Untreated Dental Caries Complications, Oral Health-Related Quality of Life, and Dental Service Utilization among Inmates in Southern Thailand

Untreated Dental Caries Complications, Oral Health-Related Quality of Life, and Dental Service Utilization among Inmates in Southern Thailand | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Untreated Dental Caries Complications, Oral Health-Related Quality of Life, and Dental Service Utilization among Inmates in Southern Thailand Manop Phongayukull, Narumanas Korwanich, Kanyarat Korwanich This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9253364/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Inmates are recognized as a vulnerable population with limited access to healthcare and generally poorer oral health than the wider community, warranting focused investigation. This study, conducted at Takuapa District Prison, Thailand, aimed to assess oral health status and oral health-related quality of life (OHRQoL) among inmates and to examine factors associated with dental service utilization. Methods A total of 535 inmates underwent oral examinations and completed questionnaires on oral health behaviors, of whom 418 also completed the Oral Impacts on Daily Performance (OIDP) index to assess OHRQoL. Data were analyzed using descriptive statistics and logistic regression analysis. Results Dental caries was present in 94.6% of inmates, with a mean DMFT score of 10.05 ± 7.23. Untreated caries affected 90.5% of participants (mean DT = 6.22 ± 5.50), while 58.9% presented with complications of untreated caries, with a mean PUFA score of 2.41 ± 3.61. Five inmates were edentulous, and among dentate inmates, 63.6% had periodontitis (CPI scores 3–4). Overall, 50.7% of inmates reported impaired OHRQoL, as assessed using the OIDP index, which was significantly associated with complications of untreated caries (PUFA). In addition, 48.6% of inmates reported access to dental services, which was also significantly associated with impaired OHRQoL. Conclusion Despite a high overall burden of oral disease among inmates at Takuapa District Prison, untreated caries complications were the only oral condition significantly associated with OHRQoL, which in turn influenced dental service utilization within the prison setting. Inmates oral health status oral health-related quality of life. Introduction/Objective Oral health is an integral component of general health and quality of life, yet it is often overlooked in marginalized populations, particularly those who are incarcerated. Prisoners experience a disproportionately high burden of oral diseases, including dental caries, periodontal disease, tooth loss, and oral lesions, compared to the general population. 1 – 3 These conditions not only affect their masticatory function and speech but also impact self-esteem, mental health, and reintegration into society following incarceration. 4 , 5 Incarcerated populations experience distinct and complex oral health needs shaped by structural and social determinants, including socioeconomic disadvantage, limited health literacy, and a high prevalence of substance use and mental health conditions. 6 Studies across various countries including Finland, 7 India, 8 United Kingdom, 9 and Brazil 10 consistently demonstrate high DMFT scores and poor periodontal status among prisoners. This substantial disease burden reflects both pre-existing behavioral risk exposures such as tobacco use alcohol consumption and illicit drug use that often precede imprisonment, 5 and systemic constraints within prison settings including limited access to preventive and curative oral health services overcrowding and under-resourced prison healthcare systems. 11 , 12 The World Health Organization has identified oral health in prison settings as a pressing public health issue requiring integration into broader prison healthcare strategies. However, many correctional facilities worldwide continue to lack dedicated dental personnel, routine dental care, and oral health promotion programmes. 12 Since 2019, Thailand has implemented the nationwide “Good Health Good Heart” project, identifying oral health as a public health priority and improving prisoners’ access to dental care. 13 Within this framework, all prisons across Thailand was provided more intensive health care including dental services aiming better quality of life of prisoner population. 14 There is a growing recognition of oral health-related quality of life (OHRQoL) as an important outcome measure in correctional health research. Poor oral health has been shown to substantially reduce OHRQoL, particularly in domains such as physical pain, psychological discomfort, and social disability. 3 , 5 Despite this, few studies adopt a multidimensional approach when evaluating oral health programs in prisons, with most research remaining focused solely on clinical indices. Understanding both the clinical status of oral health and its impact on quality of life is therefore essential for identifying the needs of this population and for guiding targeted, sustainable improvements in care provision. 15 This study aimed to assess the oral health status, oral health behaviors, OHRQoL, and to analyze the factors associated with OHRQoL and dental service utilization among inmates. The findings are expected to enhance the evidence for prisoners’ oral healthcare planning and support public health strategies targeting underserved populations. Material and Methods Clinical oral examinations were conducted by a dentist using standard forms to collect data on dental caries (DMFT index), 16 untreated caries with complications using the PUFA index which is a new measure that evaluates the prevalence and severity of oral conditions resulting from untreated dental caries by recording the number of teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f), and abscess (A/a), 17 as well as periodontal status (CPI), 16 the presence of dentures, and other oral conditions such as tooth gems. Structured questionnaires used in the study were derived from The 8th Thailand National Oral Health Survey. 18 Demographic data, criminal offences, oral health behaviors, and retrospective self-reported dental service utilization of any dental treatment within the prison. The Oral Impacts on Daily Performance (OIDP) questionnaire was used to assessed OHRQoL. 15 Trained dental nurses and dentists conducted the interviews and examinations following standardized protocols. Setting and Design This cross-sectional study was conducted at Takuapa District Prison, Thailand, a small correctional facility housing male and female inmates serving sentences of up to 10 years. The study was approved by the prison authorities, and all data collection procedures were carried out under the supervision and security regulations of prison staff. Population, Sample, and Sampling Method All 621 inmates residing in Takuapa District Prison between April and June 2023 were included in the study. The initial sample consisted of 535 inmates (498 males and 37 females) who met the inclusion criteria of being convicted, present during data collection, and willing to participate. In the first stage, oral examinations were conducted to collect clinical data. In the second stage (October 2023), 418 inmates (391 males and 27 females) were interviewed to assess OHRQoL. A total of 418 inmates completed both stages of data collection. Data Collection Data collection was conducted between April and June 2023. Demographic characteristics and oral health–related behaviors were collected using structured questionnaires adapted from the 2017 Thailand National Oral Health Survey, administered by a trained dental nurse. Clinical oral examinations were performed by a calibrated dentist using a mobile dental unit, mouth mirror, and WHO probe under dental light. Examiner reliability was acceptable, with agreement rates of 86.05% for dental caries and 83.72% for periodontal status, and kappa coefficients of 0.85 and 0.71, respectively. OIDP interviews were subsequently conducted in October 2023 using a standardized eight-item questionnaire assessing oral impacts on daily performance over the preceding six months. Interviews were administered and recorded by the same dentist. Formal permission was obtained from prison authorities, and data collection was facilitated by prison health volunteers. Data analysis Data were double-entered for accuracy prior to analysis. Statistical analyses were performed using SPSS version 31. Descriptive statistics were used to summarize the study findings. Exploratory bivariate analyses were conducted using the chi-square test to examine unadjusted associations between categorical variables. Inferential analysis was subsequently performed using binary logistic regression to assess adjusted associations between variables. Due to missing data in some variables, logistic regression analyses were conducted using listwise deletion, as the default option in SPSS. Consequently, only cases with complete data across all variables included in the model were analyzed, resulting in a reduced sample size of 418 participants. Statistical significance was set at p < 0.05. Results The study included 535 inmates housed at Takuapa District Prison between April and June 2023. Demographic characteristics and criminal offence profile presented in Table 1. A high burden of dental caries, untreated caries complications, and periodontal disease was observed among the inmates, as shown in Table 2. Additionally, 122 inmates were found to have at least one impacted third molar, and tooth gems were identified in 33 male inmates. Twelve