Caries Risk Assessment as the Strongest Predictor of Oral Health–Related Quality of Life: A Cross-Sectional Multivariate Study of Adolescent Students

Objective: This study aimed to determine the factors associated with oral health–related quality of life (OHRQoL) among adolescent students, with a particular focus on identifying the strongest predictor using a multivariate analytical approach. Material and Methods: A cross-sectional study with 249 adolescent students in Sekolah Menengah Pertama Negeri 54 Makassar, Indonesia, was conducted. Clinical examinations were performed to assess dental caries experience using the Decayed, Missing, and Filled Teeth index (DMF-T), oral hygiene status using the Oral Hygiene Index–Simplified (OHI-S), Body Mass Index (BMI), sex, and caries risk level using the Caries Risk Assessment (CRA) tool, categorized into low, medium, and high. OHRQoL was measured using the Oral Health Impact Profile-14 (OHIP-14). Multivariate linear regression analysis was applied to identify predictors of OHIP-14 scores. Results: CRA emerged as the strongest predictor of OHRQoL, with adolescents in the high-risk category demonstrating significantly higher OHIP-14 scores compared to those with low risk (β = 25.26, p < 0.001). DMF-T was also a significant predictor, indicating that greater caries experience was associated with significantly worse OHRQoL (β = 2.52, p < 0.001). BMI, OHI-S, and sex did not show significant associations with OHIP-14 scores (p > 0.05). Conclusion: Caries risk level and dental caries experience are key determinants of OHRQoL among adolescents, with the CRA as the most influential factor. These findings highlight the importance of integrating systematic caries risk assessment into school-based oral health programs to improve early detection and targeted preventive care.