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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2025 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided 

the original author and source are credited  

 

 

The Relationship Between Dental Caries and Malocclusion and the Quality of Life 
of Preschool Children 

Wiworo Haryani 1*, Quroti A’yun 2, Etty Yuniarly 3 

1,2,3 Department of Dental Health, Health Polytechnic of Yogyakarta, Yogyakarta, Indonesia 

Article Info: 
_____________________________________________ 
Article History: 

Received   06 June 2025     
Reviewed  20 July 2025 
Accepted   17 August 2025 
Published 15 Sep 2025 

_____________________________________________ 
Cite this article as:  

Haryani W, A’yun Q, Yuniarly E, The 
Relationship Between Dental Caries and 
Malocclusion and the Quality of Life of 
Preschool Children, Asian Journal of Dental 
and Health Sciences. 2025; 5(3):19-22                                                                   

DOI: http://dx.doi.org/10.22270/ajdhs.v5i3.137               

Abstract 
_________________________________________________________________________________________________________________ 
Background: Preschool children are one of the groups at high risk of having health problems. Based 
on data from the Indonesian Health Survey (SKI) in 2023, the prevalence of caries in the 3-4 years 
age group was 78.3%, while in the 5-9 years age group it was 85.8%. Dental health problems such 
as caries and malocclusion will disrupt the function and activity of the oral cavity so that it will affect 
nutritional status and will have an impact on the quality of life of preschool children. Objective: To 
determine the relationship between dental caries and malocclusion with the quality of life in 
preschool children Method: This type of observational analytical study with a cross-sectional 
design. The sampling technique was carried out by purposive sampling and obtained a total of 50 
respondents. Univariate data analysis with descriptive analysis, Bivariate analysis using chi-square 
correlation. Results: There is a relationship between dental caries and the quality of life of preschool 
children (p = 0.030). There is a relationship between malocclusion and the quality of life of children 
(p = 0.005). Conclusion: There is a relationship between dental caries and malocclusion with the 
quality of life of preschool children.  

Keywords: dental caries, malocclusion, ECOHIS, quality of life of preschool children 

*Address for Correspondence:   

Wiworo Haryani, Department of Dental Health, Health Polytechnic of Yogyakarta, Yogyakarta, Indonesia. 

 

INTRODUCTION  

Preschool children are a high-risk group for health 
problems. Data from the 2023 Indonesian Health Survey 
showed that the prevalence of caries in the 3-4 years age 
group was 78.3%, while in the 5-9 years age group it was 
85.8%.1 It is important to pay attention to the dental and 
oral health of preschool children, because they are at the 
stage of child development and are the golden age or 
golden period in the period of child growth and 
development.2 In the early stages, children require more 
attention from their families. Optimal growth and 
development depends on providing nutrition of the 
quality and quantity appropriate to their needs.3 

Children's dental and oral health is an important right, 
besides being the first gateway into the digestive system, 
at the age of 4-6 years all primary teeth have erupted and 
are entering the mixed dentition period.4 At preschool 
age, children are susceptible to caries due to the 
influence of food or drink residue. Preschool age children 
still need help from others in cleaning their oral cavity.5 
Dental caries can disrupt general health, resulting in 
disrupted growth and development of children, which 
will result in a decrease in the child's quality of life.6 

Malocclusion is the third most common oral health 
problem in Indonesia, after caries. Malocclusion disrupts 
oral function and activity, affecting nutritional status and 

quality of life.7 During childhood, these conditions can 
impact a child's growth and development and well-being. 
Children with poor oral health are 12 times more likely 
to suffer from impaired activity, including missing 
school, compared to those with good oral health. Good 
oral health can help children achieve a better quality of 
life.8 

Quality of life (QoL) measurements are very useful for 
identifying the various impacts of disease in children. 
These measurements can also be used to compare the 
effectiveness of dental care, evaluate dental health 
services, and assess oral health needs. Oral health is 
related to quality of life (OHRQoL).9 in preschool children 
and can be measured using the Early Childhood Oral 
Health Impact Scale (ECOHIS) instrument. ECOHIS was 
developed in the USA by Hernandez et al. to assess the 
negative impact of dental and oral health that affects the 
quality of life of preschool children. 10 

The ECOHIS instrument is completed by parents, 
specifically mothers. This instrument can assess the 
extent to which dental and oral health is linked to the 
quality of life of preschool-aged children.11 At preschool 
age, children do not yet understand basic health concepts 
and tend to overreact.12 Parents have a big role in caring 
for children, especially mothers who understand their 
children's needs better.10 A mother has a closer and 
greater role in maintaining her child's health, especially 

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Haryani et al.                                                                                                                               Asian Journal of Dental and Health Sciences. 2025; 5(3):19-22 

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regarding dental and oral health.13 This instrument has 
scales for children (Children Index Scale) and families 
(Family Index Scale) designed to assess the impact of 
children's dental and oral health on daily activities. 
Cognitive development in preschool children is still very 
limited, therefore the ECOHIS instrument is suitable for 
assessing quality of life in preschool children.14 

METHOD AND MATERIAL  

This type of research is observational analytic with a 
cross-sectional design. The research location is Aksa 
Tamami Godean Kindergarten School, Sleman, 
Yogyakarta. The sampling technique was carried out 
using purposive sampling. The inclusion criteria for 
research subjects are as follows: 1) Preschool children 
aged 4-6 years, 2) Children in good physical and mental 
health, 3) Willing to participate in the study with the 
mother signing an informed consent. The exclusion 
criteria are as follows: 1) Children are sick, 2) Children 
are not present when the study is conducted. The results 
of data collection at the location obtained a total of 50 
respondents. Univariate data analysis with descriptive 
analysis, bivariate analysis using chi-square correlation. 