inmates possessed removable acrylic dentures, which most of them were poorly maintained, showing issues such as looseness, fractures, and discoloration. Regarding substance use, the majority of inmates reported a history of smoking (90.8%), illicit drug use (90.1%), and alcohol consumption (65.2%) prior to incarceration. Most inmates reported brushing their teeth twice daily, once in the morning and again before returning to their living units (around 4:00 pm). Nearly half of participants had utilized dental services during incarceration in the preceding year, as detailed in Table 3. OHRQoL was assessed among 418 inmates using the OIDP questionnaire. More than half of respondents reported at least one oral health–related impact, as shown in Table 4 Untreated caries complications (PUFA ≥ 1) was the only factor significantly associated with impaired oral health–related quality of life (OIDP > 0) among inmates as shown in Table 5. The presence of missing teeth (MT ≥ 1) and impaired oral health–related quality of life (OIDP > 0) was associated with higher service utilization, whereas untreated caries complications (PUFA ≥ 1) and periodontitis (CPI > 2) were associated with lower utilization, as shown in Table 6. Discussions Globally, dental caries and untreated oral diseases in prisoners remain a major public health concern. The mean number of untreated dental caries varies across populations, was reported as 5 ± 5.1 teeth per person in Finland, 7 2.6 ± 2.9 in India, 8 2.47 ± 2.52 in the United Kingdom, 9 and 11.06 ± 5.37 in Brazil. 10 Against this global backdrop, inmates of this study exhibited a mean of 6.22 ± 5.50 untreated teeth per person, which is higher than in Finland, India, and the United Kingdom, but lower than in Brazil. The prevalence of PUFA among these inmates was 59.8% in males and 45.9% in females, exceeding the 40% reported among female inmates in the United Kingdom 9 . Moreover, periodontitis with attachment loss and the presence of periodontal pockets was observed in 63.6% of the Takuapa inmates, compared with 32.6% of the working-age population in Thailand. 19 Correspondingly, findings from this study indicate a substantial burden of dental diseases among inmates, consistent with international reports. A report by CareQuest Institute for Oral Health highlighted that incarcerated individuals exhibit higher rates of dental diseases compared with the general population, and access to dental care in correctional facilities is often restricted due to limited resources and strict treatment policies. 2 This mismatch between high disease burden and limited service utilization underscores the need for a conceptual framework to interpret patterns of dental care use in prison settings. From a theoretical perspective, health service utilization depends on the interaction between predisposing characteristics, enabling resources, and both perceived and evaluated need for care. 14 In prison contexts, where enabling resources are structurally constrained, perceived need, particularly when oral conditions interfere with daily functioning, may play a decisive role in shaping dental service utilization. Since the introduction of the “Good Health Good Heart ” program in 2019, Thailand has sought to improve healthcare access for incarcerated populations, including dental services. Under this policy, a dental clinic was established within Takuapa prison to deliver basic dental care, with services provided by Takuapa Hospital on a scheduled basis twice monthly. Care primarily focuses on basic treatments, including extractions, scaling, restorations, and the management of acute dental conditions, while more complex procedures, such as surgical removal of impacted teeth, require referral to hospital-based care. Despite improved access, service delivery remains constrained by workforce limitations and unclear budgetary allocation. Consequently, preventive and comprehensive restorative care remains insufficient, and reliance on external referral may have influenced oral health outcomes, including oral health status, OHRQoL, and dental service utilization patterns observed in this study. This study assessed inmates’ OHRQoL using the OIDP interview. Oral health was therefore conceptualized within a biopsychosocial framework. 20 The present study found that only untreated caries complication was significantly associated with impaired OHRQoL. In contrast, studies conducted among prison populations in South Korea and India have reported significant associations between oral health status and OHRQoL, particularly dental caries and periodontal disease. 21 , 22 Although evidence on the association between PUFA and OIDP among incarcerated populations remains limited, several studies in pediatric populations have consistently demonstrated that untreated caries complications, as measured by the PUFA/pufa index, are significantly associated with poorer oral health-related quality of life. 23 , 24 The present study found that inmates who reported impaired OHRQoL were significantly more likely to utilize dental services during incarceration. This finding aligns with previous literature suggesting that individuals are more likely to seek dental care when they perceive functional, psychological, or social impacts from oral conditions rather than relying solely on clinical signs of disease. 25 It also underscores the importance of subjective health perceptions in driving care-seeking behavior especially in the environment that prisoners seek health care utilization by voluntary basis like this study. 26 The positive association between missing teeth and dental service utilization, alongside the negative association with periodontal disease, should be interpreted with caution given the cross-sectional design. These findings likely reflect service delivery practices based on voluntary self-referral, where tooth extraction is the most accessible treatment, while periodontal care remains limited. Consistent with previous studies, high DMFT scores in incarcerated populations are largely driven by missing teeth, indicating a reliance on extractions rather than comprehensive care. 27 Consequently, missing teeth may represent not only pre-existing oral disease but also the outcomes of dental care received during incarceration. Because of limitations of cross-sectional design of this study, the association between untreated caries complications and lower dental service utilization can be interpreted in two ways. First, it may indicate that the presence of advanced disease alone is insufficient to prompt care-seeking, consistent with evidence that prison dental care is largely symptom-driven and constrained by systemic barriers. 28 – 31 Alternatively, this finding may reflect the nature of the PUFA index, which captures the cumulative consequences of prolonged non-utilization of dental services rather than acting as an immediate trigger for care-seeking. 17 This population-based study included all inmates during the study period, enhancing the comprehensiveness and representativeness of the findings. However, some health behaviors were self-reported and may be subject to recall bias. In the context of Takuapa District Prison, characterized by short-term incarceration and high inmate turnover, oral health services should prioritize interventions that are feasible within limited detention periods. Routine OIDP screening is recommended to identify inmates whose oral conditions substantially impair daily functioning and warrant timely care. Preventive efforts should focus on supporting self-care and can be sustained following release. The higher utilization observed among inmates with missing teeth may indicate an unmet need for functional oral rehabilitation. Accordingly, service planning should consider expanding access to basic prosthodontic care, such as removable dentures. Strengthening post-release referral pathways within the district health system may further support continuity of oral healthcare in the community. To more effectively address the complex oral health needs of incarcerated populations, an integrated approach is required, combining clinical care, behavioral interventions, and policy-level strategies. Further research is warranted to examine broader physical, social, and cultural contexts influencing oral health behaviors and dental service utilization. A clearer understanding of these determinants is essential for developing more responsive and comprehensive oral healthcare systems in prison settings. Conclusion These findings highlight that clinical disease status alone may not fully reflect the lived impact of oral health problems in this vulnerable population. Integrating OHRQoL measures alongside clinical assessment can enhance understanding of inmates’ daily functioning and support more responsive and equitable prison oral health service planning. Further research should explore environmental, social, and cultural contexts to inform the development of appropriate and sustainable prison oral health systems. Abbreviations CI, Confidence Interval; CPI, Community Periodontal Index; DMFT, Decayed, Missing, and Filled Teeth; OIDP, Oral Impacts on Daily Performance; OHRQoL, Oral Health-Related Quality of Life; aOR, Adjusted Odds Ratio; PUFA, Pulpal involvement, Ulceration, Fistula, and Abscess index. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Human Research Ethics Committee, Faculty of Dentistry, Chiang Mai University (No. 13/2566; 23 February 2023). All participants provided written informed consent prior to enrolment. Participation was voluntary, and refusal or withdrawal did not affect access to dental services within the prison. Confidentiality was strictly maintained, and findings are reported in aggregate form without personal identifiers. