Oral health, academic performance, and school absenteeism in children and adolescents: A systematic review and meta-analysis

Ryan Richard Ruff, Sashendra Senthi, Stephanie R. Susser, Atsuko Tsutsui

Research output: Contribution to journalReview articlepeer-review


Background: The authors conducted a systematic review and meta-analysis to provide a summary estimate of the association between oral health and academic performance. Types of Studies Reviewed: The authors conducted a systematic search of PubMed, Embase, and Google Scholar for studies on oral health, school absence, and academic achievement published in English from January 1945 through December 2017. Exposures included subjectively or objectively measured caries, oral pain, and periodontitis. Outcomes included school absence and school achievement. Results: The authors screened a total of 2,041 studies, from which they extracted data from 14 studies of 139,989 children (12 cross-sectional studies, 1 case-control study, and 1 longitudinal study). Five studies had school absence as the primary outcome, and 7 studies had student achievement as the primary outcome. Three studies included both outcomes. The authors found no studies for periodontitis. The average modified Newcastle-Ottawa Scale score was 3.93. The authors rated 10 studies as having a low risk of bias and 4 as having a high risk of bias. Qualitative synthesis suggested that poor oral health may have negative effects on student absenteeism and achievement, but study quality was highly variable. Results from meta-analyses indicated that poor oral health was significantly associated with increased odds of poor academic performance (pooled odds ratio, 1.52; 95% confidence interval, 1.20 to 1.83) and absenteeism (pooled odds ratio, 1.43; 95% confidence interval, 1.24 to 1.63). Conclusions and Practical Implications: Increased focus on the broader implications of improvements in oral health for children, such as educational or socioemotional development, is of further interest to practicing dentists owing to the greater connection between oral health and general health. The authors of this study found that caries or tooth pain had a negative association with academic achievement and school absenteeism. However, study quality was limited by inconsistent exposure and outcome definitions and a predominance of cross-sectional designs. Thus, causal conclusions are not supported.

Original languageEnglish (US)
Pages (from-to)111-121.e4
JournalJournal of the American Dental Association
Issue number2
StatePublished - Feb 2019


  • Oral health
  • absenteeism
  • academic performance
  • adolescent
  • caries
  • child
  • education
  • meta-analysis
  • periodontitis

ASJC Scopus subject areas

  • General Dentistry


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