Correlation Analysis between Self-perceived Oral Health andSelf-perceived General Health among Adults in China
Yi Zhen YU1, Shuo DU1, Min DING1,2, Zhi Ying CUI1, Yi LIU2, Yan SI1
Objective: To analyse the correlation between self-perceived oral health (SPOH) and selfperceived general health (SPGH) and the influencing factors.
Methods: In this study, we collected sociodemographic information and details about SPOH
DQG63*+VWDWXVIRU&KLQHVHDGXOWV \HDUV DQGDWRWDORISHRSOHZHUHLQFOXGHG
The data were analysed using SPSS software (IBM, Armonk, NY, USA) with a chi-square test
and binary logistic regression.
Results:,QWRWDORIDGXOWV VHOISHUFHLYHGRUDOKHDOWKZDVDWDJRRGOHYHODQGRIDGXOWV VHOISHUFHLYHGJHQHUDOKHDOWKZDVDWDJRRGOHYHO7KH632+ZDVFRUUHODWHGZLWK
63*+ U 3 *RRG632+ZDVDVVRFLDWHGZLWK\RXQJHUDJHQRGHQWXUHVno smoking, brushing teeth twice or more a day, periodontal health, no malocclusion and
GHFD\HGPLVVLQJDQGILOOHGWHHWK '0)7 *RRG63*+ZDVDVVRFLDWHGZLWK\RXQJHU
age, higher educational level, no dentures, no smoking, brushing teeth twice or more a day,
SHULRGRQWDOKHDOWKQRPDORFFOXVLRQDQG'0)7
Conclusion: SPOH and SPGH are correlated with each other, and greater attention shouldbe paid to oral health to promote general health.
Key words: adults, China, correlation, general health, oral health&KLQ-'HQW5HV  ±GRLMFMGUE

Health is an important factor that contributes to longevity, successful ageing and satisfaction with life1.
An increasing number of studies have found many
1 Department of Preventive Dentistry, Peking University Schooland Hospital of Stomatology, National Engineering Laboratory
for Digital and Material Technology of Stomatology, Beijing Key
Laboratory of Digital Stomatology, Beijing, P.R. China.
2 Department of Orthodontics, Peking University School and Hospitalof Stomatology, National Engineering Laboratory for Digital andMaterial Technology of Stomatology, Beijing Key Laboratory of
Digital Stomatology, Beijing, P.R. China.
Corresponding authors: Dr Yi LIU, Department of Orthodontics, Peking
University School and Hospital of Stomatology, #22 Zhongguancun
South Avenue, Haidian District, Beijing 100081, P.R. China. Tel: 86-1082195561; Fax: 86-10-62110880. Email: lyortho@163.com
Dr Yan SI, Department of Preventive Dentistry, Peking University Schooland Hospital of Stomatology, #22 Zhongguancun South Avenue, Haidian
District, Beijing 100081, P.R. China. Tel: 86-10-82195561; Fax: 86-1062173404. Email: siyanyy@163.com
This study was supported by the Oral Health Observatory (OHO) of theWorld Dental Federation (FDI).

Chinese Journal of Dental Researchlinks between oral health and general health, and people around the world are paying closer attention to therelevance of both. The World Dental Federation (FDI)
defines oral health as “the health of the mouth. No matter what your age, oral health is vital to general healthand well-being”2.
Oral health is an integral component of general
health3. Many systemic diseases and oral diseases
interact with each other, and periodontitis is a risk
factor for cardiovascular disease. Researchers havefound that periodontitis is associated with myocardial
infarction4, periodontitis and tooth loss are associatedwith the occurrence of stroke5, and severe tooth loss is
significantly related to incident coronary heart disease6.
In addition, diabetes mellitus7,8, respiratory diseases9,
preterm birth10 and underweight children11 are all associated with periodontal disease.
Self-perceived general health (SPGH) can be a sensitive barometer of physiological states, and it covers
a large spectrum of health conditions12. Many studies have shown that SPGH, with individuals asked a277

