Introduction: The literature review indicated that oral health is a serious health issue among Indian school adolescents. In India, less than 5% of adolescents have access to organised public dental health services in order to identify and treat dental caries at an early stage. Oral health literacy is important for adolescents to prevent and manage dental caries in their permanent teeth. Currently, there is no formal oral health education available in both the primary and secondary level school curriculum in Tamil Nadu. Objective: This thesis was conducted to collect baseline data to measure the epidemiology of dental caries and the level of oral health literacy among adolescents in rural and urban schools of Tamil Nadu, India. Methods: Oral health literacy and the epidemiology of dental caries were measured in 974 adolescent school students (12-15 year-olds) from both rural and urban areas of Tamil Nadu, India. There were three research questions answered in this thesis using a cross-sectional descriptive correlational quantitative study design. The first research question was addressed by measuring the Decayed, Missing and Filled teeth index (DMFT) using the WHO oral health survey method. The second research question was addressed by measuring the oral health literacy of 974 adolescent participants using a self-administered questionnaire developed for this study. The third research question was addressed by examining the association between the severity of dental caries (question 1) and oral health literacy (question 2). Results: The oral health survey indicated that prevalence of dental caries among adolescents in rural and urban parts of Tamil Nadu was 61.4% with an average DMFT score of 2.03. Multiple regression analyses indicated factors such as gender, age, mother’s education, type of schools and community/caste as significant predictors of dental caries. This is the first study to assess the impact of community on oral health literacy and status of adolescents. Almost 92% of participants reported that they had never been to a dentist. In total, 1980 teeth were affected and 98.6% (1953) affected teeth were decayed and not filled. The Cronbach’s alpha score (0.651) demonstrated the developed questionnaire had good internal consistency. In total, 35% of participants had poor oral health literacy (OHL) skills and only 8.3% of participants had good OHL skills to prevent dental caries. Parent’s education, gender and community/caste were identified as significant predictors of OHL in the regression analysis. A strong negative association between oral health literacy scores and dental caries prevalence and severity was identified in the study. Conclusion: The current study is the first to find an association between oral health literacy and dental caries in an adolescent population both in international and Indian literature. The prevalence of dental caries was decreased and severity of dental caries was increased when compared to previous research in Tamil Nadu. This result implies an imbalance in availability of oral health services in Tamil Nadu, India. The study results also imply that the majority of the study population had poor or moderate oral health literacy to prevent and manage dental caries. Females, Scheduled Caste and Tribes attending public schools in rural areas were identified as the more vulnerable populations to get affected by dental caries due to their poor oral health literacy. Oral health policies should be targeted to these adolescent populations in the Tamil Nadu region. Improving oral health literacy education in the school and pre-school curriculum could help to manage oral health in adolescents.

Indiana University-Purdue University Indianapolis (IUPUI) / Although complex phenomena such as oral diseases can be studied using generalizable conceptual frameworks, the differences in the underlying influences across countries necessitate adaptation of existing oral health frameworks to the specific conditions in each country. The aim of this dissertation was to investigate distal (indirect) and proximal (direct) influences of oral health and their interactions with both self-reported oral pain (OP) and self-rated oral health status (SROH) in Saudi Arabia (SA). Two secondary data analyses were conducted utilizing data from the national demographic and health survey (DHS) of SA in 2017. The objective of the first study was to describe the study design, and the distal and proximal influences reported in the 2017 SA DHS. The objective of second study was to explore associations between proximal and distal factors that affect OP and SROH, using the adapted framework. Path analysis modeling was used to estimate direct, indirect, and total effects. The 2017 SA DHS used an innovative multistage stratified random-sampling technique to select the population sample by using primary health care centers’ catchment areas as the primary sampling unit. The final analysis included 29,274 adults, 9910 adolescents, and 11653 children. OP in the past year was experienced in 39% in children and, 48.5% for the adolescents, and 47.1% in adults. The proportion of respondents who reported good, very good, or excellent self-rated oral health status was 92.9 % in children, 87.1% in both adolescents and adults. In children group, OP was linked to less tooth brushing, more dental visits and less dental routine examination, while less favorable SROH was linked to less tooth brushing, more dental visits and sweets consumption. In adolescents and adults groups, OP and less favorable SROH were linked to more dental visits, complaint dental visits, less tooth brushing. Many distal influences showed significant effects (direct, indirect, and total) on OP and SROH; however, differences existed among the three age groups. The studies suggest that future investigations should focus on why Saudi residents perceive their oral health positively while the prevalence of negative oral health influences and OP was high.