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study contain sensitive personal information relating to incarcerated individuals and are not publicly available due to ethical and privacy restrictions. De-identified data may be available from the corresponding author upon reasonable request and with approval from the relevant ethics committee. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Faculty of Dentistry, Chiang Mai University. The funding body had no role in the design of the study; collection, analysis, and interpretation of data; or in writing the manuscript. Authors’ contributions MP contributed to the conceptualization and design of the study, methodology, data collection, data analysis, statistical analysis, data interpretation, and drafted the manuscript. NK and KK contributed to the conceptualization and design of the study, data analysis, statistical analysis, and critically revised the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors thank the staff of Takuapa Hospital for their assistance with field data collection and the staff of Takuapa District Prison for facilitating the study and ensuring safety during data collection. 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Inmate’s Data Male ( N=498 ) Female ( N=37 ) Total ( N=535 ) Age (years old) 35.16 + 9.38 36.38 + 8.34 35.25 + 9.31 Religion - Buddhist - Muslim - Christian 378 (75.9%) 119 (23.9%) 1 (0.2%) 26 (70.3%) 11 (29.7%) 0 404 (75.5%) 130 (24.3%) 1 (0.2%) Occupation prior to imprisonment - Civil servant / government employee - Private sector employee / worker - Farmer - Student - Home maker - Own business - Casual labourer - Others - Unemployed 5 (1.0%) 16 (3.2%) 174 (35.0%) 8 (1.6%) 3 (0.6%) 56 (11.2%) 217 (43.6%) 10 (2.0%) 9 (1.8%) 0 4 (10.9%) 3 (8.1%) 0 6 (16.2%) 12 (32.4%) 12 (32.4%) 0 0 5 (1.0%) 20 (3.8%) 177 (33.1%) 8 (1.5%) 9 (1.6%) 68 (12.7%) 229 (42.8%) 10 (1.9%) 9 (1.6%) Highest level of education - No formal education - Primary school - Junior high school - High school / Vocational certificate - Diploma / Higher vocational certificate - Bachelor’s degree or higher 2 (0.4%) 234 (47.0%) 181 (36.3%) 64 (12.9%) 14 (2.8%) 3 (0.6%) 0 9 (24.3%) 14 (37.9%) 6 (16.2%) 5 (13.5%) 3 (8.1%) 2 (0.4%) 243 (45.4%) 195 (36.5%) 73 (13.6%) 16 (3.0%) 5 (1.1%) Type of offence - Drug / solvent-related offense - Property offence - Homicide-related offence - Bodily harm offence - Sexual offence - Other offence (e.g., Firearms Act ) 372 (74.7%) 67 (13.5%) 25 (5.0%) 11 (2.2%) 3 (0.6%) 20 (4.0%) 25 (67.6%) 8 (21.6%) 3 (8.1%) 0 0 1 (2.7%) 397 (74.2%) 75 (14.0%) 28 (5.2%) 11 (2.1%) 3 (0.6%) 21 (3.9%) Inmate class - Excellent - Very good - Good - Fair - Poor - Very poor 80 (16.0%) 74 (14.9%) 89 (17.9%) 137 (27.5%) 71 (14.3%) 47 (9.4%) 8 (21.6%) 2 (5.4%) 4 (10.8%) 15 (40.6%) 6 (16.2%) 2 (5.4%) 88 (16.4%) 76 (14.2%) 93 (17.4%) 152 (28.4%) 77 (14.4%) 49 (9.2%) Duration of incarceration - Up to 18 months - 18 months or more 247 (49.6%) 251 (50.4%) 21 (56.8%) 16 (43.2%) 268 (50.1%) 267 (49.9%) Table 2 Oral health status of inmates. Caries experience Male (N=498) Female (N=37) Total (N=535) Caries Prevalence 94.8 % 91.9 % 94.6 % DMFT index Mean + SD Mean + SD Mean + SD Med (Q1,Q3) DMFT 10.03 + 7.24 10.22 + 7.19 10.05 + 7.23 8 (4,15) DT 6.28 + 5.51 5.43 + 5.37 6.22 + 5.50 5 (2,9) MT 2.90 + 3.67 3.68 + 3.74 2.96 + 3.68 2 (0,4) FT 0.85 + 1.97 1.11 + 2.39 0.87 + 2.00 0 (0,1) Untre ated caries complication PUFA index Male (N=498) Female (N=37) Total (N=535) n (%) n (%) n (%) Mean + SD Med (Q1,Q3) PUFA 298 (59.8%) 17 (45.9%) 315 (58.9%) 2.41 + 3.61 1 (0,3) P 295 (59.2%) 16 (43.2%) 311 (58.1%) 2.39 + 3.60 1 (0,3) U 0 0 0 0 0 F 12 (2.4%) 1 (2.7%) 13 (2.4%) 0.03 + 0.19 0 (0,0) A 2 (0.4%) 0 (0.0%) 2 (0.4%) 0.00 + 0.06 0 (0,0) Periodontal status CPI Male (N=493) Female (N=37) Total (N=530) n (%) n (%) n (%) 1 0 0 0 2 180 (36.5%) 13 (35.1%) 193 (36.4%) 3 222 (45.0%) 23 (62.2%) 245 (46.2%) 4 91 (18.5.%) 1 (2.7%) 92 (17.4%) Note: Data are presented as mean ± SD and median (Q1, Q3). Median values are shown due to non-normal distribution. The total number for periodontal status differs, as five male inmates were edentulous. Table 3 Oral hygiene habits and OHRQoL problem among inmates. Oral hygiene habits Male (N=498) Female (N=37) Total (N=535) Oral hygiene aids - has both toothbrush and toothpaste - has either toothbrush or toothpaste only - has neither toothbrush and toothpaste 488 (98.0%) 8 (1.6%) 2 (0.4%) 37 (100%) 0 0 525 (98.1%) 8 (1.6%) 2 (0.3%) Frequency of toothbrushing per day - Never - Once a day - Twice a day - Three times a day or more 2 (0.4%) 20 (4.0%) 437 (87.8%) 39 (7.8%) 0 0 (0.0%) 36 (97.3%) 1 (2.7%) 2 (0.3%) 20 (3.7%) 473 (88.5%) 40 (7.5%) Duration of toothbrushing - Never - Less than 1 min - More than 1 min but less than 2 min - 2 min or more 2 (0.4%) 5 (1.0%) 417 (83.7%) 74 (14.9%) 0 4 (10.8%) 23 (62.2%) 10 (27.0%) 2 (0.3%) 9 (1.7%) 440 (82.3%) 84 (15.7%) Type of toothpaste - Fluoride toothpaste - Non-fluoride toothpaste - Don’t know - No toothpaste 350 (70.3%) 32 (6.4%) 114 (22.9%) 2 (0.4%) 35 (94.5%) 0 2 (5.5%) 0 385 (72.0%) 32 (6.0%) 116 (21.7%) 2 (0.3%) Prison dental service utilisation (during incarceration) - Utilised - Not Utilise 233 (46.8%) 265 (53.2%) 27 (73.0%) 10 (27.0%) 260 (48.6%) 275 (51.4%) Table 4 OHRQoL problem based on OIDP among inmates. Oral health – affected activities (based on OIDP) Male (N = 392) Female (N = 26) Total (N = 418) Impaired OHRQoL (at least 1 activity) Eating Emotional stability Smiling and laughing Sleeping / Resting Cleaning Speaking Social interaction Performing assigned tasks 195 (49.7%) 114 (29.1%) 102 (26.0%) 71 (18.1%) 32 (8.2%) 29 (7.4%) 25 (6.4%) 16 (4.1%) 7 (1.8%) 17 (65.4%) 12 (46.2%) 7 (26.9%) 5 (19.2%) 2 (7.7%) 2 (7.7%) 4 (15.4%) 3 (11.5%) 0 212 (50.7%) 126 (30.1%) 109 (26.1%) 76 (18.2%) 34 (8.1%) 31 (7.4%) 29 (6.9%) 19 (4.6%) 7 (1.7%) Table 5 Factors associated with OIDP Indepenent Variable Crude OR (95% CI) p -value aOR (95% CI) p -value Age > 35 years 1.17 (0.78-1.71) .425 Education : Secondary School or higher 0.94 (0.64-1.38) .750 Incarceration > 18 months 1.29 (0.88-1.89) .200 Dental caries (DT > 1) 1.90 (0.97-3.70) .060 Missing (MT > 1 ) 1.61 (1.06-2.46) .027* 1.50 (0.98-2.31) .063 Filled tooth (FT > 1 ) 1.31 (0.84-2.05) .235 Untreated caries complication (PUFA > 1) 1.76 (1.19-2.62) .005* 1.68 (1.13-2.51) .011* Impacted tooth > 1 0.75 (0.48-1.19) .227 Periodontitis (CPI > 2) 1.26 (0.85-1.88) .257 Note: OR = odds ratio; aOR = adjusted odds ratio; CI = confidence interval. Statistical significance was set at p 35 years 0.73 (0.52-1.03) .069 Education : Secondary School or higher 1.53 (1.09-2.15) .015* 1.16 (0.74-1.83) .521 Incarceration > 18 months 2.22 (1.57-3.13) 1) 1.28 (0.71-2.28) .413 Missing (MT > 1 ) 5.02 (3.30-7.65) <.001* 6.56 (3.80-11.32) 1 ) 1.96 (1.32-2.92) 1) 0.63 (0.44-0.89) .008 * 0.47 (0.29-0.77) .002* Impacted tooth > 1 1.33 (0.89-2.00) .167 Periodontitis (CPI > 2) 0.43 (0.30-0.62) <.001* 0.36 (0.22-0.59) 0) 1.85 (1.26-2.73) .002* 2.07 (1.31-3.27) .002* Note: OR = odds ratio; aOR = adjusted odds ratio; CI = confidence interval. Statistical significance was set at p < 0.05. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9253364","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631301994,"identity":"3eb86170-5818-49d1-b569-77c05c6cde5a","order_by":0,"name":"Manop Phongayukull","email":"","orcid":"","institution":"Faculty of Dentistry, Chiang Mai University","correspondingAuthor":false,"prefix":"","firstName":"Manop","middleName":"","lastName":"Phongayukull","suffix":""},{"id":631301995,"identity":"570eeb83-ea7e-47f0-b0b2-09e45b40bce4","order_by":1,"name":"Narumanas Korwanich","email":"","orcid":"","institution":"Faculty of Dentistry, Chiang Mai University","correspondingAuthor":false,"prefix":"","firstName":"Narumanas","middleName":"","lastName":"Korwanich","suffix":""},{"id":631301996,"identity":"21fb6248-3312-4a7b-b3f3-f3da1e9baa06","order_by":2,"name":"Kanyarat Korwanich","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABHUlEQVRIie3RPUsDMRjA8ZTIuTyS9TlS9CtcObjFl34VJdApdXRRfFmuy6FroF9CEJwcAoFzqq4WOuhy0w3VQqGgYq60IpIrjg75LwlP8oNACPH5/mH4vYPlglQvZ8Eqgj9IsL8Y0r8Ru4VoJQl7gxxnd3unBEw+gZNRk/Wz17dhSrbYOcufHYTDYSfMCoFkIxV9yAvA0eCGd1PSUpquRw6ySWSCoCkSBjGVgYEIu7fUksa1fRi6CCuT8F2fLchnRWRRkXYd4SgTDtrYh2WxvTknQUUO6kioyni7qe/DFHJBPy4N4FMn5vIBhTI0cRF8lK1hqY8ZA2EaamraTImXiTza2b3qXRQuYlubz39/gR1S930bHdce+Xw+n6/qC6iiU241jfi/AAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of Dentistry, Chiang Mai University","correspondingAuthor":true,"prefix":"","firstName":"Kanyarat","middleName":"","lastName":"Korwanich","suffix":""}],"badges":[],"createdAt":"2026-03-28 14:09:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9253364/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9253364/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108803902,"identity":"d6c2924e-fd78-4c6b-900e-2b67102ea42a","added_by":"auto","created_at":"2026-05-08 15:10:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":472870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9253364/v1/779f4058-301a-4fb4-a6a3-24374fa65df8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Untreated Dental Caries Complications, Oral Health-Related Quality of Life, and Dental Service Utilization among Inmates in Southern Thailand","fulltext":[{"header":"Introduction/Objective","content":"\u003cp\u003e Oral health is an integral component of general health and quality of life, yet it is often overlooked in marginalized populations, particularly those who are incarcerated. Prisoners experience a disproportionately high burden of oral diseases, including dental caries, periodontal disease, tooth loss, and oral lesions, compared to the general population.