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Philosophiae Doctor - PhD / Oral diseases are a major public health problem in the Seychelles, amidst a contracting budget coupled by a lack of national oral health policy and strategic plan to promote oral health. The oral disease burden is attributed to numerous determinants operating at different levels –macro, population and community, and at the person level. The study set out to examine the determinants that contribute to poor oral health in the Seychelles through an exploration of the social, cultural, economic and environmental factors influencing the oral health of adults. The purpose of the study was to develop an evidence-based theoretical framework that would inform future policy and practice for oral health. Set in the mixed research paradigm, a qualitative and quantitative research approach was used to obtain a deeper understanding of the pathways and mechanisms operationalizing determinants. Using a purposive sampling approach, individual and group interviews were conducted with patients, dental staff and a representative of the upper management.

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

When adolescents forgo oral health treatment, factors that hinder them from obtaining these services put them at risk of detrimental consequences in their oral and overall health. The purpose of this qualitative phenomenological study was to identify the various barriers that adolescents encounter causing them to defer oral treatment. Through this study, public health officials, school health care providers, the state, and parents could be made aware of these factors and work together to implement programs and supplemental aid to help adolescents become more knowledgeable of the importance of oral care and encourage them to desire and seek treatment. The oral health and behavioral conceptual models provided foundations for the development of the research questions, and they highlighted the selection of risk factors on the deferment process. Twenty adolescents who had oral health treatment/services in the past 12 months participated in the study. Interviews were transcribed verbatim and analyzed thematically. The results of this study show that oral health beliefs, as well as personal, behavioral, and environmental factors, shaped adolescents' decision to forgo oral health treatment. Financial barriers, dental fear, and transportation obstructed their capacity to seek care for themselves. The positive social change implications of this study include increasing the proportion of adolescents receiving oral health treatment yearly through the development of targeted interventions (such as school programs) that are designed to increase the adolescents' access to and use of dental care services. Such efforts would support the strategies implemented to achieve Healthy People 2020 objectives.

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