YU et alsimple question to rate their overall health on a scalefrom excellent to poor, is a strong predictor of futuremorbidity and mortality13-15. SPGH and self-perceived
oral health (SPOH) are commonly used health and oral
health indicators in most national and international
surveys. SPOH has also been found to be significantly
associated with clinical oral health status16, and has
been suggested as a health assessment tool17.
However, relatively few studies have explored therelationship between SPOH and SPGH status in China,
and the results were often obtained from a very simple
questionnaire. Based on this background, the purpose ofthis study was to explore Chinese adults’ evaluation of
their own oral health and general health, the correlation
between the two, and the influencing factors.
Materials and methods
6XEMHFWVThis cross-sectional study used data from the 2020 Oral
Health Observatory (OHO). The target population was
residents aged 18 and above in China.
The sample size was 

 
deff is the design efficiency, p is the prevalence ofdental disease in the group aged 35 to 44 years from
WKH WK 1DWLRQDO 2UDO +HDOWK 6XUYH\ ȝ LV WKH OHYHORI FRQILGHQFH DQG į LV WKH UHODWLYH HUURU &RQVLGHULQJthe expected response rate of 85%, the estimatedsample should be composed of no fewer than 2163
people. Systematic cluster sampling was conductedby the sample of registered members of the Chinese
Stomatological Association (CSA) ordered by the initials of their region, with a final sample size of 2233
people.
Data collection and methods
The questionnaire delivered to participants covered theirage, sex and education and other demographic information, information related to oral health behaviour such as
wearing dentures, smoking, tooth brushing and intake ofsugary food, as well as SROH and SRGH, which werefilled in by the participants themselves. After oral examination by dental practitioners, a record that included information about oral disease, such as periodontal health,decayed, missing and filled teeth (DMFT) and dental278

erosion, was completed by dental practitioners. The
questionnaire and record were combined by matching
the same patients’ information. All the information fromthe online questionnaire and the record was collectedusing mobile phone application software.
For the questions answered by patients, the optionsfor SPOH and SPGH were “very good”, “good”, “general”, “poor” and “very poor”, which were recoded
so that "very good" and "good" were grouped under"good" and the other options were classified as "poor".
The age groups were 18 to 24 years, 25 to 34 years,
35 to 44 years, 45 to 54 years and 55 years and over.
DMFT was categorised into four groups based on experience of caries lesions (DMFT 0, 1 to 5, 6 to 12
and > 12). Our classification of DMFT referred to thegroup aged from 35 to 44 years' mean DMFT (4.54)
which was rounded up to 5, from the Fourth National
Oral Health Survey (2015 to 2016) in mainland China,
and the median DMFT was 6 in our study. Our analysis
revealed little group differences in the groups of DMFT
VRZHFRQVLGHUHGWKHJURXSRI'0)7!DVD
group in which caries were severe.
Statistical analysis
All statistical analyses were performed using SPSS Statistics v. 26.0 (IBM, Armonk, NY, USA). A nonparametric test (Mann-Whitney U test) was performed tocompare the indices. Chi-squared tests were then used
to examine the potential correlation between SPOH and
SPGH and their respective potential association between
SPOH and SPGH, both as dependent variables, and thedifferent study variables (independent variables). Multivariate binary logistic regression analysis was used todetermine the related factors affecting SPOH and SPGH.
All statistical tests were performed with a level of significance of P < 0.05.
Results
Basic information
A total of 2233 subjects were selected, 1292 of whomwere women and 941 were men. In terms of education,
secondary education and a bachelor’s degree or above
were reported most frequently (38.4% and 56.0%, respectively). Only 7.4% of participants reported having
worn dentures, 26.7% smoked or had smoked previously, 79.4% brushed their teeth twice or more a day,and up to 91.3% and 83.9% consumed sugary foods anddrinks, respectively. The overall periodontal health rate

Volume 25, Number 4, 2022

YU et al

Table 1 Characteristics of the study sample.
Variable

Age, ySex

Education

Dental prosthesis
SmokingBrush teeth twice or more a day
Consumption of sugary foodConsumption of sugary drinks
Periodontal health

DMFT

Acid erosion
Malocclusion
Good SPGHGood SPOH

18–24
25–34
35–44
45–54
> 55
Male
FemalePrimary education or less
Secondary education
Bachelor’s degree or higher
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
0
1-5
6-12
>12
Yes
No
Yes
No
Yes
No
Yes
No

was 37.8%, the proportion of caries-free participants
was 7.6%, the prevalence of dental erosion was 21.1%
and the prevalence of malocclusion was 15.4%. A totalof 43.4% of participants considered their oral health tobe good. In contrast, up to 57.9% thought they had good
general health. All of the variables are shown in Table 1.
SPOH and SPGH
Comparison of DMFT groups showed a significant differHQFHEHWZHHQ'0)7!DQGWKHUHPDLQLQJ'0)7
groups in the univariate analysis of SPOH and SPGH, but
QRVLJQLILFDQWGLIIHUHQFHEHWZHHQWKH'0)7JURXSVThe variables that affected SPOH were younger age,female sex, higher education level, no dentures, no smoking, brushing teeth twice or more a day, eating sugary