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e These conditions not only affect their masticatory function and speech but also impact self-esteem, mental health, and reintegration into society following incarceration.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIncarcerated populations experience distinct and complex oral health needs shaped by structural and social determinants, including socioeconomic disadvantage, limited health literacy, and a high prevalence of substance use and mental health conditions.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Studies across various countries including Finland,\u003csup\u003e7\u003c/sup\u003e India,\u003csup\u003e8\u003c/sup\u003e United Kingdom,\u003csup\u003e9\u003c/sup\u003e and Brazil\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e consistently demonstrate high DMFT scores and poor periodontal status among prisoners. This substantial disease burden reflects both pre-existing behavioral risk exposures such as tobacco use alcohol consumption and illicit drug use that often precede imprisonment,\u003csup\u003e5\u003c/sup\u003e and systemic constraints within prison settings including limited access to preventive and curative oral health services overcrowding and under-resourced prison healthcare systems.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe World Health Organization has identified oral health in prison settings as a pressing public health issue requiring integration into broader prison healthcare strategies. However, many correctional facilities worldwide continue to lack dedicated dental personnel, routine dental care, and oral health promotion programmes.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Since 2019, Thailand has implemented the nationwide \u0026ldquo;Good Health Good Heart\u0026rdquo; project, identifying oral health as a public health priority and improving prisoners\u0026rsquo; access to dental care.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Within this framework, all prisons across Thailand was provided more intensive health care including dental services aiming better quality of life of prisoner population.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e There is a growing recognition of oral health-related quality of life (OHRQoL) as an important outcome measure in correctional health research. Poor oral health has been shown to substantially reduce OHRQoL, particularly in domains such as physical pain, psychological discomfort, and social disability.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Despite this, few studies adopt a multidimensional approach when evaluating oral health programs in prisons, with most research remaining focused solely on clinical indices. Understanding both the clinical status of oral health and its impact on quality of life is therefore essential for identifying the needs of this population and for guiding targeted, sustainable improvements in care provision.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e This study aimed to assess the oral health status, oral health behaviors, OHRQoL, and to analyze the factors associated with OHRQoL and dental service utilization among inmates. The findings are expected to enhance the evidence for prisoners\u0026rsquo; oral healthcare planning and support public health strategies targeting underserved populations.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003eClinical oral examinations were conducted by a dentist using standard forms to collect data on dental caries (DMFT index),\u003csup\u003e16\u003c/sup\u003e untreated caries with complications using the PUFA index which is a new measure that evaluates the prevalence and severity of oral conditions resulting from untreated dental caries by recording the number of teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f), and abscess (A/a),\u003csup\u003e17\u003c/sup\u003e as well as periodontal status (CPI),\u003csup\u003e16\u003c/sup\u003e the presence of dentures, and other oral conditions such as tooth gems. Structured questionnaires used in the study were derived from The 8th Thailand National Oral Health Survey.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Demographic data, criminal offences, oral health behaviors, and retrospective self-reported dental service utilization of any dental treatment within the prison. The Oral Impacts on Daily Performance (OIDP) questionnaire was used to assessed OHRQoL.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Trained dental nurses and dentists conducted the interviews and examinations following standardized protocols.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting and Design\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted at Takuapa District Prison, Thailand, a small correctional facility housing male and female inmates serving sentences of up to 10 years. The study was approved by the prison authorities, and all data collection procedures were carried out under the supervision and security regulations of prison staff.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePopulation, Sample, and Sampling Method\u003c/h3\u003e\n\u003cp\u003eAll 621 inmates residing in Takuapa District Prison between April and June 2023 were included in the study. The initial sample consisted of 535 inmates (498 males and 37 females) who met the inclusion criteria of being convicted, present during data collection, and willing to participate. In the first stage, oral examinations were conducted to collect clinical data. In the second stage (October 2023), 418 inmates (391 males and 27 females) were interviewed to assess OHRQoL. A total of 418 inmates completed both stages of data collection.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData collection was conducted between April and June 2023. Demographic characteristics and oral health\u0026ndash;related behaviors were collected using structured questionnaires adapted from the 2017 Thailand National Oral Health Survey, administered by a trained dental nurse. Clinical oral examinations were performed by a calibrated dentist using a mobile dental unit, mouth mirror, and WHO probe under dental light. Examiner reliability was acceptable, with agreement rates of 86.05% for dental caries and 83.72% for periodontal status, and kappa coefficients of 0.85 and 0.71, respectively.\u003c/p\u003e \u003cp\u003e OIDP interviews were subsequently conducted in October 2023 using a standardized eight-item questionnaire assessing oral impacts on daily performance over the preceding six months. Interviews were administered and recorded by the same dentist. Formal permission was obtained from prison authorities, and data collection was facilitated by prison health volunteers.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were double-entered for accuracy prior to analysis. Statistical analyses were performed using SPSS version 31. Descriptive statistics were used to summarize the study findings. Exploratory bivariate analyses were conducted using the chi-square test to examine unadjusted associations between categorical variables. Inferential analysis was subsequently performed using binary logistic regression to assess adjusted associations between variables. Due to missing data in some variables, logistic regression analyses were conducted using listwise deletion, as the default option in SPSS. Consequently, only cases with complete data across all variables included in the model were analyzed, resulting in a reduced sample size of 418 participants. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 535 inmates housed at Takuapa District Prison between April and June 2023. Demographic characteristics and criminal offence profile presented in Table 1. A high burden of dental caries, untreated caries complications, and periodontal disease was observed among the inmates, as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eAdditionally, 122 inmates were found to have at least one impacted third molar, and tooth gems were identified in 33 male inmates. Twelve inmates possessed removable acrylic dentures, which\u0026nbsp;most of them\u0026nbsp;were poorly maintained, showing issues such as looseness, fractures, and discoloration. Regarding substance use, the majority of inmates reported a history of smoking (90.8%), illicit drug use (90.1%), and alcohol consumption (65.2%) prior to incarceration.\u003c/p\u003e\n\u003cp\u003eMost inmates reported brushing their teeth twice daily, once in the morning and again before returning to their living units (around 4:00 pm). Nearly half of participants had utilized dental services during incarceration in the preceding year, as detailed in Table 3. OHRQoL\u0026nbsp;was assessed among 418 inmates using the OIDP questionnaire. More than half of respondents reported at least one oral health\u0026ndash;related impact, as shown in Table 4\u003c/p\u003e\n\u003cp\u003eUntreated caries complications (PUFA \u0026ge; 1) was the only factor significantly associated with impaired oral health\u0026ndash;related quality of life (OIDP \u0026gt; 0) among inmates as shown in Table 5. The presence of missing teeth (MT \u0026ge; 1) and impaired oral health\u0026ndash;related quality of life (OIDP \u0026gt; 0) was associated with higher service utilization, whereas untreated caries complications (PUFA \u0026ge; 1) and periodontitis (CPI \u0026gt; 2) were associated with lower utilization, as shown in Table 6.