Oral Health status and Dental Service Utilization among school adolescents of Mohmand Agency, Pakistan using Anderson Model. A cross-sectional study

Oral Health status and Dental Service Utilization among school adolescents of Mohmand Agency, Pakistan using Anderson Model. 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A cross-sectional study Khursand Bint-e-Azam, Farrah Pervaiz, Salman Shahid, Rameesha Shauket, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8441003/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Poor dental health is a public health problem in Pakistan, particularly in underserved regions such as Mohmand Agency, Khyber Pakhtunkhwa, where oral health is neglected compared to infectious diseases, maternal and child health, and nutrition. Limited awareness and inadequate dental facilities have worsened the situation, though improving oral health aligns with SDG3. This study assessed the oral health status of school-going adolescents and identify determinants of dental caries using Andersen’s Behavioral Model. Methods : A cross-sectional survey among 385 adolescents aged 13–18 years was conducted through multistage cluster random sampling. Oral health was measured using DMFT index, while a structured questionnaire collected information on predisposing, enabling, need-based, and behavioral factors. Data were analyzed using SPSS v20.0 with Kruskal-Wallis H and Mann-Whitney U tests with Bonferroni correction. Results : Most participants were male (83%), early adolescents (53.2%), and from low-income households (66.2%),39% had never visited a dentist. The prevalence of dental caries was 97.7%. DMFT was not associated with age (p = 0.095) and education (p = 0.327), but parental income and last dental visit were significantly related to DMFT (p < 0.001). Post hoc tests revealed higher DMFT scores among those from the lowest income group and those who had never visited a dentist. Conclusion : Adolescents exhibited high burden of untreated dental caries, influenced by financial barriers and lack of dental care. The findings underscore the need for oral health promotion, improved service accessibility, and policy interventions to address disparities in underserved regions. Adolescents Andersen Model DMFT Oral Health Pakistan Introduction Dental health is a fundamental component of general health and well-being. Effective oral hygiene acts as a barrier against pathogenic microorganisms. Given their complex etiology, oral diseases must be detected early. Notably, in developing countries poor oral conditions lower nutrition levels and impede nutritive index of children. Adolescents’ mental well-being and school performance is hindered due to inadequate oral health and they are at risk of social isolation. [ 1 ] Oral conditions estimated for over 50 million hours of lost time in schools annually. [ 2 ] Globally, oral diseases affect ~ 3.5 billion people—surpassing collective burden of the next five most common non-communicable diseases. Untreated dental decay, advanced periodontal disease, complete tooth loss, and oral/lip cancer are key contributors. [ 3 ] As part of the 2030 SDGs, Universal Health Coverage (UHC) is essential for achieving the broader objective of SDG 3, which promotes health and well-being for all populations. Despite this focus, the incorporation of oral health into UHC initiatives has been limited, and progress toward universal oral health coverage (UOHC) has been slow.[ 4 ] Adolescence is characterized by hormonal, behavioral, and psychological changes that affect diet and aesthetics, making them susceptible to cavities, malocclusion, gingivitis, and periodontal disease. The poor oral health diminishes self-confidence, academic outcome and social participation. Oral health–related quality of life is strongly influenced by socioeconomic factors, maternal education and family income. [ 5 ] A significant population of Pakistan lack basic oral health. The children specifically are thought to have poor dental health due to their lifestyle choices and factors related to socioeconomic status. [ 1 ] Poor dental health among the major health problems of Pakistan. It plays a significant role in appearance, interpersonal connections, dietary habits, nutritional intake, and speech. While reviewing the available literature, it becomes explicit that there exists a significant gap in data regarding oral health in Mohmand Agency, a tribal district in Khyber Pakhtunkhwa, Pakistan. This contrasts with the relatively more abundant data on other medical conditions like infectious diseases, maternal and child health, and nutrition. This discrepancy highlights the urge for dedicated research on dental health to address this neglected area. Dental health has been degraded as a result of absence of awareness and unavailability of dental clinics. Numerous research studies revealed a link between dental health and the entire well-being. Adoption of oral health care and