Chinese Journal of Dental Research

n

%

425
762
428
300
318
941
1292
123
832
1213
166
2067
597
1636
1741
452
2023
194
1852
355
830
1365
160
708
904
330
469
1757
343
1890
1290
937
964
1262

19.0
34.1
19.2
13.4
14.2
42.1
57.9
5.6
38.4
56.0
7.4
92.6
26.7
73.3
79.4
20.6
91.2
8.8
83.9
16.1
37.8
62.2
7.6
33.7
43.0
15.7
21.1
78.9
15.4
84.6
57.9
42.1
43.4
56.6

food, drinking sugary drinks, periodontal health, DMFT
QRGHQWDOHURVLRQDQGQRPDORFFOXVLRQ 7DEOH 
These variables were associated with better SPOH.
The variables that were associated with good SPGH
were consistent with good SPOH, such as younger age,female sex, higher education level, no dentures, nosmoking, brushing teeth twice or more a day, drinking
VXJDU\GULQNVSHULRGRQWDOKHDOWK'0)7QRGHQtal erosion, and no malocclusion (Table 3).
Correlation between SPOH and SPGH
Table 4 shows that SPOH and SPGH are positively correlated and subjects with good SPOH had good SPGH,
whereas those with poor SPOH had poor SPGH. A
Spearman correlation coefficient showed a moderate279

YU et al

Table 2Distribution of SPOH according to the different variables. A chi square test was used.

Variable

Age, ySocial demographics
Sex

Education

Dental prosthesis
Smoking
Oral hygiene habits

Brush teeth twice or more a day
Sugary food consumption
Sugary drink consumption
Periodontal health

DMFT
Oral disease
Acid erosion
Malocclusion

18–24
25–34
35–44
45–54
> 55
Male
FemalePrimary education or less
Secondary education
Bachelor’s degree or higher
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
0
1–5
6–12
> 12
Yes
No
Yes
No

correlation but was statistically significant (r = 0.593;
P < 0.05).

P value

SPOH
Good
n
%

Not good
n
%

232
387
173
97
75
353
611
26
304
605
31
933
172
792
827
123
887
68
848
108
463
487
85
369
381
78
173
788
124
840

190
373
253
203
243
585
677
96
522
608
135
1127
423
839
912
325
1131
126
999
247
363
875
75
337
520
250
293
965
217
1045

55.0
50.9
40.6
32.3
23.6
37.6
47.4
21.3
36.8
49.9
18.7
45.3
28.9
48.6
47.6
27.5
44.0
35.1
45.9
30.4
56.1
35.8
53.1
52.3
42.3
23.8
37.1
45.0
36.4
44.6

45.0
49.1
59.4
67.7
76.4
62.4
52.6
78.7
63.2
50.1
81.3
54.7
71.1
51.4
52.4
72.5
56.0
64.9
54.1
69.6
43.9
64.2
46.9
47.7
57.7
76.2
62.9
55.0
63.6
55.4

< 0.001

0.001< 0.001< 0.001< 0.001< 0.0010.019< 0.001< 0.001< 0.001

0.003
0.005

twice or more times a day, sugary drink intake, periRGRQWDOKHDOWKQRPDORFFOXVLRQDQG'0)7ZHUH
factors influencing SPGH (Table 6).

Multivariate analysis
Multivariate binary logistic regression analysis showedworse SPOH in the age groups above 35 years compared to the group aged 18 to 24 years. No dentures, nosmoking, brushing teeth twice or more times a day, periRGRQWDOKHDOWKQRPDORFFOXVLRQDQG'0)7ZHUH
positively related to good SPOH (Table 5).
The influencing factors of SPGH were similar to
those of SPOH. The group aged 25 to 34 years had poor
SPGH compared to those aged 18 to 24 years. Higher
education, no dentures, no smoking, brushing teeth
280

Discussion
In the present study, the same independent variables
were used to assess the factors associated with SPGH
and SPOH. The results showed that in Chinese adults,
good SPGH and good SPOH were associated with demographic information, oral health behaviours and oral disease factors, and there were many common influencing
factors between the two. An individual’s self-perceived
health represents a summary statement concerning theways in which various aspects of health, subjective andVolume 25, Number 4, 2022

YU et al

Table 3Distribution of SPGH according to the different variables. A chi-square test was used.