Despite growing interest in maternal oral health, research aimed at this population is scant. To date, no qualitative studies of adolescent maternal oral health exist. Therefore, the purpose of this descriptive, exploratory, concurrent, mixed-methods study was to explore oral health status, beliefs, and practices, and pregnancy and parenting outcomes in this population by triangulating both quantitative and qualitative data. A non-probability, convenience sample of 46 pregnant and parenting adolescents was recruited. Five questionnaires were administered and visual oral examinations were conducted. Twenty-four of these 46 participants also participated in the qualitative component of the study. Adolescents in this study were both pregnant (n = 20; 43.5%) and parenting (n = 26; 56.5%), and primarily of Hispanic decent (n = 38; 83%). Of the 20 adolescents who were pregnant, four had been told by a nurse or physician that they had a pregnancy complication(s). Among the parenting adolescents, the most common past pregnancy complications were self-reported as prematurity (n = 6; 35%) and high blood pressure (n = 3; 18%). Thirty-three (72%) participants reported ever having dental insurance. While 16 (35%) participants had seen a dentist in the past 6 months, another 15 (33%) did not recall their last dental visit. One adolescent reported never having been to a dentist. Associations among visual oral health status and selected contextual variables were non-significant, which may be attributed to the small sample size. However, moderate significant correlations were found between social connectedness and oral-health-related quality of life, as well as between visual oral health status and measures of self-reported dental health. For the qualitative component, six themes related to oral health value and well-being, oral health knowledge, practices, myths, and barriers to accessing oral health services emerged. Triangulation of the quantitative and qualitative data did not produce statistical significance; however, discrepancies were found between the overall objective, visual oral health status, and the subjective perception of oral health status, which supports the overall findings. Future research should focus on larger studies to further explore associations between social connectedness, oral-health-related quality of life, and objective and subjective measures of oral health status and behaviors. / text

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<p>A qualitative study was carried out to assess the role of traditional healers in oral health care in Kwa-Zulu Natal province, South Africa. The aim and objectives of the study were to assess the oral care knowledge and practices among traditional healers, to determine the extent to which traditional healers can diagnose oral conditions and how they could be used in the provision of primary health care and prevention of the spread of HIV infection. Another objective was to use the information collected to serve as a guide for collaborative oral disease prevention programme development.</p> <p><br /> Three categories of traditional healers were identified in the sample: Isangomas, Nyangas and Umthandezelis. The average age of the sample was 45 years and the majority was female. Most healers were in training for between eight months and ten years. All traditional healers reported seeing patients with oral diseases and 93% reported that they referred patients elsewhere for additional help. All healers treated their patients with natural remedies. Seventy three per cent of the sample reported that they treated patients with HIV/AIDS. Less than 30% of the sample knew that AIDS was caused by a virus and 47% reported being &lsquo / told&rsquo / by the ancestors whether an oral disease was HIV/AIDS.</p> <p><br /> In this study traditional healers were shown a series of ten photographs of common oral diseases and oral HIV lesions and asked to identify as many lesions as possible. Following basic training and education about the causes and diagnostic features of the lesions, 100% of traditional healers were then able to identify aphthous ulcers, 80% Kaposi's sarcoma and 73% could recognize cancer of the tongue. These results showed that given proper education, traditional healers could play an important role in early detection of not only the common oral diseases but also the oral manifestations of HIV/AIDS. In addition, most traditional healers are skilled in interpersonal relations and if provided with the correct information they could be very effective as AIDS councilors.</p> <p><br /> The traditional healers demonstrated good knowledge of the transmission, risk groups and prevention strategies for HIV/AIDS and they could serve as an important resource of information and should be incorporated in community based AIDS prevention and other programmes.</p>