promotion aligns with the goals of SDG3. Hence the aims of this study were (a) to determine the oral health status of school going adolescents through DMFT index and (b) to ascertain various determinants based on Anderson model affecting DMFT Index among school going adolescents. This will alleviate the burden on the healthcare system and help to devise a policy and health care system for dental care in that area. Methods This cross-sectional study was conducted among adolescents aged 13–18 years enrolled in classes 6–10 in Ghallanai, Mohmand Agency, Pakistan. A multistage cluster random sampling was applied: of 37 schools, 6 met the eligibility criteria (> 100 students in classes 6–10), and 4 were randomly selected by lottery. From these schools, 400 students were invited; 15 were excluded (7 undergoing dental treatment, 8 with deciduous dentition), yielding a final sample of 385 participants. Ethical approval was obtained from the Armed Forces Post Graduate Medical Institute’s Ethical Review Board (Re: 538-AAA-ERC-AFPGMI/31st October 2024) and it was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from parents/guardians of participants younger than 18 years, along with adolescents’ assent, while those aged 18 years provided consent on their own. The sample size was calculated using the WHO sample size calculator (95% confidence level, 5% margin of error, and an assumed prevalence of 50%), giving a required sample of 385. From13th January to 13th July 2025 data was collected. Participants seated on regular school chairs while the principal investigator, a licensed dentist, performed oral examinations using a disposable mirror and dental probe in daylight. With the exception of third molars, every permanent tooth was evaluated for caries, restorations, and missing teeth, and the DMFT index was calculated. Data collection was followed by administration of a pre-translated Urdu questionnaire, previously reliability-tested (Cronbach’s alpha = 0.76). The administration of the questionnaire and the clinical examination were carried out by the principal investigator. The first two sections covered predisposing and enabling factors and their effect on dental service use. Participants’ self-reported oral health conditions are targeted by need based variables which is the fifth and concluding segment. [ 6 ] [ 7 ] WHO-based interpretation of average DMFT scores for the population [ 8 ] Very low (less than) 1.2 Low 1.2–2.6 Moderate 2.7–4.4 High 4.5–6.5 Very high (more than) 6.5 Variables Dependent Variable: Total DMFT Score. Components of DMFT (decayed, missing, and filled teeth) described independently. Independent Variables: Socio-demographic: age (categorized as 13–14, 15–16, and 17–18 years), gender, and school classes (6th–10th). Monthly income was categorized during analysis: >PKR 10,000 but PKR 50,000 but PKR 100,000 but PKR 150,000 but < PKR 200,000; and ≥ PKR 200,000. Health status: presence of systemic disease, regular use of medication. Behavioral: frequency of tooth cleaning, use of toothpaste, cigarette use. Utilization and access: last dental visit, availability of dental facilities, time to reach the nearest facility, reasons for not visiting a dentist. Self-perceived oral health: self-rated dental status, tooth pain/discomfort in the past 12 months, dry mouth experience. Statistical Analysis Descriptive statistics were presented as frequencies and percentages and medians with interquartile ranges for DMFT components. Normality of the Total DMFT Score was assessed using the Shapiro-Wilk test, confirming non-normal distribution (p < 0.05). Consequently, non-parametric tests were applied: Associations between DMFT scores and categorical independent variables were assessed using the Kruskal-Wallis H test. Where significant differences were found, post-hoc pairwise comparisons were performed using the Mann-Whitney U test with Bonferroni correction to control Type I error, adjusted significance level of p < .005 was used. Analyses focused on age, parental income, education level, and time since last dental visit. All analyses were conducted using SPSS Statistics v20.0 with significance set at p < 0.05. Results The study included 385 adolescents, mostly aged 13–14 years (53.2%); males comprised 83%. Mostly (66.2%), earning PKR 10,000–50,000 while only 3.4% earned above PKR 200,000. Systemic disease and regular medication use were reported by 3.9% and 4.9%. Only 8.6% were brushing twice or more daily and 58.4% using toothpaste. The majority (75.3%) had never smoked. Self-rated oral health was average in 44.7%, and 41% reported tooth pain in the past year. Access to care was limited: 44.2% reported no nearby facility, and only 12.2% visited a dentist in the past year, while 39% had never visited. Major barriers to dental care were lack of services (41.6%), cost (20.5%), and fear (14.3%) (Table 1 ). Table 1 Descriptive Statistics of the Sample (n = 385). Variable Frequency Percentage Age