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eGlobally, dental caries and untreated oral diseases in prisoners remain a major public health concern. The mean number of untreated dental caries varies across populations, was reported as 5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 teeth per person in Finland,\u003csup\u003e7\u003c/sup\u003e 2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 in India,\u003csup\u003e8\u003c/sup\u003e 2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52 in the United Kingdom,\u003csup\u003e9\u003c/sup\u003e and 11.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37 in Brazil.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Against this global backdrop, inmates of this study exhibited a mean of 6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50 untreated teeth per person, which is higher than in Finland, India, and the United Kingdom, but lower than in Brazil. The prevalence of PUFA among these inmates was 59.8% in males and 45.9% in females, exceeding the 40% reported among female inmates in the United Kingdom\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Moreover, periodontitis with attachment loss and the presence of periodontal pockets was observed in 63.6% of the Takuapa inmates, compared with 32.6% of the working-age population in Thailand.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCorrespondingly, findings from this study indicate a substantial burden of dental diseases among inmates, consistent with international reports. A report by CareQuest Institute for Oral Health highlighted that incarcerated individuals exhibit higher rates of dental diseases compared with the general population, and access to dental care in correctional facilities is often restricted due to limited resources and strict treatment policies.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e This mismatch between high disease burden and limited service utilization underscores the need for a conceptual framework to interpret patterns of dental care use in prison settings.\u003c/p\u003e \u003cp\u003eFrom a theoretical perspective, health service utilization depends on the interaction between predisposing characteristics, enabling resources, and both perceived and evaluated need for care.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In prison contexts, where enabling resources are structurally constrained, perceived need, particularly when oral conditions interfere with daily functioning, may play a decisive role in shaping dental service utilization.\u003c/p\u003e \u003cp\u003eSince the introduction of the \u0026ldquo;Good Health Good Heart\u003cb\u003e\u0026rdquo;\u003c/b\u003e program in 2019, Thailand has sought to improve healthcare access for incarcerated populations, including dental services. Under this policy, a dental clinic was established within Takuapa prison to deliver basic dental care, with services provided by Takuapa Hospital on a scheduled basis twice monthly. Care primarily focuses on basic treatments, including extractions, scaling, restorations, and the management of acute dental conditions, while more complex procedures, such as surgical removal of impacted teeth, require referral to hospital-based care.\u003c/p\u003e \u003cp\u003eDespite improved access, service delivery remains constrained by workforce limitations and unclear budgetary allocation. Consequently, preventive and comprehensive restorative care remains insufficient, and reliance on external referral may have influenced oral health outcomes, including oral health status, OHRQoL, and dental service utilization patterns observed in this study.\u003c/p\u003e \u003cp\u003eThis study assessed inmates\u0026rsquo; OHRQoL using the OIDP interview. Oral health was therefore conceptualized within a biopsychosocial framework.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study found that only untreated caries complication was significantly associated with impaired OHRQoL. In contrast, studies conducted among prison populations in South Korea and India have reported significant associations between oral health status and OHRQoL, particularly dental caries and periodontal disease.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Although evidence on the association between PUFA and OIDP among incarcerated populations remains limited, several studies in pediatric populations have consistently demonstrated that untreated caries complications, as measured by the PUFA/pufa index, are significantly associated with poorer oral health-related quality of life.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study found that inmates who reported impaired OHRQoL were significantly more likely to utilize dental services during incarceration. This finding aligns with previous literature suggesting that individuals are more likely to seek dental care when they perceive functional, psychological, or social impacts from oral conditions rather than relying solely on clinical signs of disease.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e It also underscores the importance of subjective health perceptions in driving care-seeking behavior especially in the environment that prisoners seek health care utilization by voluntary basis like this study.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe positive association between missing teeth and dental service utilization, alongside the negative association with periodontal disease, should be interpreted with caution given the cross-sectional design. These findings likely reflect service delivery practices based on voluntary self-referral, where tooth extraction is the most accessible treatment, while periodontal care remains limited. Consistent with previous studies, high DMFT scores in incarcerated populations are largely driven by missing teeth, indicating a reliance on extractions rather than comprehensive care.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Consequently, missing teeth may represent not only pre-existing oral disease but also the outcomes of dental care received during incarceration.\u003c/p\u003e \u003cp\u003eBecause of limitations of cross-sectional design of this study, the association between untreated caries complications and lower dental service utilization can be interpreted in two ways. First, it may indicate that the presence of advanced disease alone is insufficient to prompt care-seeking, consistent with evidence that prison dental care is largely symptom-driven and constrained by systemic barriers.\u003csup\u003e\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Alternatively, this finding may reflect the nature of the PUFA index, which captures the cumulative consequences of prolonged non-utilization of dental services rather than acting as an immediate trigger for care-seeking.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis population-based study included all inmates during the study period, enhancing the comprehensiveness and representativeness of the findings. However, some health behaviors were self-reported and may be subject to recall bias.\u003c/p\u003e \u003cp\u003eIn the context of Takuapa District Prison, characterized by short-term incarceration and high inmate turnover, oral health services should prioritize interventions that are feasible within limited detention periods. Routine OIDP screening is recommended to identify inmates whose oral conditions substantially impair daily functioning and warrant timely care. Preventive efforts should focus on supporting self-care and can be sustained following release.\u003c/p\u003e \u003cp\u003e The higher utilization observed among inmates with missing teeth may indicate an unmet need for functional oral rehabilitation. Accordingly, service planning should consider expanding access to basic prosthodontic care, such as removable dentures. Strengthening post-release referral pathways within the district health system may further support continuity of oral healthcare in the community.\u003c/p\u003e \u003cp\u003e To more effectively address the complex oral health needs of incarcerated populations, an integrated approach is required, combining clinical care, behavioral interventions, and policy-level strategies. Further research is warranted to examine broader physical, social, and cultural contexts influencing oral health behaviors and dental service utilization. A clearer understanding of these determinants is essential for developing more responsive and comprehensive oral healthcare systems in prison settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese findings highlight that clinical disease status alone may not fully reflect the lived impact of oral health problems in this vulnerable population. Integrating OHRQoL measures alongside clinical assessment can enhance understanding of inmates\u0026rsquo; daily functioning and support more responsive and equitable prison oral health service planning. Further research should explore environmental, social, and cultural contexts to inform the development of appropriate and sustainable prison oral health systems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCI, Confidence Interval; CPI, Community Periodontal Index; DMFT, Decayed, Missing, and Filled Teeth; OIDP, Oral Impacts on Daily Performance; OHRQoL, Oral Health-Related Quality of Life; aOR, Adjusted Odds Ratio; PUFA, Pulpal involvement, Ulceration, Fistula, and Abscess index.