Impact of Dental Status on Oral Health-related Quality of Life in Children with Missing or Multiple Teeth in Saudi Arabia: A Cross-sectional Analysis

A bstract Objectives: This study assessed associations between dental health status and oral health-related quality of life (OHRQoL) in 11–14-year-old children at a Saudi university pediatric dental clinic, identifying clinical and psychosocial predictors of OHRQoL. Methods: A cross-sectional study recruited 385 children (71.7% Saudi, 28.3% non-Saudi) via convenience sampling. Clinical measures included dental caries [decayed, missing, and filled teeth (DMFT) index], Plaque index, and Dental Aesthetic Index (DAI) per World Health Organization/International caries detection and assessment system criteria. OHRQoL was assessed using the validated Arabic Child Perceptions Questionnaire 11–14. Self-reported perceptions of general/oral health and dental aesthetics were collected. Non-parametric tests (Kruskal–Wallis, Mann–Whitney with Bonferroni correction), Spearman correlations, and multiple linear regression were performed ( α = 0.05). Results: The sample comprised 68.8% older adolescents (13–14 years) with a balanced gender distribution (51.9% male). Contrary to expectations, objective clinical measures showed no significant associations with OHRQoL. Neither DMFT [ B = 0.001, 95% confidence interval (CI): −0.019, 0.020, P = 0.951] nor DAI ( B = 0.003, 95% CI: −0.003, 0.009, P = 0.308) predicted overall OHRQoL, with negligible correlations across all domains ( r = −0.055 to 0.050, P > 0.05). Instead, age was a strong negative predictor, most pronounced for emotional well-being ( B = −0.848, 95% CI: −0.993, −0.703, P < 0.001) and overall OHRQoL ( B = −0.720, 95% CI: −0.847, −0.594, P < 0.001), with older adolescents reporting significantly poorer OHRQoL. Participant background (Saudi vs. non-Saudi) significantly predicted higher OHRQoL among Saudi participants ( B = 0.907, 95% CI: 0.805, 1.009, P < 0.001). Self-reported perceptions—including satisfaction with oral health, perceived dental aesthetics, and treatment needs—demonstrated stronger associations with OHRQoL than clinical indicators ( P < 0.001 across domains after Bonferroni correction). Conclusion: In this convenience sample, objective clinical measures (DMFT, DAI) did not predict OHRQoL. Quality of life was predominantly influenced by age, participant background, and self-perceptions of oral health and aesthetics, reflecting the psychosocial significance of this developmental stage. Convenience sampling from a single clinic limits generalizability. Future interventions should integrate psychosocial support with clinical care and address health care access disparities. Population-based studies are needed for validation.