Pathways to oral health-related quality of life in preschool children: a structural model from SB Brasil 2023.

The aim was to test a structural equation model examining the direct and indirect pathways between early childhood caries (ECC) severity and oral health-related quality of life (OHRQoL) in Brazilian preschool children, incorporating dental pain, treatment urgency, dental visits, anterior open bite (AOB), and maternal schooling into the model. A population-based study was conducted using data on five-year-old children from the 2023 Brazilian National Oral Health Survey (SB Brasil). The Brazilian version of the SOHO-5 was used to measure the impact of oral health conditions on OHRQoL. Calibrated dentists assessed ECC (dmft and pufa indices), AOB (Foster & Hamilton), and urgent oral health care needs. Parents or caregivers answered a questionnaire addressing dental pain, dental visits, and mother's schooling. Structural equation modeling was performed. Children with greater ECC severity (β = 0.674; p < 0.001) and dental pain (β = 0.241; p < 0.019) were more likely to require urgent care. Greater ECC severity was also directly associated with worse OHRQoL by both by the self-report (β = 0.261; p < 0.001) and proxy-report (β = 0.303; p < 0.001), and indirectly mediated by dental pain in both the self-report (β = 0.426; p < 0.001) and proxy report (β=0.401; p<0.001). Dental pain was associated with worse OHRQoL according to both self-report (β = 0.633; p < 0.001) and proxy-report (β = 0.597; p < 0.001). The structural model demonstrated that ECC severity negatively impacts OHRQoL through direct effects and indirect pathways mediated by dental pain. ECC and dental pain were also associated with a higher likelihood of urgent treatment.