The relationship between anxiety, quality of life, and oral health of children aged 4-6 years in kindergartens in Tehran, Iran

Background: Although oral health indicators have shown significant improvement in recent decades, oral diseases are still considered a common chronic disease with high prevalence in society. These diseases are considered important community health issues due to the effects they have on people s lives and the effects their treatment may have. Numerous studies have shown an association between anxiety and decreased oral health indicators, with anxiety disorders being the most common childhood psychiatric disorders. This study attempts to determine the link between anxiety, quality of life and oral health in children. Methods: This study was performed on a random sample of 600 children aged 4–6 years in kindergartens in Tehran, and finally, 443 were evaluated. The Preschool Anxiety Scale (PAS) questionnaire measured children s anxiety, and the Early Childhood Oral Health Impact Scale (F-ECOHIS) questionnaire was used for quality of life. Structural equation modelling (SEM) was used to evaluate the simultaneous effect of anxiety and oral health variables on the life quality related to oral health. The causal relationship between the variables were investigated and confirmed with this tool and the X2/df, GFI, CFI, NNFI(TGF), and RMSEA indices. Results: The reliability of the PAS and F-ECOHIS questionnaire was confirmed by Cronbach s alpha coefficient. Structural equation modeling (SEM) was used to investigate the concurrent effects of anxiety and oral health on OHRQOL. Two SEM models were selected for our purpose. Both models were statistically suitable, but the model in which anxiety directly impacted dmft and directly or indirectly influences oral health-related quality of life was clinically justified and was selected as the final model. Conclusion: Anxiety directly affects oral health (DMFT) and has a direct and indirect effect on the quality of life related to the oral health of preschool children.