Group 13–14 years 205 53.2% 15–16 years 156 40.5% 17–18 years 24 6.2% Gender Male 320 83% Female 65 17% Education Level Class 6th 129 33.5% Class 7th 81 21.0% Class 8th 20 5.2% Class 9th 96 24.9% Class 10th 59 15.3% Parental Income >PKR 10,000 but PKR 50,000 but PKR 100,000 but PKR 150,000 but < PKR 200,000 44 11.4% PKR 200,000 and above 13 3.4% Systemic Disease Yes 15 3.9% No 370 96.1% Regular Use of Medicines Yes 19 4.9% No 366 95.1% How often do you clean your teeth? Never 35 9.1% Once a month 11 2.9% 2–3 times a month 27 7.0% Once a week 89 23.1% 2–6 times a week 74 19.2% Once a day 116 30.1% Twice or more a day 33 8.6% Toothpaste use Yes 225 58.4% No 160 41.6% Cigarette Use Never 290 75.3% Seldom 40 10.4% Several times a month 19 4.9% Once a month 0 0% Several times a week 16 4.2% Everyday 9 2.3% Self-Reported State of Teeth Excellent 10 2.6% Good 99 25.7% Very Good 50 13.0% Average 172 44.7% Poor 22 5.7% Very Poor 0 0% Don’t know 32 8.3% Tooth Pain/Discomfort in Last 12 Months Yes 158 41.0% No 197 51.2% Don’t know 30 7.8% No answer 0 0% Dry Mouth Never 273 70.9% Sometimes 82 21.3% Often 24 6.2% Always 6 1.6% Dental Facilities None 170 44.2% Government hospital 144 37.4% Private practitioner/private hospital 46 11.9% Don't know 25 6.5% Time to Reach Dental Facility Can't say 195 50.6% More than one hour 106 27.5% Half an hour to one hour 53 13.8% Less than half an hour 31 8.1% Last Dental Visit Less than 6 months 14 3.6% 6–12 months 33 8.6% > 1 year but < 2 years 64 16.6% 2–5 years 124 32.2% Never received dental care 150 39.0% Reason for not visiting Dentist No service available 160 41.6% Can't afford 79 20.5% Afraid of dentist 55 14.3% Too busy 40 10.4% Didn’t have a dental problem 26 6.8% (Table 2 ) shows that among 385 participants, 17.9% had five decayed teeth and 17.1% had six, while only 2.3% had none, reflecting untreated decay. For missing teeth, 28.8% had two and 28.3% had one, with only 12.5% reporting none. Most (84.2%) had no filled teeth; 3.9% had one, 7.5% had two, and none had more than four. The median number of decayed teeth was 5.0 (IQR = 3.0), missing teeth 2.0 (IQR = 2.0), and filled teeth 0.0 (IQR = 0.0). Table 2 Distribution of DMFT Components Among Participants (n = 385). Variable Frequency / Percentage Number of Teeth Decayed Teeth Missing Teeth Filled Teeth 0 9 (2.3%) 48 (12.5%) 324 (84.2%) 1 39 (10.1%) 109 (28.3%) 15 (3.9%) 2 38 (9.9%) 111 (28.8%) 29 (7.5%) 3 46 (11.9%) 58 (15.1%) 15 (3.9%) 4 39 (10.1%) 40 (10.4%) 2 (0.5%) 5 69 (17.9%) 19 (4.9%) - 6 66 (17.1%) - - 7 40 (10.4%) - - 8 27 (7.0%) - - 9 11 (2.9%) - - 10 1 (0.3%) - - Average DMFT scores across Classes 6–10 ranged from 6.27 to 7.65, all within WHO’s “very high” category, indicating a consistently high burden of untreated caries. Overall, dental caries prevalence was 97.7% (Table 3 ). Table 3 Comparison of Average DMFT Scores Across Education Level (n = 385). Education Level DMFT Score WHO DMFT Category Class 6th 6.80 Very high > 6.5 Class 7th 6.79 Very high > 6.5 Class 8th 7.65 Very high > 6.5 Class 9th 6.67 Very high > 6.5 Class 10th 6.27 High (4.5–6.5) Dental Caries Prevalence 97.7% In (Table 4 ) The Kruskal–Wallis H test showed no significant association between age groups and DMFT scores (p = .095). Similarly, no significant differences were observed across educational levels (p = .327). In contrast, a significant difference in DMFT scores was found across parental income groups, (p < .001) and last dental visit (p < .001). Table 4 Association of Total DMFT with Age, Education Level, Parental Income and Last Dental visit. Variables Compared with Total DMFT p-value a Total DMFT with Age p = 0.095 Total DMFT Education Level p = 0.327 Total DMFT with Parental Income p < 0.001 Total DMFT with Last Dental Visit p < 0.001 a = p-value from the Kruskal Wallis H Test Mann–Whitney U post hoc tests with Bonferroni correction (adjusted p < .005) showed adolescents from the lowest-income households (PKR 10,000–50,000) had significantly higher DMFT scores than those from higher-income groups (p ≤ .003). Similarly, adolescents who had never visited a dentist had higher DMFT scores than all other visit categories (p < .001), except between those who visited 2–5 years ago and 6–12 months ago, where no significant difference was observed (p = .841). (Table 5 ). Table 5 Mann–Whitney U Post-Hoc Comparisons of DMFT with Income Groups and Last Dental Visit Variable Pairwise Comparison U z r a p-value b Income Groups 10K–50K vs. 50K–100K 119.00 -1.311 0.067 0.190 10K–50K vs. 100K–150K 3960.50 -7.308 0.372 < 0.001 10K–50K vs. 150K–200K 2775.00 -5.397 0.275 < 0.001 10K–50K vs. 200K and above 846.50 -3.003 0.153 0.003 50K–100K vs. 100K–150K 46.00 -0.859 0.044 0.391 50K–100K vs. 150K–200K 33.00 -0.597 0.030 0.550 50K–100K vs. 200K and above 11.00 -0.348 0.018 0.728 100K–150K vs. 150K–200K 1543.50 -0.108 0.005 0.914 100K–150K vs. 200K and above 428.50 -0.414 0.021 0.679 150K–200K vs. 200K and above 267.00 -0.364 0.019 