Poor child oral health and school absences: a population-wide data linkage study

Child dental caries is highly prevalent worldwide, with significant treatment costs, but its broader societal impact remains underexplored. This cross-sectional study examined associations between child oral health and school absences in Scotland.

Four population-wide data sets were linked at the individual level, where the outcome was part-day school absence during first primary school year across six academic years (2008/2009-2010/2011, 2012/2013, 2014/2015 and 2016/2017). Oral health was assessed using three metrics: caries experience, urgent need of dental treatment (UNDT) and dental extractions under general anaesthetic (DGA). Gamma-distributed general linear models (identity link) estimated adjusted mean differences, including interaction terms for socioeconomic deprivation (Scottish Index of Multiple Deprivation (SIMD) deciles). Models adjusted for sex, age, academic year and SIMD.

Records from 263 597 children (mean age: 5.5 years) showed 33% had caries experience (median 16 part-day absences), 9% had UNDT (median 19) and 2% had DGA (median 20). Children without caries experience had a median of 11 part-day absences. Adjusted models showed mean differences of 5.0 (95% CI 4.9 to 5.2) more absences for children with caries experience versus none; 6.2 (95% CI 5.9 to 6.5) more absences for UNDT versus no UNDT; and 6.5 (95% CI 5.8 to 7.1) more for DGA versus no DGA. Interaction analysis showed a deprivation gradient: children in the 10% most deprived areas had nearly twice the burden of absences related to poor oral health compared with the 10% least deprived.

Poor oral health was associated with higher absenteeism, with socioeconomic inequalities exacerbating the impact.