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Human Research Ethics Committee, Faculty of Dentistry, Chiang Mai University (No. 13/2566; 23 February 2023). All participants provided written informed consent prior to enrolment. Participation was voluntary, and refusal or withdrawal did not affect access to dental services within the prison. Confidentiality was strictly maintained, and findings are reported in aggregate form without personal identifiers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study contain sensitive personal information relating to incarcerated individuals and are not publicly available due to ethical and privacy restrictions. De-identified data may be available from the corresponding author upon reasonable request and with approval from the relevant ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Faculty of Dentistry, Chiang Mai University. The funding body had no role in the design of the study; collection, analysis, and interpretation of data; or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMP contributed to the conceptualization and design of the study, methodology, data collection, data analysis, statistical analysis, data interpretation, and drafted the manuscript. NK and KK contributed to the conceptualization and design of the study, data analysis, statistical analysis, and critically revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the staff of Takuapa Hospital for their assistance with field data collection and the staff of Takuapa District Prison for facilitating the study and ensuring safety during data collection. The authors are grateful to all incarcerated individuals who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Oral health in prisons \u0026ndash; a public health concern. Copenhagen: WHO Regional Office for Europe; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCareQuest Institute for Oral Health. Oral health in incarcerated persons. 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J Clin Med. 2025;14(5):1499. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm14051499\u003c/span\u003e\u003cspan address=\"10.3390/jcm14051499\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 \u0026nbsp;Demographic data and criminal offence profile of inmates.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInmate\u0026rsquo;s Data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eN=498\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003cstrong\u003eN=37\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003eN=535\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years old)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e35.16 \u003cu\u003e+\u003c/u\u003e 9.38\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e36.38 \u003cu\u003e+\u003c/u\u003e 8.34\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e35.25 \u003cu\u003e+\u003c/u\u003e 9.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- Buddhist\u003c/p\u003e\n \u003cp\u003e- Muslim\u003c/p\u003e\n \u003cp\u003e- Christian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e378 (75.9%)\u003c/p\u003e\n \u003cp\u003e119 (23.9%)\u003c/p\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26 (70.3%)\u003c/p\u003e\n \u003cp\u003e11 (29.7%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e404 (75.5%)\u003c/p\u003e\n \u003cp\u003e130 (24.3%)\u003c/p\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation prior to imprisonment\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Civil servant\u0026nbsp;/\u0026nbsp;government employee\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Private sector employee\u0026nbsp;/\u0026nbsp;worker\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Farmer\u003c/p\u003e\n \u003cp\u003e- Student\u003c/p\u003e\n \u003cp\u003e- Home maker\u003c/p\u003e\n \u003cp\u003e- Own business\u003c/p\u003e\n \u003cp\u003e- Casual labourer\u003c/p\u003e\n \u003cp\u003e- Others\u003c/p\u003e\n \u003cp\u003e- Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (1.0%)\u003c/p\u003e\n \u003cp\u003e16 (3.2%)\u003c/p\u003e\n \u003cp\u003e174 (35.0%)\u003c/p\u003e\n \u003cp\u003e8 (1.6%)\u003c/p\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003cp\u003e56 (11.2%)\u003c/p\u003e\n \u003cp\u003e217 (43.6%)\u003c/p\u003e\n \u003cp\u003e10 (2.0%)\u003c/p\u003e\n \u003cp\u003e9 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (10.9%)\u003c/p\u003e\n \u003cp\u003e3 (8.1%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e6 (16.2%)\u003c/p\u003e\n \u003cp\u003e12 (32.4%)\u003c/p\u003e\n \u003cp\u003e12 (32.4%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (1.0%)\u003c/p\u003e\n \u003cp\u003e20 (3.8%)\u003c/p\u003e\n \u003cp\u003e177 (33.1%)\u003c/p\u003e\n \u003cp\u003e8 (1.5%)\u003c/p\u003e\n \u003cp\u003e9 (1.6%)\u003c/p\u003e\n \u003cp\u003e68 (12.7%)\u003c/p\u003e\n \u003cp\u003e229 (42.8%)\u003c/p\u003e\n \u003cp\u003e10 (1.9%)\u003c/p\u003e\n \u003cp\u003e9\u0026nbsp;(1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest level of education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- No formal education\u003c/p\u003e\n \u003cp\u003e- Primary school\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Junior high school\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;High school /\u0026nbsp;Vocational certificate\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Diploma / Higher vocational certificate\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Bachelor\u0026rsquo;s degree or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003cp\u003e234 (47.0%)\u003c/p\u003e\n \u003cp\u003e181 (36.3%)\u003c/p\u003e\n \u003cp\u003e64 (12.9%)\u003c/p\u003e\n \u003cp\u003e14 (2.8%)\u003c/p\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e9 (24.3%)\u003c/p\u003e\n \u003cp\u003e14 (37.9%)\u003c/p\u003e\n \u003cp\u003e6 (16.2%)\u003c/p\u003e\n \u003cp\u003e5 (13.5%)\u003c/p\u003e\n \u003cp\u003e3 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003cp\u003e243 (45.4%)\u003c/p\u003e\n \u003cp\u003e195 (36.5%)\u003c/p\u003e\n \u003cp\u003e73 (13.6%)\u003c/p\u003e\n \u003cp\u003e16 (3.0%)\u003c/p\u003e\n \u003cp\u003e5 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of offence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- Drug /\u0026nbsp;solvent-related offense\u003c/p\u003e\n \u003cp\u003e- Property offence\u003c/p\u003e\n \u003cp\u003e- Homicide-related offence\u003c/p\u003e\n \u003cp\u003e- Bodily harm offence\u003c/p\u003e\n \u003cp\u003e- Sexual offence\u003c/p\u003e\n \u003cp\u003e- Other offence (e.g., Firearms Act )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e372 (74.7%)\u003c/p\u003e\n \u003cp\u003e67 (13.5%)\u003c/p\u003e\n \u003cp\u003e25 (5.0%)\u003c/p\u003e\n \u003cp\u003e11 (2.2%)\u003c/p\u003e\n \u003cp\u003e3 (0.6%)\u003c/p\u003e\n \u003cp\u003e20 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (67.6%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (21.6%)\u003c/p\u003e\n \u003cp\u003e3 (8.1%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e397 (74.2%)\u003c/p\u003e\n \u003cp\u003e75 (14.0%)\u003c/p\u003e\n \u003cp\u003e28 (5.2%)\u003c/p\u003e\n \u003cp\u003e11 (2.1%)\u003c/p\u003e\n \u003cp\u003e3\u0026nbsp;(0.6%)\u003c/p\u003e\n \u003cp\u003e21 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInmate class\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Excellent\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Very good\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Good\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Fair\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Poor\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Very poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e80 (16.0%)\u003c/p\u003e\n \u003cp\u003e74 (14.9%)\u003c/p\u003e\n \u003cp\u003e89 (17.9%)\u003c/p\u003e\n \u003cp\u003e137 (27.5%)\u003c/p\u003e\n \u003cp\u003e71 (14.3%)\u003c/p\u003e\n \u003cp\u003e47 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (21.6%)\u003c/p\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003cp\u003e4 (10.8%)\u003c/p\u003e\n \u003cp\u003e15 (40.6%)\u003c/p\u003e\n \u003cp\u003e6 (16.2%)\u003c/p\u003e\n \u003cp\u003e2 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e88 (16.4%)\u003c/p\u003e\n \u003cp\u003e76 (14.2%)\u003c/p\u003e\n \u003cp\u003e93 (17.4%)\u003c/p\u003e\n \u003cp\u003e152 (28.4%)\u003c/p\u003e\n \u003cp\u003e77\u0026nbsp;(14.4%)\u003c/p\u003e\n \u003cp\u003e49 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of incarceration\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- Up to 18 months\u003c/p\u003e\n \u003cp\u003e- 18 months or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e247 (49.6%)\u003c/p\u003e\n \u003cp\u003e251 (50.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (56.8%)\u003c/p\u003e\n \u003cp\u003e16 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e268\u0026nbsp;(50.1%)\u003c/p\u003e\n \u003cp\u003e267 (49.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 \u0026nbsp;Oral health status of inmates.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 633px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaries experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=498)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=535)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaries\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e94.8 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e91.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 215px;\"\u003e\n \u003cp\u003e94.6 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDMFT index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMean \u003cu\u003e+\u003c/u\u003e SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMean \u003cu\u003e+\u003c/u\u003e SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMean \u003cu\u003e+\u003c/u\u003e SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMed (Q1,Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDMFT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10.03 \u003cu\u003e+\u003c/u\u003e 7.