School academic climate and oral health (tooth loss) in adolescents

Preventing tooth loss depends on oral health maintenance behaviors. This study hypothesized that adolescents with educational aspirations have greater motivation to invest in the future, including maintenance of oral health status. To analyze the association between a school academic climate of educational aspirations and tooth loss (first permanent molars) among adolescents. A cross-sectional study was designed to include 2,500 adolescents (aged 14-19 years) enrolled in public high schools of Olinda located in Northeast Brazil. Multilevel Poisson regression random intercept models were conducted with tooth loss (first permanent molars) as the outcome. The primary cohort of interest was school academic climate, as measured by the proportion of students taking the national high school exams. Tooth loss of the first permanent molars (assessed by clinical exam) was more prevalent in adolescents from more disadvantaged backgrounds (receiving family allowance, low maternal education). However, after controlling for a wide range of individual characteristics, adolescents enrolled in schools with lower academic climate had a higher prevalence of tooth loss (PR 1.42, 95%CI: 1.09,1.85). The school academic climate is associated with tooth loss, suggesting that educational aspirations are linked to adolescent oral health maintenance behaviors.