Contextual, Family, and Individual Pathways from Screen Time to Oral Health

Abstract

Children and adolescents often spend substantial time engaged in screen-based activities for both educational and recreational purposes. Excessive screen time has been associated with adverse health outcomes, potentially mediated by shared unhealthy behaviors such as poor dietary habits and inadequate toothbrushing. The aim of this study was to examine the direct and indirect pathways linking screen time to adolescents’ oral clinical conditions and oral health–related quality of life (OHRQoL), considering contextual, family, and individual factors within a comprehensive theoretical framework. An observational longitudinal study was conducted in Manaus, Brazil, from 2024 to 2025, including 610 twelve-year-old adolescents enrolled in urban public schools. The theoretical model, adapted from Fisher-Owens et al (2007), incorporated community, family, and individual-level variables. Data were collected through self-administered questionnaires completed by participants and their parents/guardians, alongside clinical oral examinations conducted in private settings within schools. Structural equation modeling (SEM) was used to estimate direct and indirect effects. A hierarchical structure of associations across contextual, socioeconomic, relational, and individual levels influencing oral health outcomes was observed. Screen time was not directly associated with oral clinical conditions but was linked to a higher impact on OHRQoL (β = 0.202, P = 0.002) and lower toothbrushing frequency (β = −0.139, P = 0.031). A higher impact on OHRQoL was also related to higher sugar consumption (β = 0.142, P = 0.004) and poorer clinical oral condition (β = 0.174, P = 0.005). Socioeconomic status played a major role, contributing to multiple direct and indirect pathways linking contextual and relational factors to the outcomes. In conclusion, screen-related behaviors are embedded within broader familial and social contexts, with socioeconomic conditions influencing multiple pathways to adolescents’ oral health outcomes. Interventions targeting family environments, parental practices, and behavioral habits, alongside strategies addressing socioeconomic disparities, may reduce behavioral risks and improve adolescent oral health.

The authors' abstract, as published at the source. Journal of Dental Research, 2026 · DOI ↗