Variable

Age, ySocial demographics
Sex

Education

Dental prosthesis

Smoking
Oral hygiene habits
Brush teeth twice or more a day
Sugary food consumption
Sugary drink consumption
Periodontal health

DMFT
Oral disease
Acid erosion
Malocclusion

objective, are combined within their perceptual framework18. SPOH may be an appropriate indicator for use
in diverse sociocultural contexts19. Some findings haveindicated that oral health perception may be a usefulmeasure in public health due to its relationship withhealth determinants and health service use20.
We asked subjects to evaluate their own oral andgeneral health condition with a single intuitive question. The proportion of respondents with good SPOH
was 43.4%. This was significantly lower than reported in studies conducted in Yemen (51%)16, Canada(81.5%)21, Nigeria (58.3%)22 and Brazil (59.7%)23.
The proportion of participants who considered they
had good SPGH was 57.9%, a significantly higher
result than that for SPOH, and higher than in Japan

Chinese Journal of Dental Research

P value

SPGH
Good
n
%

Not good
n
%

18–24
25–34
35–44
45–54
> 55
Male
FemalePrimary education or less
Secondary education
Bachelor’s degree or higher
Yes

281
491
227
154
137
500
790
34
415
805
55

66.4
64.6
53.3
51.3
43.1
53.2
61.3
27.6
50.1
66.5
33.1

142
269
199
146
181
439
498
89
414
405
111

33.6
35.4
46.7
48.7
56.9
46.8
38.7
72.4
49.9
33.5
66.9

No

1235 59.9

826

40.1

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
0
1–5
6–12
> 12
Yes
No
Yes
No

254
1036
1098
178
1184
96
1117
162
546
722
107
447
532
123
49
1039
179
1111

341
596
639
273
834
98
731
193
282
639
53
259
370
205
217
715
163
774

57.3
36.5
36.8
60.5
41.3
50.5
39.6
54.4
34.1
47.0
33.1
36.7
41.0
62.5
46.6
40.8
47.7
41.1

42.7
63.5
63.2
39.5
58.7
49.5
60.4
45.6
65.9
53.0
66.9
63.3
59.0
37.5
53.4
59.2
52.3
58.9

< 0.001

0.001< 0.001< 0.001< 0.001< 0.0010.015< 0.001< 0.001< 0.001

0.027
0.024

Table 4 Correlation between responses concerning SPOH
and SPGH.

Good
SPOH Not
good

SPGH
Good
n
%

P
Not good value
n
%

881

91.5

82

408

32.4

850 67.6

Spearmancorrelation

8.5< 0.001 0.593(36.9%)24 but lower than in the USA (83.0%)25. The
diversity of findings could be explained by differencesin age, health knowledge and awareness, the quality ofhealth services in different countries and personality
differences in ethnic groups in different countries. The
281

YU et al

Table 5

Ordinal regression for the effect of study variables on SPOH status.

VariableOR

Age, yDental prosthesis
SmokingBrush teeth twice or more a day
Sugary drink consumption
Periodontal health
Does patient have any other oral diseases –malocclusion?

DMFT

Table 6

18–24
25–34
35–44
45–54
> 55
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
0
1–5
6–12
> 12

1 (reference)
0.938
0.665
0.636
0.56
0.494
1 (reference)
0.597
1 (reference)
1.717
1 (reference)
1.592
1 (reference)
1.674
1 (reference)
0.730
1 (reference)
1.864
1.703
1.380
1 (reference)

Upper

NA
0.717
0.489
0.444
0.377
0.305
NA
0.472
NA
1.329
NA
1.198
NA
1.366
NA
0.557
NA
1.171
1.207
0.996
NA

NA
1.228
0.905
0.911
0.832
0.800
NA
0.756
NA
2.219
NA
2.114
NA
2.051
NA
0.955
NA
2.967
2.403
1.913
NA

Age, yEducation

Dental prosthesis
SmokingBrush teeth twice or more a day
Sugary drink consumption
Periodontal health
Does patient have any other oral diseases – malocclusion?

282

0.644
0.009
0.014
0.004
0.003
NA
< 0.001NA< 0.001
NA0.001
NA< 0.001
NA
0.022
NA
0.009
0.002
0.053
NA

Ordinal regression for the effect of study variables on SPGH status.