The decline in dental caries in many industrialised countries has prompted a reassessment of preventive strategies for dental caries. Although methods to prevent dental caries are well established, few data exist on defining the most appropriate combination of preventive methods to be used for differing levels of dental caries. Texts that do outline preventive methods do not make recommendations on the dental caries conditions under which they should be used. The most popular approach is the identification of individuals or groups at high risk. This research aimed to formulate a basis for strategic approaches for the prevention of dental caries in children based on the distribution of dental caries in the population at different caries severity levels. The objectives were to analyse the shapes of distributions and patterns of distribution of caries both within child populations and in individuals at differing severity levels and factors, such as presence or absence of water fluoridation, associated with the distributions. Using Rose's concepts on preventive strategies, approaches to the prevention of caries were developed based on the analyses. The study was divided into three phases. First, both the incremental and distributive properties of dental caries were analysed using the longitudinal United States National Preventive Dentistry Demonstration Programme's data set. The results were subsequently tested using data from both the British Association for the Study of Community Dentistry's national programme in the United Kingdom and from a study carried out by the University of Wales and Walsall Health Authority. Secondly, the intra-oral distribution of caries, by tooth type and sites on the teeth, was analysed to provide the scientific basis for the identification of the differing components of a preventive package. The third phase developed the findings from the first two phases to form the basis for strategy component selection at differing levels of caries. Results indicate that standard relationships exist between the distribution of dental caries within populations and in individuals and that the risk of caries increments will affect the strategic approach. Knowing the DMF provides information on the prevalence and frequency distribution of caries, the variance, the teeth affected and the sites on the affected teeth that will be carious. There is a relationship between the mean caries score of a population and the prevalence of caries within a population which is independent of water fluoride levels. Furthermore, the distributive properties indicate that a small decrease in the risk for a whole population has a greater overall impact on total caries increment than a large decrease in high risk individuals. There is a hierarchy of susceptibility to caries within the mouth which is tooth and tooth site specific. The hierarchy is not linear, certain sites are grouped. This size of the grouping varies. At low levels of caries the groupings are smaller than at high levels of disease. A reduction in the attack intensity which benefited the groupings at higher levels of disease would lead to substantial savings in cavitated sites. The findings suggest that the adoption of a policy for prevention should be determined by the caries level within the child population and that the hierarchical development should affect the choice of components for any preventive strategy. At low levels of caries, only a relatively low percentage of people would benefit from a population based fissure sealant strategy, whilst at high disease levels substantial numbers of a given population will develop approximal lesions in those teeth which would be sealed. Fluoride reduces the overall attack intensity and is not site type specific in its action. Current shortfalls in knowledge relating to fluoride regimes prevent their impact from being modelled accurately.

Magister Public Health - MPH (Public Health) / The oral health programme in Lesotho aims to offer curative, preventive, promotive and rehabilitative oral health services. However, observations as well as annual reports suggest that oral health service utilization is poor, as most patients only attend dental clinics with advanced stages of decayed teeth which can only be extracted. The reasons for this very undesirable late utilization of oral health services have not been systematically explored and understood in Lesotho. This makes it difficult for health planners to find solutions for improving access, utilizations and responsiveness of oral health services.

This qualitative exploration takes place within the context of homelessness, oral health and health promotion. The idea for this work was associated with 'An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland', which identified homeless people as a priority group. This led to ‘Something to Smile About’ (STSA), a pilot oral health promotion intervention for homelessness sector practitioners and homeless clients. An evaluation of STSA, which was judged to have failed, highlighted the interplay between intervention design, and the two principal stakeholders: practitioners and homeless clients. The aim of the research was to explore the contextual and experiential elements of homelessness that influence homeless people’s engagement with health promotion. As the research progressed, these two factors were conceptualised as the public and private faces of homelessness. It became apparent that to fully understand the issues surrounding homeless people’s engagement, it would be necessary to explore the private, innermost elements of homelessness. Seventeen homelessness sector practitioners and 34 homeless people took part in a qualitative exploration, in order to examine the engagement process from the perspective of both stakeholders. It emerged that that the homelessness policy context, coupled with work environments and perceptions of clients, shaped practitioners’ interactions and thus influenced client engagement. Practitioners utilised a narrow ‘window of engagement opportunity’ within a wider framework of managing client health problems and preparation for engagement, engaging with clients, and finally, disengaging from clients. From the work with homeless people, a ‘journey’ through homelessness emerged, in the form of a trajectory from ‘deconstruction’ of pre-homeless identity, to ‘construction’ of a homeless identity, and finally, to ‘reconstruction’ of a post-homeless, ‘reclaimed’ life. Appropriate points for engagement on this trajectory were identified. The thesis ends with a set of recommendations to assist practitioners to engage their homeless clients, and from the client perspective, encourage and facilitate engagement with practitioners and health promotion services.

