The school social environment and oral health-related quality of life in children: a multilevel analysis.

This study aimed to explore the association between schoolchildren's oral health-related quality of life (OHRQoL) and the school-related social environment (contextual factors). A cross-sectional study was performed with 1,211 children, aged 8-12 yr, from 20 private and public schools. Sociodemographic information was collected from a questionnaire given to parents, and children were interviewed using the Child Perceptions Questionnaire (CPQ) and examined for oral health conditions. Contextual variables were obtained from school coordinators regarding the social environment. Data analysis was performed through multilevel Poisson regression. A high negative impact on OHRQoL was found for participants who were girls, older, had very severe malocclusion, had dental trauma and caries, and had mothers with less schooling. A negative impact on OHRQoL was also found for children who attended schools in which police security was required (rate ratios [RR] = 1.11; 95% CI: 1.01-1.22) and in which violence among students occurred in the last year (RR = 1.17; 95% CI: 1.02-1.35). The need for police security was associated with a negative impact on the emotional well-being domain, and violence among students was associated with negative impact on the oral symptoms, functional limitations, and social well-being domains. Children in healthier environments have better OHRQoL.