Objectives: To determine access to dental care among preschool children of Arabic-speaking immigrant families; to investigate the influence of social and cultural factors on access to dental care; and to measure preschool children’s oral health as reported by their parents. Methods: This survey used a semi-structured questionnaire to interview 100 Arabic-speaking parents of children under the age of 5 who were identified from community centres. Five scales were used to measure acculturation, social capital, oral health literacy, oral health knowledge, and health literacy. Results: Only 34% of families had visited the dentist to obtain dental care for their preschool children. Nineteen-percent of Arabic parents in our sample rated their children’s oral health as being fair or poor. None of the scales used in this study had a significant impact on access to dental care; however, higher scores on these scales tended to be associated with better access to dental care.

Objectives: To determine access to dental care among preschool children of Arabic-speaking immigrant families; to investigate the influence of social and cultural factors on access to dental care; and to measure preschool children’s oral health as reported by their parents. Methods: This survey used a semi-structured questionnaire to interview 100 Arabic-speaking parents of children under the age of 5 who were identified from community centres. Five scales were used to measure acculturation, social capital, oral health literacy, oral health knowledge, and health literacy. Results: Only 34% of families had visited the dentist to obtain dental care for their preschool children. Nineteen-percent of Arabic parents in our sample rated their children’s oral health as being fair or poor. None of the scales used in this study had a significant impact on access to dental care; however, higher scores on these scales tended to be associated with better access to dental care.

Oral health plays an integral role in our general health, wellbeing, and quality of life. Practicing evidence-based oral hygiene behaviors prevent oral diseases and improve systemic health. The burden of preventable oral diseases persists worldwide and weighs particularly heavy on specific population groups. While many studies have explored oral health among those of advanced age, children, and minority groups, there are a very few exploring the oral health care needs of postsecondary students, specifically those born outside of the United States (U.S.). Recognizing this gap in the literature, this study sought to gain a better understanding of oral health access among non-US born postsecondary students with a goal of identifying factors affecting their oral health behaviors. To achieve the objectives of this explorative study, a cross-sectional study design was implemented. A 30-question survey was provided to individuals born outside the U.S. and currently enrolled in postsecondary educational institutions. Descriptive statistics was presented, and a quantitative analysis was performed. The study results suggest that foreign-born postsecondary students may perceive oral health care in the U.S as inaccessible due to economic barriers such as costs and lack of insurance. Moreover, it was found that this population is less likely to visit a dentist because they cannot find a "convenient time" or because they believed their "mouth is healthy". Factors associated with perceived improvements in oral hygiene behaviors included enrollment in postsecondary education and the number of years they've resided in the U.S. Conversely, factors associated with a decline in perceived oral hygiene behaviors included school-induced stress and acculturative stress. It was also found that on-campus dental clinics were less frequently utilized than off-campus dental clinics, with many preferring to receive oral health care outside of the U.S. Citizenship status was also found to be a factor influencing student's oral health seeking behaviors.

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Aim: The aim of this project was to find the level of oral health literacy of parents of preschool age children regarding their child’s oral health. The primary objective was to improve the oral health status of preschoolers and to prevent early childhood caries. Methods: 117 participants (parents of preschoolers) completed a self-administered oral health literacy questionnaire. Data obtained from the study was analysed using a statistical package (SPSS). Firstly, descriptive analysis was undertaken generating tables and graphs of sociodemographic variables. Later, associations between oral health literacy and sociodemographic variables were identified and also relation between parents’ oral health literacy and their attitude towards water fluoridation in Christchurch was identified using bivariate and multivariate analysis. Psychometric analysis was generated to test validity and reliability of the oral health literacy questionnaire. Results: In the total sample, 38% of participants had poor oral health literacy regarding their child’s oral health. The results also indicated that there were associations present between parents’ oral health literacy and socio-demographic variables such as ethnicity, education and family income. Nearly half of the parents opted for water fluoridation in Christchurch. A strong association between parents’ oral health literacy and their attitude towards water fluoridation was identified. In the total sample, 40% of parents were not aware of need for first dental visit before the school age. Reliability was good for the developed oral health literacy instrument. Conclusions: This study of parents’ oral health literacy in Christchurch, New Zealand identified association of oral health literacy and socio-demographic variables which gives future guidance to improving oral health status of New Zealand children. The relation 6 between parents’ oral health literacy and their attitude towards water fluoridation was shown in this study. This result might be used in future water fluoridation surveys. Future studies are needed to examine health care provider’s perspective in improving parents’ oral health literacy and to tailor more effective public health interventions to improve parents’ oral health literacy.

