The search strategy found 362 articles. The evaluators had 100% agreement and had completely read 48 studies. Only 22 systematic reviews were included, as shown in figure 1.
Characteristics and methodological quality of eligible studies
This systematic umbrella review found 22 articles. Only one article was written in Portuguese [26], and 21 studies were written in English, between 2009 and 2021. Malocclusion was the most collected variable in the studies [9,20,27,35,42,44] and traumatic dental injury (TDI) [28,29,39,45,46]. All systematic reviews have search criteria, eligibility criteria and study characterization. However, different quality assessment methods were used. The most cited method was the PRISMA. However, 9 systematic reviews showed no risk of bias in the analyzed studies and 10 studies did not perform meta-analysis.
Oral conditions, characteristics of the selected studies and the OHRQoL measurement instruments can be found in the supplementary material of this article.
The methodological quality of the systematic reviews included (Table 1), based on the criteria proposed by AMSTAR 2, considered 10 articles of critically low quality [9,27,30,34-36,42,44-45], 10 articles of low quality[28,30-32,37-43], one systematic review of moderate quality [33], and one of moderate/high quality [45].
Oral Conditions and Oral Health Relates Quality of Life in Adolescents
Impact of malocclusion on OHRQoL
All studies agree that occlusal disorders have a negative impact on OHRQoL in adolescents [9,20,27,35,42,44]. There are divergences related to the degree of severity of impact on OHQoL. The emotional and social domains obtained higher scores when compared to the functional domains. Aesthetics and satisfaction with appearance have the greatest impact on OHQoL [45]. The studies evaluated incisal crowding, maxillary anterior irregularity ≥ 2 mm, and overjet ≥ 5 mm.
Two systematic reviews note that only cross-sectional studies were included, which cannot record causality [35,42]. In addition, it was inferred that adolescents with malocclusion have a greater impact on OHRQoL when compared to children. Adolescents who had never received orthodontic treatment had a greater impact on quality of life compared to patients who had already completed treatment [34, 36, 38, 43,45]. Studies indicate that the degree of negative impact on OHRQoL is directly proportional to the need for orthodontic treatment and its consequent aesthetic impairment [45].
Traumatic Dental Injury (TDI) and OHRQoL
The impact of dental trauma sequelae on OHRQoL in adolescents was observed in 5 systematic reviews [28,29,39,45,46]. Studies show that uncomplicated traumatic injuries do not have a negative impact on the OHRQoL of adolescents. The negative effect is greater when it involves pulp exposure or darkening of the dental element [29], and the age group from 11 to 14 years is the most affected [46]. Adolescents report difficulty smiling, eating, socializing, presence of pain, difficulty in chewing [45].
Treatment of TDI reduces the negative impact on OHRQoL in adolescents, based on parental perception [39]. Individuals with a fractured tooth, who do not receive treatment, have a four times greater risk of reporting an impact on OHRQoL when compared to the group without trauma [45]. Negative self-perception remains after tooth restoration.
Dental caries, periodontal disease, toothache, dental erosion, agenesis, edentulism, bruxism, DTM and OHRqO
The impact of dental caries on OHRQoL was addressed in 5 systematic reviews [9,26, 30,31,45]. Three articles report that the greater the severity of the carious lesion, the worse the impact on OHRQoL in adolescents [9,26,45]. As well as individuals with severe periodontitis had worse OHRQoL scores [9]. The association between caries and periodontal disease was demonstrated in an RS. And the operative treatment of caries lesions has a positive effect on OHRQoL, despite the low quality of evidence [9]. Toothache, TMD and tooth loss have a high impact on OHRQoL in adolescents. While dental erosion and bruxism have not been shown to impact the quality of life of adolescents [26]. In contrast, tooth agenesis does not have enough scientific evidence to support a relationship between OHRQoL [37].
Impact of health determinants on OHRQoL
Only 3 systematic reviews assessed the impact of oral health determinants on OHRQoL [30,33,41]. It was observed that health promotion programs have a positive effect on OHRQoL. The reduction of oral problems and increased satisfaction with oral health in the development of daily activities such as chewing, brushing, talking, smiling and sleeping are reported in studies [33].
Another finding demonstrated that having parents who can provide dental care and safe housing are positive predictors for OHRQoL. The systematic review reports factors that physical disability, visual impairment, mental disorders, poor diet and irregular brushing negatively impact OHRQoL. While the influence of religion and age on OHRQoL is unknown [30].
Socioeconomic factors related to the area of residence, satisfaction with oral health and dental care were shown to be directly proportional to the HRQoL outcome [30]. The parental socioeconomic factor and family environment also influenced OHRQoL [41]. Adolescents from families with higher incomes and higher levels of maternal education have better OHRQoL scores [45]. Being an only child, growing up in your nuclear family or family structure, household conditions, and number of people per household and maternal age are predictors of better OHRQoL [41]. While parental occupation, marital status, and the family provider being the mother or direct caregiver were not factors capable of impacting OHRQoL [41]. It is noteworthy that the parent’s place of origin, place of study, deleterious habits in the family, resistance to dental care on the part of the mother and use of dental care services do not have strong evidence.
Assessment instruments and OHRQoL
Systematic reviews report the use of different OHRQoL assessment instruments in adolescents. We found 21 questionnaires used in different study methodologies. CPQ, OIDIP, ECOHIS and OHIP, Child OIDP were the most frequent measurement systems. The annex to this article contains the different HRQoL measurement instruments used in the 22 studies included in this umbrella systematic review.