Introduction

One of the primary goals of dental health professionals is to prevent disease in patients. Health promotion can be defined as the process which enables people to gain control over their health determinants in order to improve their health and enabling them to live an active and productive life.¹ This definition contains three important components. First, it includes the recognition of the determinants (biological factors) of health (endogenous determinants); the physical and social environment and lifestyle (exogenous determinants) as well as the system of healthcare. Second, it sets an objective of leading an active productive life. Third, it refers to the activity or the enabling process in which the determinants of health are used to reach the objective in a dialectic relationship between people, the setting, and the enablers. At the heart of the process is the respect for people as active participating subjects.¹

Previous studies have shown oral health behaviors are associated with various psychological traits including self-esteem, self-efficacy, life satisfaction, optimism, sense of coherence, anxiety, depression, locus of control, stress, and cynical hostility.² The theory of self-esteem is well-known and has been used in health behavior studies for a long time. Self-esteem is described by Rosenberg,³ who postulates individuals with high self-esteem respect themselves, considers themselves to be at least on an equal plane with others, recognizes their own limitations, and expects to grow and improve. Research has linked high self-esteem to many positive outcomes including occupational success, healthy social relationships, subjective well-being, positive perceptions by peers, academic achievement, persistence in the face of failure, and improved coping and self-regulation skills.⁴ In the dental sphere higher self-esteem has been associated with a greater frequency of toothbrushing.^5-8 By contrast, the role of self-esteem on dental visits is less clear with some⁵ but not all studies find an association with dental appointment compliance.^8-9 Conversely, low self-esteem has been linked to a number of problematic outcomes including depressive symptoms, health problems, and antisocial behavior.⁴

Affective lability is a rapid change of the emotional expression in which a person responds to environmental and internal stimuli in an unpredictable, hyper-responsive fashion. Affective lability can be characterized as unpredictable shifts in intensity or frequency of a patient’s baseline emotional expressivity. Affective lability has also been described as an emotional expression in excess of cultural norms with repeated, rapid, and abrupt emotional shifts. Affective lability has been associated with a variety of medical disorders including hyperthyroidism, epilepsy, diabetes, and steroid related syndromes.¹⁰ Several studies have found significant relationships between affective lability and areas of emotional and behavioral problems including late-life suicide, substance-use related problems,¹¹ impulsive-aggressive behavior, borderline personality disorder, and bipolar disorder.^12-14

Since there is a lack of information about this area available in the literature, the aim of the present study was to examine the impact of instability of self-esteem and affective lability on students’ self-rated oral health and oral health-related behaviors.