0.716 Last Dental Visit Never vs. >1 year but < 2 yrs ago 448.00 -10.642 0.542 < 0.001 Never vs. 2–5 yrs ago 88.50 -5.783 0.295 < 0.001 Never vs. 6–12 months ago 223.50 -8.307 0.423 < 0.001 Never vs. <6 months ago 966.50 -12.998 0.662 1 year but < 2 yrs ago vs. 2–5 yrs ago 0.00 -6.442 0.328 1 year but < 2 yrs ago vs. 6–12 months ago 0.00 -8.489 0.433 1 year but < 2 yrs ago vs. <6 months ago 0.00 -11.758 0.599 < 0.001 2–5 yrs ago vs. 6–12 months ago 223.50 -0.201 0.010 0.841 2–5 yrs ago vs. <6 months ago 0.00 -6.813 0.347 < 0.001 6–12 months ago vs. <6 months ago 0.00 -9.467 0.482 < 0.001 a = r : Effect Size, \(\:r=\frac{z}{\sqrt{N}}\) (z= z-score from test statistic, N= total number of observations) b = p- value from Mann Whitney U Post-Hoc Comparison with Bonferroni Correction Discussion This study assessed adolescent oral health using the DMFT index within Andersen’s Behavioral Model. Oral health was significantly associated with socio-demographic, enabling, and behavioral factors, while age showed no significant association (p = 0.095), despite reported increases: 5.19 to 8.90 at 14–20 vs. 21–25 years (p < 0.001) [ 9 ], from 0.6 at 9 to 1.23 at 11 years in Iran [ 10 ], and from 2.32 at 12 to 4.09 at 15 years in Serbia [ 11 ]. Gender was skewed (83% males); prior studies show higher female DMFT in the UK (IRR 1.28–1.16; mean 6.37 vs. 4.66) [ 12 ] and similar findings in Pakistan, India, Saudi Arabia, and the Philippines [ 13 ]. Education showed no association (p = 0.327), whereas studies in Norway [ 14 ] and Italy (DMFT 4.37 ± 3.06; p < 0.05) [ 15 ] found higher caries with lower education. Longer intervals between visits corresponded to poorer oral health, consistent with Quetta [ 16 ], while a China study linked more visits to higher caries due to symptom-driven care (p < 0.001) [ 17 ]. Oral hygiene was suboptimal (30.1% brushed once, 8.6% twice, 9.1% never), aligning with Brazil (40% higher caries with twice vs. ≥3 times brushing), China (32.6% brushed twice) [ 18 ], Sweden/Denmark (26–33%) [ 19 ], and Pakistan (76% suboptimal; OR = 1.86; p = 0.04) [ 16 ]. Toothpaste use was 58.4%, compared with 91% in China (77.8% fluoridated) [ 18 ]; Pakistani daily fluoride users had 20% caries vs. 50% in occasional and 40% in non-users (p < 0.001) [ 20 ]. Smoking (6.5%) remained harmful, with Lithuanian adolescents showing higher caries and poorer periodontal health (p = 0.023) [ 21 ], and Pakistani smokers demonstrating higher DMFT, periodontal disease (45%), lesions (15%), and increased odds of caries (OR = 2.8) and periodontal disease (OR = 3.5) [ 22 ]. Self-rated oral health reflected clinical need: 44.7% rated their teeth as average, 5.7% as poor, and 41% reported discomfort, consistent with Northwest China (11% poor, 53% moderate, 36% good) [ 23 ] and Pakistan (59.1% average) [ 1 ]. Caries prevalence was 97.7%, with median scores of 5.0 decayed, 2.0 missing, and 0.0 filled teeth; most had 5–6 decayed teeth, and 84.2% had no restorations, indicating substantial unmet need. International prevalence ranges from 72.9%–88.6% in Saudi Arabia and Poland (DMFT 4–5) [ 24 ] [ 25 ], while an Indian review reported 54.2% [ 26 ]. Pakistani studies report 69.4%–76% prevalence, confirming widespread untreated decay [ 26 ] [ 27 ]. Most adolescents (66.2%) belonged to households earning PKR 10,000–50,000, and DMFT scores varied significantly by income (p < .001). The lowest-income group had the highest mean rank (227.80), while higher-income households (PKR 100,000–200,000) had lower ranks, confirming socioeconomic gradients in caries. Similar findings were reported in Korea (p < 0.001) [ 28 ] and a meta-analysis of 493,360 European adolescents (p < 0.01) [ 11 ]. In Pakistan, low-SES children show poorer oral health [ 26 ], though data specific to ages 13–18 remain limited. Geographic barriers were substantial: 44.2% reported no facility nearby; 50.6% were unsure of travel time; 27.5% travelled over an hour, and only 8.1% had access within 30 minutes. Similar disparities exist in the U.S., where 1.7 million lack a clinic within 30 minutes and 24.7 million live in shortage areas (1 dentist per 5,000) [ 29 ], and in Malaysia and Saudi Arabia, where only ~ 40% access clinics within 30 minutes [ 30 ]. The main barriers to dental visits were service unavailability (41.6%) [ 31 ], cost (20.5%) [ 32 , 33 ], fear (14.3%) [ 31 ], time constraints (10.4%) [ 33 ], lack of perceived need (6.8%) [ 34 ], and other reasons (6.5%).This study highlights how predisposing, enabling, and need-based factors shape adolescent oral health in rural Pakistan, underscoring the need for targeted public health interventions. Much of the information was self-reported, which may introduce recall or reporting bias. The sample was predominantly male and limited to a single district, so the findings may not fully represent all adolescents. Additionally, we did not collect objective measures of access such as travel time or mapping of nearby