Abstract
Background
Health literacy (HL), the ability to deal with information related to one’s health, may affect oral health via several routes. Therefore, this study aimed to examine the association of HL with oral diseases, and whether this association is mediated by oral health behaviour and dental care utilisation.
Methods
We included 26,983 participants from the prospective multigenerational Dutch Lifelines Cohort Study to estimate the association between limited health literacy, and self-reported oral health outcomes (edentulism and gingivitis), and mediation by oral health behaviour and dental care utilisation. Structural equation modelling was used to assess HL's direct, indirect, and total effects on oral health outcomes.
Results
Limited health-literate participants had increased odds of having poor oral health outcomes, i.e. edentulism (odds ratio: 1.42; 95%-confidence interval: 1.28 to 1.58) and gingivitis (1.22; 1.15 to 1.31). After adjustment for age, income, and education, brushing behaviour and dental care utilization showed a significant mediation effect. Brushing behaviour accounted for 7.4% of the total effect of HL on edentulism and 6.7% for gingivitis. Dental visits accounted for 38.0% of the total effect of HL on edentulism and 16.4% for gingivitis.
Conclusions
Limited HL makes edentulism and gingivitis more likely, with poor oral health behaviour and inadequate dental care utilisation being important mediators. The findings suggest that interventions to improve HL could have a considerable direct and indirect impact on improving oral health outcomes. Enhancing the abilities of dental professionals to identify patients with limited HL and to cope with limited HL impacts may be promising.
Keywords: edentulism, health literacy, oral health, oral health literacy, structural equation modelling