Variable

DMFT

P value

OR (95% CI)
Lower

18–24
25–34
35–44
45–54
> 55
Primary education or less
Secondary education
Bachelor’s degree or higher
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
0
1–5
6–12
> 12

OR

OR (95% CI)
P value
Lower Upper

1 (reference)
0.979
0.670
0.958
0.918
1 (reference)
1.706
2.535
0.647
1 (reference)
0.571
1 (reference)
1.829
1 (reference)
1.536
1 (reference)
1.253
1 (reference)
0.757
1 (reference)
1.836
1.579
1.602
1 (reference)

NA
0.734
0.488
0.667
0.662
NA
1.032
1.511
0.429
NA
0.455
NA
1.431
NA
1.171
NA
1.015
NA
0.583
NA
1.154
1.140
1.186
NA

NA
1.305
0.920
1.376
1.355
NA
2.82004.2510
0.976
NA
0.715
NA
2.334
NA
2.020
NA
1.547
NA
0.984
NA
2.923
2.186
2.164
NA

0.884
0.013
0.817
0.666
NA
0.037
< 0.0010.036
NA< 0.001NA< 0.001
NA
0.002
NA
0.036
NA
0.037
NA
0.010
0.006
0.002
NA

Volume 25, Number 4, 2022

YU et al

results obtained showed that SPGH is at a slightly betterlevel than SPOH, but still requires attention. The results
suggest that more attention should be paid to oral healthby improving people’s oral health knowledge and behaviour through relevant policies and social publicity;in this way, we can also improve oral health.
In the multivariate analysis, subjects who smokedor used to smoke had bad SPOH and SPGH. This may
be due to the fact that smoking is prone to altering
oral, lung and intestinal microbiota, leading to various
general diseases like periodontitis, asthma, chronic
obstructive pulmonary disease, Crohn’s disease, ulcerative colitis and cancer26. Good SPOH and SPGH status
were also associated with the oral health behaviour ofbrushing the teeth twice or more times a day. The oral
environment is a highly complex microenvironment
in which a wide variety of microorganisms coexist27.
Tooth brushing may help to maintain the oral flora balance. Some bacteria in the oral microbiota are directly
associated with respiratory pathogens that cause pneumonia28, and general inflammation can also be causedby the oral pathogen soluble antigen29. It was reported
that some links between oral diseases and generaldiseases may be due to unhealthy behaviours that areharmful to both oral and general health30, for example
smoking. Furthermore, studies supported that the areasin which oral disorders had the most significant impact
were tooth brushing and cleaning31,32. Subjects without
dentures were found to have better SPOH and SPGH;
denture wear may be associated with previous oraldisease, multiple dentition defects or full edentulism
and the discomfort of wearing removable dentures.
Furthermore, we found that periodontal disease, caries
and malocclusion have an effect on SPOH and SPGH,
which is consistent with the findings of Arantes andFrazão19. This result indicates that SPOH can partiallyreflect actual oral health status, so it can be considered
as a more effective oral health evaluation index whenassessing people’s oral health status. Oral disease–related variables have an impact on SPGH status, and thisalso indicates that oral disease is partially associatedwith general health. This may be because periodontitis
is a risk factor in the complex pathogenesis of diabetes,
cardiovascular disease, kidney disease and recurrent
pneumonia33. Caries lesions and periodontal disease canalso cause some pain and tooth loss, which can affectchewing function. Oral health can impact food choices
and have a negative effect on food intake, resulting
in poor nutritional conditions and leading to chronicsystemic disease, which in turn affects oral health34.
Malocclusion can affect the aesthetic appearance of theface. Dental crowding in malocclusion can easily lead

Chinese Journal of Dental Research

to plaque retention and can affect tooth cleaning, leading to caries lesions and periodontal disease.
The results showed a significant positive correlation
between SPOH and SPGH. A study confirmed that oral
health is an integral part of systemic health, and it iscertain that oral health is part of general health35. We
found many common risk factors related to oral healthbetween SPOH and SPGH. This suggests that to preventand control oral diseases and systemic diseases, wemust not ignore the role of oral health–related factors
and that there should not be just one method for prevention and treatment of oral or systemic diseases, butrather multidisciplinary cooperation, with oral healtheducation included in general disease prevention anddisease control projects.
Conclusion
SPOH better reflects actual oral health status and canbe used as a regular indicator to predict oral health status. SPOH and SPGH have many common risk factors
related to oral health, so more attention must be paid tooral health in order to promote general health.
Acknowledgements
This study was supported by the Oral Health Observatory (OHO) of the FDI. The authors express their sincere
thanks to all participants in the study.
Conflicts of interest
The authors declare no conflicts of interest related tothis study.
Author contribution
Drs Yi Zhen YU, Shuo DU, Min DING and Zhi Ying
CUI analysed the data; Dr Yi Zhen YU drafted the paper;Drs Yan Si and Yi Liu conceived the programme ofresearch, checked the analysis and critically revised themanuscript. All authors approved the final manuscript
for submission.
(Received Jan 8, 2022; accepted Jun 15, 2022)
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Volume 25, Number 4, 2022