facilities. A high burden of untreated dental decay was observed. To address these gaps, efforts must focus on expanding access, affordability, and raising awareness for underserved populations. Declarations Acknowledgments The authors are deeply thankful to the participating schools, students, and their families for their cooperation and support throughout the study. Clinical trial number : not applicable. Funding Declaration : No Funding. Data Availability: The datasets generated and analyzed during the current study are not publicly available due to ethical and confidentiality considerations involving human participants, particularly minors. All participant identifiers were removed, and data were anonymized prior to analysis. Due to these ethical restrictions, public data deposition is not possible; however, anonymized datasets are available from the corresponding author upon reasonable request. References Moin M, Maqsood A, Haider MM, Asghar H, Rizvi KF, Shqaidef A, Sharif A, Suleman R, Das G, Alam G MK, et al. The Association of Socioeconomic and Lifestyle Factors with the Oral Health Status in School-Age Children from Pakistan: A Cross-Sectional Study. 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Åstrøm AN, Agdal ML, Sulo G. Exploring avoidance of dental care due to dental fear and economic burden –A cross-sectional study in a national sample of younger adults in Norway. Int J Dent Hyg. 2024;22(1):148–57. Castillo KB, Echeto L, Schentrup D. Barriers to dental care in a rural community. J Dent Educ. 2023;87(5):625–30. Crouch E, Nelson J, Merrell MA, Martin A. The oral health status of America’s rural children: An opportunity for policy change. J Public Health Dent. 2021;81(4):251–60. Additional Declarations No competing interests reported. Supplementary Files EnglishQuestionnaireAndersonModel.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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19:46:26","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":106288,"visible":true,"origin":"","legend":"","description":"","filename":"EnglishQuestionnaireAndersonModel.docx","url":"https://assets-eu.researchsquare.com/files/rs-8441003/v1/3eefe6ab584ccaef7343da69.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral Health status and Dental Service Utilization among school adolescents of Mohmand Agency, Pakistan using Anderson Model. A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental health is a fundamental component of general health and well-being. Effective oral hygiene acts as a barrier against pathogenic microorganisms. Given their complex etiology, oral diseases must be detected early. Notably, in developing countries poor oral conditions lower nutrition levels and impede nutritive index of children. Adolescents\u0026rsquo; mental well-being and school performance is hindered due to inadequate oral health and they are at risk of social isolation. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Oral conditions estimated for over 50\u0026nbsp;million hours of lost time in schools annually. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGlobally, oral diseases affect\u0026thinsp;~\u0026thinsp;3.5\u0026nbsp;billion people\u0026mdash;surpassing collective burden of the next five most common non-communicable diseases. Untreated dental decay, advanced periodontal disease, complete tooth loss, and oral/lip cancer are key contributors. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] As part of the 2030 SDGs, Universal Health Coverage (UHC) is essential for achieving the broader objective of SDG 3, which promotes health and well-being for all populations. Despite this focus, the incorporation of oral health into UHC initiatives has been limited, and progress toward universal oral health coverage (UOHC) has been slow.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Adolescence is characterized by hormonal, behavioral, and psychological changes that affect diet and aesthetics, making them susceptible to cavities, malocclusion, gingivitis, and periodontal disease. The poor oral health diminishes self-confidence, academic outcome and social participation. Oral health\u0026ndash;related quality of life is strongly influenced by socioeconomic factors, maternal education and family income. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] A significant population of Pakistan lack basic oral health. The children specifically are thought to have poor dental health due to their lifestyle choices and factors related to socioeconomic status. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Poor dental health among the major health problems of Pakistan. It plays a significant role in appearance, interpersonal connections, dietary habits, nutritional intake, and speech. While reviewing the available literature, it becomes explicit that there exists a significant gap in data regarding oral health in Mohmand Agency, a tribal district in Khyber Pakhtunkhwa, Pakistan. This contrasts with the relatively more abundant data on other medical conditions like infectious diseases, maternal and child health, and nutrition. This discrepancy highlights the urge for dedicated research on dental health to address this neglected area. Dental health has been degraded as a result of absence of awareness and unavailability of dental clinics. Numerous research studies revealed a link between dental health and the entire well-being. Adoption of oral health care and promotion aligns with the goals of SDG3. Hence the aims of this study were (a) to determine the oral health status of school going adolescents through DMFT index and (b) to ascertain various determinants based on Anderson model affecting DMFT Index among school going adolescents. This will alleviate the burden on the healthcare system and help to devise a policy and health care system for dental care in that area.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study was conducted among adolescents aged 13\u0026ndash;18 years enrolled in classes 6\u0026ndash;10 in Ghallanai, Mohmand Agency, Pakistan. A multistage cluster random sampling was applied: of 37 schools, 6 met the eligibility criteria (\u0026gt;\u0026thinsp;100 students in classes 6\u0026ndash;10), and 4 were randomly selected by lottery. From these schools, 400 students were invited; 15 were excluded (7 undergoing dental treatment, 8 with deciduous dentition), yielding a final sample of 385 participants. Ethical approval was obtained from the Armed Forces Post Graduate Medical Institute\u0026rsquo;s Ethical Review Board (Re: 538-AAA-ERC-AFPGMI/31st October 2024) and it was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from parents/guardians of participants younger than 18 years, along with adolescents\u0026rsquo; assent, while those aged 18 years provided consent on their own. The sample size was calculated using the WHO sample size calculator (95% confidence level, 5% margin of error, and an assumed prevalence of 50%), giving a required sample of 385. From13th January to 13th July 2025 data was collected.\u003c/p\u003e \u003cp\u003eParticipants seated on regular school chairs while the principal investigator, a licensed dentist, performed oral examinations using a disposable mirror and dental probe in daylight. With the exception of third molars, every permanent tooth was evaluated for caries, restorations, and missing teeth, and the DMFT index was calculated. Data collection was followed by administration of a pre-translated Urdu questionnaire, previously reliability-tested (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.76). The administration of the questionnaire and the clinical examination were carried out by the principal investigator. The first two sections covered predisposing and enabling factors and their effect on dental service use. Participants\u0026rsquo; self-reported oral health conditions are targeted by need based variables which is the fifth and concluding segment. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cb\u003eWHO-based interpretation of average DMFT scores for the population\u003c/b\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eVery low (less than) 1.2\u003c/p\u003e \u003cp\u003eLow 1.2\u0026ndash;2.6\u003c/p\u003e \u003cp\u003eModerate 2.7\u0026ndash;4.4\u003c/p\u003e \u003cp\u003eHigh 4.5\u0026ndash;6.5\u003c/p\u003e \u003cp\u003eVery high (more than) 6.5\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eDependent Variable:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTotal DMFT Score.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eComponents of DMFT (decayed, missing, and filled teeth) described independently.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eIndependent Variables:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSocio-demographic: age (categorized as 13\u0026ndash;14, 15\u0026ndash;16, and 17\u0026ndash;18 years), gender, and school classes (6th\u0026ndash;10th). Monthly income was categorized during analysis: \u0026gt;PKR 10,000 but \u0026lt;\u0026thinsp;PKR 50,000; \u0026gt;PKR 50,000 but \u0026lt;\u0026thinsp;PKR 100,000; \u0026gt;PKR 100,000 but \u0026lt;\u0026thinsp;PKR 150,000; \u0026gt;PKR 150,000 but \u0026lt;\u0026thinsp;PKR 200,000; and \u0026ge;\u0026thinsp;PKR 200,000.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealth status: presence of systemic disease, regular use of medication.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBehavioral: frequency of tooth cleaning, use of toothpaste, cigarette use.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUtilization and access: last dental visit, availability of dental facilities, time to reach the nearest facility, reasons for not visiting a dentist.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSelf-perceived oral health: self-rated dental status, tooth pain/discomfort in the past 12 months, dry mouth experience.