Objectives: To determine oral health literacy levels among Hispanic adults living in Iowa, and assess the relationship between oral health literacy and dental utilization. Methods: This cross-sectional study included a convenience sample of self-identifying Hispanic/Latino adults. Participants were recruited via mass email, word of mouth, and from faith-based organizations that provided church services in Spanish. Participants were recruited from urban and rural communities in Central and Eastern Iowa. Participants were asked to complete a questionnaire, in either English or Spanish, that contained questions pertaining to: oral health literacy, dental utilization, acculturation, language proficiency, demographic information, country of origin, number of years living in the United States, and preferences pertaining to the characteristics of their dental providers (e.g. importance of dentist to be able to speak Spanish). Oral health literacy was assessed using the Comprehensive Measure of Oral Health Knowledge (Macek and colleagues). Oral health knowledge levels were categorized as low (0-14) or high (15-23). Dental utilization was defined as visiting a dental provider within the past 12 months or more than 12 months ago. Bivariate analyses were conducted using the Chi-square test with oral health knowledge and dental utilization being the two main outcome variables. Multiple logistic regression models were created to identify the variables related to low oral health knowledge irregular dental utilization. Statistical significance was set as p<0.05. IRB approval was obtained prior to conducting the study. Results: Three hundred thirty-eight participants completed the questionnaire. Sixty-seven percent of participants (n=228) completed the questionnaire in Spanish. The mean oral health knowledge score was 14 (low knowledge =51% vs. high knowledge = 49%). Thirty-five percent reported visiting the dentist <12 months ago. Bivariate analyses revealed that the following respondents were more likely to have low oral health knowledge (p<0.05): being older (i.e. 55-71 years of age), male, self-reporting low health literacy, having less than a high-school education, earning ≤$25,000, not having dental insurance, having low acculturation, being born outside of the United States, preferring a dental provider who speaks Spanish, perceiving one’s oral health to be fair/poor/or not knowing the status of one’s oral health, seeking dental care someplace other than a private dental office, and being more likely to seek care for a problem related visit rather than routine care. Having low oral health knowledge was statistically significantly associated visiting a dentist >12 months ago. Many other variables were also associated (p<;0.05) with infrequent dental utilization: low health literacy, being male, having <12th grade degree or a high school diploma, earning ≤$25,000, not having dental insurance, having low acculturation, reporting fewer years living in the United States, preferring a dental provider who speaks Spanish, perceiving one’s oral health to be fair/poor/or not knowing the status of one’s oral health, and seeking dental care someplace other than a private dental office. Final logistic regression analyses indicated that having less than a 12th grade education, lack of dental insurance, and a preference for receiving care from a Spanish speaking dental provider were associated with low oral health literacy. Furthermore, final logistic regression results predicting irregular dental utilization demonstrated that the following variables were statistically significant: being male, earning ≤$25,000 per year, not having dental insurance and having a history of tooth decay. Conclusion: Dental utilization and oral health knowledge appear to be associated. Patients with low oral health literacy may be less likely to utilize dental care, thus decreasing the opportunity to increase dental knowledge. Dental teams should recognize which patients are more likely to have low oral health literacy and provide dental education in patients’ preferred language.

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.