RESULT AND DISCUSSION 

Table 1: Frequency Distribution based on respondent 
characteristics 

Variable n % 

Age  

4 years 31 62.0 

5 years 14 28.0 

6 years 5 10.0 

Gender 
Man 22 44.0 

Women 28 56.0 

Mother's 
Education 

Junior high school 2 4.0 

Senior high school 13 26.0 

College 35 70.0 

Parents' job 

Government employees 10 70 

Private 31 62.0 

Etc 1 2.0 

Doesn't work 8 16.0 

 

Table 1 shows that of the 50 preschool children, 31 
(62.0%) were 4 years old. Most of the children were girls, 
28 (56.0%). The highest maternal education level was 
college, with 35 (70.0%), and the highest parental 

occupation was private, with 31 (62.0%). ECOHIS 
assessments impacted the quality of life of children aged 
4-5 years. Children with higher DMF-T scores had 
significantly lower quality of life.15 

Table 2: Frequency Distribution of Respondents for 
Caries, Malocclusion, and Quality of Life 

Variable n % 

Caries 
Yes 8 16.0 

No 42 84.0 

Malocclusion 
Yes 20 40.0 

No 30 60.0 

Quality of 
Life 

Low (Score ECOHIS>21) 14 28.0 

Good (Score ECOHIS 13-21) 36 72.0 

 

Table 2 shows that 8 preschool children (16.0%) 
experienced caries, and 20 children (40.0%) had 
malocclusion. Most preschool children (36 children) had 
a good quality of life. Based on the results of the Basic 
Health Research (Riskesdas), the Indonesian population 
has dental and oral problems and the incidence of dental 
caries increased from 2013 to 2018, with the prevalence 
of dental caries at the age of 3 years (60%), 4 years 
(85%), and 5 years (86.4%).16 A study of preschool 
children in Jordan showed a significant association 
between caries and quality of life in children aged 4-5 
years. Caries scores had a significant effect on the Early 
Childhood Oral Health Impact Scale (ECOHIS), while 
other confounding factors showed no impact.17 The mean 
ECOHIS score increased with increasing DMFT index in 
children aged 3-6 years, indicating a significant 
relationship between the DMFT index and ECOHIS score. 
These results can be used as an appropriate resource for 
developing preventive policies and improving dental and 
oral health in early childhood.18 

Malocclusion has an impact on the function of chewing, 
speech, oral health and a person's psychology.19 
Impaired chewing function due to limited food intake can 
impact quality of life. People with malocclusion are also 
susceptible to tooth decay because they have difficulty 
reaching all parts of their teeth, which can lead to poor 
tooth cleaning.19,20  A person with an anterior open bite 
or large overjet will experience impaired chewing due to 
difficulty biting into food. This impaired chewing 
function due to limitations in food consumption will 
impact their quality of life. The impact of malocclusion 
significantly impacts chewing function, speech, oral 
health, and psychological well-being.5

 

 

 

 

 

 



Haryani et al.                                                                                                                               Asian Journal of Dental and Health Sciences. 2025; 5(3):19-22 

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Table 3: Results of Analysis of Motivation and Oral Health Behavior with Quality of Life in Adolescents 

 

Quality of Life   

Low (>23) Good (13-21) p OR 

n % n %   

Caries Yes 5 62.5 3 37.5 0.030* 6.11 

No 9 21.4 33 78.6   

Malocclusion Yes 10 50 10 50 0.050* 6.50 

No 4 13.3 26 86.7   

 

The results of table 3 show that preschool children with 
dental caries experienced a low quality of life category of 
5 children (62.5%) more than those without dental caries 
9 children (21.4%) with a significant difference of p = 
0.030 and an OR value of 6.11 meaning that children with 
a low quality of life were found in children who had 
dental caries 6.11 times higher. The results of this study 
are in accordance with the opinion of Silva et al. (2023) 
that economic status, caries experience and oral hygiene 
have a significant effect on the quality of life of preschool 
children.21 Untreated caries and the socio-economic 
status of parents have a significant relationship with the 
quality of life of children aged 3-5 years.22 Children with 
malocclusion experienced a low quality of life category, 
there were 10 children (50.0%) more than children 
without malocclusion, namely 4 children (13.3%) with a 
significant difference of p = 0.005 and an OR value of 6.50, 
meaning that children with a low quality of life were 
found in children with malocclusion 6.50 times higher. 
Dental caries and malocclusion have an impact on 
children's quality of life.23 There is a significant 
relationship between children's quality of life and the 
need for orthodontic treatment.4 Specific oral health 
conditions have a significant impact on the quality of life 
of children and adolescents.24 

CONCLUSION 

Based on the research results, it can be concluded that 
there is a significant relationship between dental caries 
(p=0.030) and malocclusion (p=0.005) and quality of life. 
This indicates a relationship between dental caries and 
malocclusion and the quality of life of preschool children. 
The higher the prevalence of caries and malocclusion, the 
lower the quality of life of preschool children. 

Acknowledgements: The authors thank to all 
participants and research assistants. 

Conflict of Interest: The authors declare that they have 
no conflicts of interest. 

Ethical Clearance: This research has received a 
certificate of appropriate research ethics from the 
Yogyakarta Health Research Ethics Commission 
No.DP.04.03/e-KEPK.1/592/2025 dated 24 April 2025. 

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