Toothbrushing ability, caries burden, and oral health-related quality of life among stunted preschool children in Bandung-Indonesia.

BACKGROUND: Stunting remains a significant public health challenge in Indonesia and may affect children’s neuromotor development, including fine motor coordination required for effective toothbrushing. Impaired oral hygiene behaviors in stunted children may contribute to increased caries burden and reduced oral health–related quality of life (OHRQoL). OBJECTIVE: To investigate the relationship between toothbrushing ability, caries burden, and OHRQoL among stunted and non-stunted preschool children in Bandung, Indonesia. METHODS: A cross-sectional study was conducted among 554 children aged 1–5 years selected through consecutive sampling from identified stunting loci. Clinical assessments of caries (def-t index) and oral hygiene (Debris Index from OHI-S) were conducted by calibrated dentists. Toothbrushing ability was assessed using a structured checklist, and OHRQoL was assessed using the validated Indonesian version of the Parental-Caregiver Perception Questionnaire (P-CPQ). Statistical analyses included descriptive statistics and chi-square tests to examine bivariate associations, with linear-by-linear association tests for ordinal variables. RESULTS: Nutritional status was significantly associated with toothbrushing ability (p = 0.034) and OHRQoL (p < 0.001), but not with caries burden (p = 0.924). Toothbrushing ability was significantly associated with caries burden (p < 0.001) and oral hygiene (p < 0.001). Oral hygiene was also associated with caries burden (p < 0.001). Brushing frequency (p = 0.048) and technique (p = 0.027) differed significantly by nutritional status, whereas brushing duration, parental assistance, and grip type did not. No significant associations were observed between caries burden, oral hygiene, toothbrushing ability, and OHRQoL, likely due to the highly skewed distribution of OHRQoL categories, with 97.5% classified as “very low impact.” CONCLUSION: Stunted children demonstrated poorer toothbrushing ability compared to their non-stunted peers, and caries burden was closely related to oral hygiene and brushing practices. Nutritional status was associated with OHRQoL, although other variables showed no significant relationship due to limited variability in OHRQoL scores. Integrating oral health promotion with nutrition improvement programs may support better oral and general health outcomes among nutritionally vulnerable populations.