Low or marginal health literacy affect nearly 90 million citizens in the United States, compromising health outcomes, including oral health. Oral health literacy has been studied in diverse populations, yet the assessments used were developed and validated for English-speaking populations. A validated Spanish-language oral health literacy assessment was needed to help researchers and practitioners evaluate oral health literacy in the Hispanic population. Using the oral health literacy framework, the purpose of this study was to translate, culturally adapt, and validate a Spanish version of a previously validated English-language oral health literacy. A translation-back-translation process was applied to the English version of the REALD-30. Face and content validity were established using a panel of dental and health literacy experts. The Spanish version was field tested among Spanish-speaking community health center patients (N=114), and included a random subsample (N=11) to check for test-retest reliability. The results showed that the Spanish REALD-30 has a good internal reliability (=r=.687) and an acceptable convergent reliability (r =.857), when assessing health literacy against the SAHLSA-50. This study's implications for positive social change include providing the dental profession and research community with an assessment tool for oral health literacy. This tool may allow oral health professionals to understand the dynamics and challenges among Hispanics regarding oral health literacy, while the study fills an existing gap in scholarly literature.

This study sought to identify the level of oral health literacy held by people who live in transitional and distressed Kentucky Appalachian areas and if this effects how often they are using oral hygiene techniques. Data were also collected to describe the attitudes Kentucky Appalachian adults hold toward oral hygiene and oral health status. Current documentation shows that poor oral health remains a public health threat in this population despite efforts such as school-based sealant programs and increased dental insurance coverage. This study followed a quantitative design and 99 participants were polled using a survey specifically developed for this study's use. Composite median scores and Spearman's correlation values established the existence of a low oral health literacy level across the participant pool, an also documented that oral hygiene techniques are not used in frequencies recommended for proper oral health. A poor self-efficacy towards the ability to utilize these techniques properly was also identified. Using the Mann-Whitney U test, responses were compared based on county designation and few significant differences were found. These findings show that oral health status and related beliefs are similar across the region and not just isolated to the economically poorest areas as the currently available literature suggests. Applying the health belief model it is predicted that Kentucky Appalachians are unlikely to adopt proper oral hygiene habits until their self-efficacy is improved. A recommendation of this study is that public health officials should promote personal control when designing public health programs geared towards improving the oral health status of this population. To do so would introduce a positive social change in that people with good oral health are less likely to experience the pain, malnutrition, and negative social stigma that is associated with poor oral health.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Goal and Objectives. The main goal of this study is to assess childcare center directors (CCCDs) oral health literacy, knowledge, and attitudes towards pediatric oral health. We also determined the associations between CCCDs oral health literacy, knowledge, attitudes towards pediatric oral health, and 1) number of oral health preventive strategies (OHPS) implemented in their child care center (CCC), and 2) intent to adopt OHPS in the future. Background. Childcare utilization has substantially increased over the past decade with children enrolled in these centers spending substantial amount of time. CCCs, a non-traditional setting, can be used to actively promote pediatric oral health. However, before this setting can be used to promote oral health, a better understanding of Florida CCCDs' oral health literacy, knowledge, and attitudes on pediatric oral health is needed. Methods. In this cross-sectional study we used a 45-item pre-tested questionnaire to survey Florida CCCDs working primarily in licensed CCCs through survey monkey online portal. Descriptive, bivariate statistics and multivariate regression analyses were conducted using SAS analysis software. Results. Of the 877 CCCD participants, 90% did not train staff about traumatic dental injuries, 87% did not have an oral health consultant, and 82% did not promote enrollees to brush their teeth after meals or snacks. Mean oral health literacy (12.3±2.3) and attitude levels (16.8±2.7) were high, however mean oral health knowledge (1.6±2.0) was low. CCCDs with more years of experience (p=0.01), who work at Head Start CCCs ( p<0.0001), and have more positive attitudes (p<0.0001), were more likely to have implemented OHPS in their centers compared to their counterparts. Non-White CCCDs (p=0.03), those with more positive attitudes(p=0.001), and who reported to have already implemented one or more OHPS (p=0.002) were more willing to implement OHPS in the future compared to their counterparts. Conclusions. No significant associations between oral health literacy, knowledge and number of OHPS implemented were observed. Similarly, oral health literacy, oral health knowledge was not associated with intent to implement OHPS in the future. CCCDs with more positive attitudes towards pediatric oral health had implemented more OHPS within their CCCs, and also were willing to implement more OHPS in the future compared to their counterparts.