Objectives: The purpose of this study was to explore the level to which dental caries and socio-demographic factors impact the oral health-related quality of life (OHRQoL) in a sample of Amish children. Methods: This cross-sectional study was embedded within a pilot study of medical management of caries in the primary dentition using silver nitrate. Parents were asked to complete a baseline questionnaire which included questions regarding socio-demographics and an OHRQoL questionnaire- a 16-item Parent Perception Questionnaire (PPQ). Parents were also asked to make a global rating of their child’s oral health status and its impact on the child’s overall wellbeing. Oral examinations were completed by two previously trained and calibrated dentists for the assessment of dental caries experience. Descriptive and bivariate analyses were performed including the Spearman Correlation and Wilcoxon rank sum test. Multivariable linear modeling was used to model the covariate effects on OHRQoL. Results: 77 children were analyzed. OHRQoL was negatively impacted by caries as per the Oral Domain of the PPQ (p < .02) and the global oral health status rating (p < 0.0001). There was no significant difference between males and females in the OHRQoL outcome measures (p > 0.05). The effect of income on OHRQoL was tenuous as the results were inconsistent. Conclusions: According to parents’ perceptions, a higher caries experience was associated with a poorer oral health status rating and had a negative impact on oral symptoms as they related to the OHRQoL of the children. Finally, there may be cultural differences regarding the value and/or expectations of oral health.

Magister Chirurgiae Dentium (MChD) / Hearing impairment contributes significantly to the global burden of disabilities and has reported to be a prevalent disability in South Africa. The hearing impaired population has been associated with low levels of oral health due to numerous factors concomitant with reduced oral health care and knowledge. This predisposes these persons to oral disease including periodontal disease. Aim: To determine the prevalence of periodontal disease and the associated factors in adults with hearing impairment in designated facilities in the Western Cape, South Africa. Objectives: 1. To determine the oral health care practices in adults with hearing impairment. 2. To determine oral health knowledge of adults with hearing impairment. 3. To determine the frequency of dental visits of adults with hearing impairment and identify any associated barriers. 4. To determine the prevalence of periodontal disease in adults with hearing impairment in designated facilities in the Western Cape, South Africa. 5. To determine the relationship between the prevalence of periodontal disease and associated factors including; sociodemographic factors, oral health care practices, oral health knowledge and frequency of dental visits in adults with hearing impairment. Methodology: A quantitative, analytical cross-sectional study design was employed. A research questionnaire was used to evaluate oral health care practices, oral health knowledge, frequency of dental visits and related barriers to access oral health care. An intra-oral examination was conducted to determine the plaque index (PI), gingival index (GI) and clinical attachment loss (CAL) using the Ramjford six teeth. Data was analysed in Microsoft Excel and StataCorp using frequencies, means, standard deviations, confidence intervals, Chi-square and Fishers exact tests. Results: The prevalence of gingivitis was 100% and the prevalence of periodontitis was 26.09% amongst hearing impaired adults. The mean gingival index score (GI) was 1.24 (STD±0.49; 95% CI: 1.14-1.35) and the mean plaque index score (PI) was 1.3 (STD±0.5; 95% CI: 1.2-1.4). Periodontitis prevalence was established for those participants presenting with an average clinical attachment loss (CAL) of >3mm and the mean clinical attachment loss was 4.47mm (STD ±1.41; 95% CI: 4.18-4.76mm) for those presenting with evidence of periodontitis. Age was statistically significant (p<0.05). Prevalence of periodontitis was evident amongst participants over the age of 35 years with a mean age of 48years (STD±13). Oral health care showed a lack of the use of dental floss and regular dental visits. Access to dental care was compromised primarily due to communication barriers, dental fear and a low priority of oral health. Conclusion: The necessity of oral health care and oral health knowledge in hearing impaired adults such as education and motivation for the need of dental flossing, the use of fluoridated toothpastes and the benefits of regular dental visits, must be emphasized. Oral health care workers should strive to intensify efforts to facilitate a favourable periodontal health status amongst hearing impaired adults.