Assessing Oral Health Literacy in Children and Adolescents: Current Evidence, Measurement Gaps, and Developmental Considerations

Oral health literacy (OHL) is increasingly recognized as a multidimensional construct associated with oral health behaviors, healthcare utilization, clinical outcomes, and oral health-related quality of life. However, the strength and consistency of these associations vary across populations, outcomes, study designs, and measurement approaches, and much of the available evidence derives from adult populations. This narrative review examines current evidence on OHL-related outcomes with particular attention to children and adolescents and critically evaluates direct and caregiver-based assessment approaches. The review identifies a substantial developmental and measurement gap in pediatric OHL research. Studies involving children have frequently assessed parental or caregiver OHL rather than children’s own competencies, although these represent related but distinct constructs. Direct assessment of children and adolescents is feasible, but currently available instruments remain limited, have generally been evaluated within restricted age ranges and sociocultural settings, and predominantly emphasize functional or cognitive competencies. Broader dimensions such as communication, critical appraisal, navigation, decision-making, and application of oral health information are less consistently assessed. Developmentally appropriate OHL assessment should therefore account for cognitive and linguistic development, reading ability, communication skills, and increasing autonomy rather than simply adapting adult instruments. Future research should prioritize age-appropriate, culturally adaptable, and psychometrically robust measures that directly assess children’s and adolescents’ OHL across developmental stages and help clarify its relationships with oral health behaviors, service utilization, clinical outcomes, and oral health-related quality of life.