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10.22 \u003cu\u003e+\u003c/u\u003e 7.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e10.05 \u003cu\u003e+\u003c/u\u003e 7.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e8 (4,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e6.28 \u003cu\u003e+\u003c/u\u003e 5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5.43 \u003cu\u003e+\u003c/u\u003e 5.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e6.22 \u003cu\u003e+\u003c/u\u003e 5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e5 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2.90 \u003cu\u003e+\u003c/u\u003e 3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e3.68 \u003cu\u003e+\u003c/u\u003e 3.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2.96 \u003cu\u003e+\u003c/u\u003e 3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (0,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.85 \u003cu\u003e+\u003c/u\u003e 1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1.11 \u003cu\u003e+\u003c/u\u003e 2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.87 \u003cu\u003e+\u003c/u\u003e 2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 633px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUntre\u003c/strong\u003e\u003cstrong\u003eated caries complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePUFA\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eindex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003e(N=498)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 323px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=535)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMean \u003cu\u003e+\u003c/u\u003e SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMed (Q1,Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePUFA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e298 (59.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e17 (45.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e315 (58.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2.41 \u003cu\u003e+\u003c/u\u003e 3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (0,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e295 (59.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e16 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e311 (58.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2.39 \u003cu\u003e+\u003c/u\u003e 3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (0,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e12 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e13 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.03 \u003cu\u003e+\u003c/u\u003e 0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0.00 \u003cu\u003e+\u003c/u\u003e 0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 633px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeriodontal status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003e(N=493)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=530)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e180 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e13 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e193 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e222 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e23 (62.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e245 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e91 (18.5.%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e92 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e Data are presented as mean \u0026plusmn; SD and median (Q1, Q3). Median values are shown due to non-normal distribution. The total number for periodontal status differs, as five male inmates were edentulous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 \u0026nbsp;Oral hygiene habits and OHRQoL problem among inmates.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral hygiene habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eMale \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=498)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;(N=37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N=535)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003eOral hygiene aids\u003c/p\u003e\n \u003cp\u003e- has both toothbrush and toothpaste\u003c/p\u003e\n \u003cp\u003e- has either toothbrush or toothpaste only\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- has neither toothbrush and toothpaste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e488 (98.0%)\u003c/p\u003e\n \u003cp\u003e8\u0026nbsp;(1.6%)\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37\u0026nbsp;(100%)\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e525\u0026nbsp;(98.1%)\u003c/p\u003e\n \u003cp\u003e8\u0026nbsp;(1.6%)\u003c/p\u003e\n \u003cp\u003e2 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003eFrequency of toothbrushing per day\u003c/p\u003e\n \u003cp\u003e- Never\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-\u0026nbsp;\u003c/strong\u003eOnce a day\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Twice a day\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Three times a day or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;(0.4%)\u003c/p\u003e\n \u003cp\u003e20\u0026nbsp;(4.0%)\u003c/p\u003e\n \u003cp\u003e437\u0026nbsp;(87.8%)\u003c/p\u003e\n \u003cp\u003e39\u0026nbsp;(7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;(0.0%)\u003c/p\u003e\n \u003cp\u003e36\u0026nbsp;(97.3%)\u003c/p\u003e\n \u003cp\u003e1\u0026nbsp;(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;(0.3%)\u003c/p\u003e\n \u003cp\u003e20\u0026nbsp;(3.7%)\u003c/p\u003e\n \u003cp\u003e473\u0026nbsp;(88.5%)\u003c/p\u003e\n \u003cp\u003e40\u0026nbsp;(7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003eDuration of toothbrushing\u003c/p\u003e\n \u003cp\u003e- Never\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Less than 1 min\u003c/p\u003e\n \u003cp\u003e- More than 1 min but less than 2 min\u003c/p\u003e\n \u003cp\u003e- 2 min or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003cp\u003e5\u0026nbsp;(1.0%)\u003c/p\u003e\n \u003cp\u003e417 (83.7%)\u003c/p\u003e\n \u003cp\u003e74\u0026nbsp;(14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e4\u0026nbsp;(10.8%)\u003c/p\u003e\n \u003cp\u003e23 (62.2%)\u003c/p\u003e\n \u003cp\u003e10\u0026nbsp;(27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;(0.3%)\u003c/p\u003e\n \u003cp\u003e9\u0026nbsp;(1.7%)\u003c/p\u003e\n \u003cp\u003e440\u0026nbsp;(82.3%)\u003c/p\u003e\n \u003cp\u003e84\u0026nbsp;(15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003eType of toothpaste\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Fluoride toothpaste\u003c/p\u003e\n \u003cp\u003e-\u0026nbsp;Non-fluoride toothpaste\u003c/p\u003e\n \u003cp\u003e- Don\u0026rsquo;t know\u003c/p\u003e\n \u003cp\u003e- No toothpaste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e350\u0026nbsp;(70.3%)\u003c/p\u003e\n \u003cp\u003e32\u0026nbsp;(6.4%)\u003c/p\u003e\n \u003cp\u003e114\u0026nbsp;(22.9%)\u003c/p\u003e\n \u003cp\u003e2 \u0026nbsp;(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35 (94.5%)\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u0026nbsp;(5.5%)\u003c/p\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e385 (72.0%)\u003c/p\u003e\n \u003cp\u003e32\u0026nbsp;(6.0%)\u003c/p\u003e\n \u003cp\u003e116\u0026nbsp;(21.7%)\u003c/p\u003e\n \u003cp\u003e2 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003ePrison dental service utilisation\u003c/p\u003e\n \u003cp\u003e(during incarceration)\u003c/p\u003e\n \u003cp\u003e- Utilised\u003c/p\u003e\n \u003cp\u003e- Not Utilise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e233 (46.8%)\u003c/p\u003e\n \u003cp\u003e265 (53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (73.0%)\u003c/p\u003e\n \u003cp\u003e10 (27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e260 (48.6%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;275 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eOHRQoL problem based on OIDP among inmates.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral health \u0026ndash; affected activities\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(based on OIDP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003e(N = 392)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003e(N = 26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(N = 418)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003eImpaired OHRQoL (at least 1 activity)\u003c/p\u003e\n \u003cp\u003eEating\u003c/p\u003e\n \u003cp\u003eEmotional stability\u003c/p\u003e\n \u003cp\u003eSmiling and laughing\u003c/p\u003e\n \u003cp\u003eSleeping / Resting\u003c/p\u003e\n \u003cp\u003eCleaning\u003c/p\u003e\n \u003cp\u003eSpeaking\u003c/p\u003e\n \u003cp\u003eSocial interaction\u003c/p\u003e\n \u003cp\u003ePerforming assigned tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e195 \u0026nbsp;(49.7%)\u003c/p\u003e\n \u003cp\u003e114 (29.1%)\u003c/p\u003e\n \u003cp\u003e102 (26.0%)\u003c/p\u003e\n \u003cp\u003e71 (18.1%)\u003c/p\u003e\n \u003cp\u003e32 (8.2%)\u003c/p\u003e\n \u003cp\u003e29 (7.4%)\u003c/p\u003e\n \u003cp\u003e25 (6.4%)\u003c/p\u003e\n \u003cp\u003e16 (4.1%)\u003c/p\u003e\n \u003cp\u003e7 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e17 (65.4%)\u003c/p\u003e\n \u003cp\u003e12 (46.2%)\u003c/p\u003e\n \u003cp\u003e7 (26.9%)\u003c/p\u003e\n \u003cp\u003e5 (19.2%)\u003c/p\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003cp\u003e4 (15.4%)\u003c/p\u003e\n \u003cp\u003e3 (11.5%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e212 \u0026nbsp;(50.7%)\u003c/p\u003e\n \u003cp\u003e126 \u0026nbsp;(30.1%)\u003c/p\u003e\n \u003cp\u003e109 \u0026nbsp;(26.1%)\u003c/p\u003e\n \u003cp\u003e76 (18.2%)\u003c/p\u003e\n \u003cp\u003e34 (8.1%)\u003c/p\u003e\n \u003cp\u003e31 (7.4%)\u003c/p\u003e\n \u003cp\u003e29 (6.9%)\u003c/p\u003e\n \u003cp\u003e19 (4.6%)\u003c/p\u003e\n \u003cp\u003e7 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Factors associated with\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eOIDP\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eIndepenent Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;aOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eAge \u003cu\u003e\u0026gt;\u003c/u\u003e 35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.17 (0.78-1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eEducation : Secondary School or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.94 (0.64-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eIncarceration \u003cu\u003e\u0026gt;\u003c/u\u003e 18 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.29 (0.88-1.