School-Related Factors Associated with Oral Health Behaviors among Adolescents

Background: This study examined the associations of academic achievement and school stress with oral health behaviors among adolescents to inform school-based oral health education and preventive interventions implemented by dental hygienists.Methods: Using data from the 21st Korea Youth Risk Behavior Web-Based Survey, this cross-sectional study included 54,170 middle and high school students.Oral health behaviors were defined as brushing teeth ≥3 times daily, brushing teeth before bedtime, and visiting a dentist within the past 12 months.The analyses adjusted for sex, grade level, household economic status, smoking history, and alcohol consumption as confounding variables.Data were analyzed using the Rao-Scott χ 2 test and complex sample logistic regression.Results: Academic achievement was significantly associated with all evaluated oral health behaviors (p＜0.001).Students with high academic achievement were more likely to brush their teeth ≥3 times daily (odd ratio [OR]=1.25),brush their teeth before bedtime (OR=1.14),and visit a dentist within the past 12 months (OR=1.52)compared with those demonstrating low academic achievement.School stress was significantly associated only with brushing teeth before bedtime; specifically, high levels of school stress correlated with a reduced likelihood of this behavior (OR=0.82;95% confidence interval [CI]=0.77∼0.87).Conclusion: Academic achievement served as a critical factor associated with all measured oral health behaviors, whereas school stress correlated selectively with brushing teeth before bedtime.These findings highlight the need for tailored, school-based oral health education and preventive interventions that account for students' school-related characteristics.