2003;25(2):129-34.

David J, Astrøm AN, Wang NJ. Prevalence and correlates of self-reported state of teeth among schoolchildren in Kerala, India. BMC Oral Health. 2006 Jul 3;6:10. doi: 10.1186/1472-6831-6-10.

de Paula JS, Mialhe FL. Impact of oral health conditions on school performance and lost school days by children and adolescents: What are the actual pieces of evidence? Braz J Oral Sci. 2013;12(3):189-98.

Detty AM, Oza-Frank R. Oral health status and academic performance among Ohio third-graders, 2009-2010. J Public Health Dent. 2014 Fall;74(4):336-42. doi: 10.1111/jphd.12063.

Edelstein B, Vargas CM, Candelaria D, Vemuri M. Experience and policy implications of children presenting with dental emergencies to US pediatric dentistry training programs. Pediatr Dent. 2006 Sep-Oct;28(5):431-7.

Feitosa S, Colares V, Pinkham J. The psychosocial effects of severe caries in 4-year-old children in Recife, Pernambuco, Brazil. Cad Saude Publica. 2005 Sep-Oct;21(5):1550-6. doi: 10.1590/s0102-311x2005000500028.

Freire MC, Sheiham A, Netuveli G. Relationship between height and dental caries in adolescents. Caries Res. 2008;42(2):134-40. doi: 10.1159/000121437.

Garg N, Anandakrishna L, Chandra P. Is there an Association between Oral Health Status and School Performance? A Preliminary Study. Int J Clin Pediatr Dent. 2012 May;5(2):132-5. doi: 10.5005/jp-journals-10005-1150.

Gherunpong S, Tsakos G, Sheiham A. A sociodental approach to assessing dental needs of children: concept and models. Int J Paediatr Dent. 2006 Mar;16(2):81-8. doi: 10.1111/j.1365-263X.2006.00701.x.

Halboub ES, Al-Maweri SA, Al-Jamaei AA, Al-Wesabi MA, Shamala A, Al-Kamel A, et al. Self-Reported Oral Health Attitudes and Behavior of Dental and Medical students, Yemen. Glob J Health Sci. 2016 Oct 1;8(10):56676. doi: 10.5539/gjhs.v8n10p143.

Honkala S, Honkala E, Newton T, Rimpelä A. Toothbrushing and smoking among adolescents--aggregation of health damaging behaviours. J Clin Periodontol. 2011 May;38(5):442-8. doi: 10.1111/j.1600-051X.2011.01709.x.

Jürgensen N, Petersen PE. Oral health behaviour of urban and semi-urban schoolchildren in the Lao PDR. Community Dent Health. 2011 Dec;28(4):280-5.

Kumar VS, Karuveettil V, Joseph J, Yeturu SK, Suseela RP, Janakiram C. Association of dental caries and oral health impact profile in 12-year-old school children: a cross-sectional study. J Clin Diagnostic Res. 2018;12(9):ZC12-5. doi: 10.7860/JCDR/2018/35029.11984.

Logan DE, Simons LE, Stein MJ, Chastain L. School impairment in adolescents with chronic pain. J Pain. 2008 May;9(5):407-16. doi: 10.1016/j.jpain.2007.12.003. Epub 2008 Feb 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 Mar 21;17(1):65. doi: 10.1186/s12903-017-0358-5.

Mittal M, Dwivedi S, Vashishth P, Jaiswal D. Prevalence and impact of oral pain in 8 year-old children in india. J Oral Sci Oral Rehabil. 2012;2:37-40.

Muirhead V, Marcenes W. An ecological study of caries experience, school performance and material deprivation in 5-year-old state primary school children. Community Dent Oral Epidemiol. 2004 Aug;32(4):265-70. doi: 10.1111/j.1600-0528.2004.00147.x.

Muirhead VE, Locker D. School performance indicators as proxy measures of school dental treatment needs: a feasibility study. J Public Health Dent. 2006 Fall;66(4):269-72. doi: 10.1111/j.1752-7325.2006.tb04080.x.

Murray C, Densie IK, Morgan C. Dental attendance, perceptions of cost and self-care of school year 12 and 13 students: A focus on Southland, New Zealand. N Z Dent J. 2015 Dec;111(4):133-41.

Naavaal S, Kelekar U. School hours lost due to acute/unplanned dental care. Health Behavior and Policy Review. 2018;5(2):66-73. doi: 10.14485/HBPR.5.2.7.

Ng MW. Children with both poor oral health and general health may be more likely to have poor school performance. J Evid Based Dent Pract. 2011 Mar;11(1):69-70. doi: 10.1016/j.jebdp.2010.11.001.

Pau A, Khan SS, Babar MG, Croucher R. Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country. Eur J Oral Sci. 2008 Oct;116(5):451-7. doi: 10.1111/j.1600-0722.2008.00563.x.

Petersen PE, Jiang H, Peng B, Tai BJ, Bian Z. Oral and general health behaviours among Chinese urban adolescents. Community Dent Oral Epidemiol. 2008 Feb;36(1):76-84. doi: 10.1111/j.1600-0528.2007.00375.x.

Petridou E, Athanassouli T, Panagopoulos H, Revinthi K. Sociodemographic and dietary factors in relation to dental health among Greek adolescents. Community Dent Oral Epidemiol. 1996 Oct;24(5):307-11. doi: 10.1111/j.1600-0528.1996.tb00867.x.

Pourat N, Nicholson G. Unaffordable dental care is linked to frequent school absences. Policy Brief UCLA Cent Health Policy Res. 2009 Nov;(PB2009-10):1-6.

Shaikh S, Siddiqui AA, Aljanakh M. School Absenteeism due to Toothache among Secondary School Students Aged 16-18 Years in the Ha'il Region of Saudi Arabia. Pain Res Treat. 2016;2016:7058390. doi: 10.1155/2016/7058390.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2024 Sarah Arangurem Karam, Francine dos Santos Costa, Luiz Alexandre Chisini, Rodrigo Darley, Flávio Fernando Demarco, Marcos Britto Correa


Download data is not yet available.