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eDental caries (DT \u003cu\u003e\u0026gt;\u003c/u\u003e 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.90 (0.97-3.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eMissing (MT \u003cu\u003e\u0026gt;\u003c/u\u003e 1 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.61 (1.06-2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.027*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.50 (0.98-2.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eFilled tooth (FT \u003cu\u003e\u0026gt;\u003c/u\u003e 1 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.31 (0.84-2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUntreated caries complication (PUFA \u003cu\u003e\u0026gt;\u003c/u\u003e 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.76 (1.19-2.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.68 (1.13-2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eImpacted tooth \u003cu\u003e\u0026gt;\u003c/u\u003e 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.75 (0.48-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePeriodontitis (CPI \u0026gt; 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.26 (0.85-1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e OR = odds ratio; aOR = adjusted odds ratio; CI = confidence interval.\u003c/p\u003e\n\u003cp\u003eStatistical significance was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6 Factors associated with\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eprison dental service utilization\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eIndepenent Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;aOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e -value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eAge \u003cu\u003e\u0026gt;\u003c/u\u003e 35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.73 (0.52-1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eEducation : Secondary School or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.53 (1.09-2.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.015*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.16 (0.74-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eIncarceration \u003cu\u003e\u0026gt;\u003c/u\u003e 18 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.22 (1.57-3.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.53 (0.97-2.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eDental caries (DT \u003cu\u003e\u0026gt;\u003c/u\u003e 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.28 (0.71-2.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eMissing (MT \u003cu\u003e\u0026gt;\u003c/u\u003e 1 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5.02 (3.30-7.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e6.56 (3.80-11.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eFilled tooth (FT \u003cu\u003e\u0026gt;\u003c/u\u003e 1 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.96 (1.32-2.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.44 (0.83-2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUntreated caries complication (PUFA \u003cu\u003e\u0026gt;\u003c/u\u003e 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.63 (0.44-0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.008 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.47 (0.29-0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eImpacted tooth \u003cu\u003e\u0026gt;\u003c/u\u003e 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.33 (0.89-2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePeriodontitis (CPI \u0026gt; 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.43 (0.30-0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.36 (0.22-0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eImpaired OHRQoL (OIDP \u0026gt; 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.85 (1.26-2.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.07 (1.31-3.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e OR = odds ratio; aOR = adjusted odds ratio; CI = confidence interval.\u003c/p\u003e\n\u003cp\u003eStatistical significance was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Inmates, oral health status, oral health-related quality of life.","lastPublishedDoi":"10.21203/rs.3.rs-9253364/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9253364/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eInmates are recognized as a vulnerable population with limited access to healthcare and generally poorer oral health than the wider community, warranting focused investigation. This study, conducted at Takuapa District Prison, Thailand, aimed to assess oral health status and oral health-related quality of life (OHRQoL) among inmates and to examine factors associated with dental service utilization.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A total of 535 inmates underwent oral examinations and completed questionnaires on oral health behaviors, of whom 418 also completed the Oral Impacts on Daily Performance (OIDP) index to assess OHRQoL. Data were analyzed using descriptive statistics and logistic regression analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDental caries was present in 94.6% of inmates, with a mean DMFT score of 10.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23. Untreated caries affected 90.5% of participants (mean DT\u0026thinsp;=\u0026thinsp;6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50), while 58.9% presented with complications of untreated caries, with a mean PUFA score of 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.61. Five inmates were edentulous, and among dentate inmates, 63.6% had periodontitis (CPI scores 3\u0026ndash;4). Overall, 50.7% of inmates reported impaired OHRQoL, as assessed using the OIDP index, which was significantly associated with complications of untreated caries (PUFA). In addition, 48.6% of inmates reported access to dental services, which was also significantly associated with impaired OHRQoL.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e Despite a high overall burden of oral disease among inmates at Takuapa District Prison, untreated caries complications were the only oral condition significantly associated with OHRQoL, which in turn influenced dental service utilization within the prison setting.\u003c/p\u003e","manuscriptTitle":"Untreated Dental Caries Complications, Oral Health-Related Quality of Life, and Dental Service Utilization among Inmates in Southern Thailand","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 11:42:37","doi":"10.21203/rs.3.rs-9253364/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"209321468374418808531882627961903305187","date":"2026-05-19T02:52:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"292388078804009629458876257416960202445","date":"2026-05-11T22:47:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213994398684677711824790343905075436671","date":"2026-05-09T12:21:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263951616744598615883013236961796757842","date":"2026-04-27T05:56:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258168313976048424760578573118638922639","date":"2026-04-26T05:51:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-20T20:19:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T20:16:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-09T15:47:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T14:52:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-04-09T13:46:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14e4d41c-5acf-4e53-93c9-0e44a2076be8","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"209321468374418808531882627961903305187","date":"2026-05-19T02:52:28+00:00","index":114,"fulltext":""},{"type":"reviewerAgreed","content":"292388078804009629458876257416960202445","date":"2026-05-11T22:47:06+00:00","index":107,"fulltext":""},{"type":"reviewerAgreed","content":"213994398684677711824790343905075436671","date":"2026-05-09T12:21:34+00:00","index":105,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T11:42:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 11:42:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9253364","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9253364","identity":"rs-9253364","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}