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were presented as frequencies and percentages and medians with interquartile ranges for DMFT components. Normality of the Total DMFT Score was assessed using the Shapiro-Wilk test, confirming non-normal distribution (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Consequently, non-parametric tests were applied: Associations between DMFT scores and categorical independent variables were assessed using the Kruskal-Wallis H test. Where significant differences were found, post-hoc pairwise comparisons were performed using the Mann-Whitney U test with Bonferroni correction to control Type I error, adjusted significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;.005 was used. Analyses focused on age, parental income, education level, and time since last dental visit. All analyses were conducted using SPSS Statistics v20.0 with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 385 adolescents, mostly aged 13\u0026ndash;14 years (53.2%); males comprised 83%. Mostly (66.2%), earning PKR 10,000\u0026ndash;50,000 while only 3.4% earned above PKR 200,000. Systemic disease and regular medication use were reported by 3.9% and 4.9%. Only 8.6% were brushing twice or more daily and 58.4% using toothpaste. The majority (75.3%) had never smoked. Self-rated oral health was average in 44.7%, and 41% reported tooth pain in the past year. Access to care was limited: 44.2% reported no nearby facility, and only 12.2% visited a dentist in the past year, while 39% had never visited. Major barriers to dental care were lack of services (41.6%), cost (20.5%), and fear (14.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics of the Sample (n\u0026thinsp;=\u0026thinsp;385).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;14 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;16 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u0026ndash;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 6th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 7th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 8th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 9th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass 10th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;PKR 10,000 but \u0026lt;\u0026thinsp;PKR 50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; PKR 50,000 but \u0026lt;\u0026thinsp;PKR 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;PKR 100,000 but \u0026lt;\u0026thinsp;PKR 150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;PKR 150,000 but \u0026lt;\u0026thinsp;PKR 200,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePKR 200,000 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSystemic Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegular Use of Medicines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow often do you clean your teeth?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3 times a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;6 times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwice or more a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eToothpaste use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCigarette Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeveral times a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeveral times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEveryday\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-Reported State of Teeth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery Good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery Poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTooth Pain/Discomfort in Last 12 Months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDry Mouth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental Facilities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate practitioner/private hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime to Reach Dental Facility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCan't say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than one hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHalf an hour to one hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than half an hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLast Dental Visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 year but \u0026lt;\u0026thinsp;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever received dental care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReason for not visiting Dentist\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo service available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCan't afford\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfraid of dentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToo busy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDidn\u0026rsquo;t have a dental problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) shows that among 385 participants, 17.9% had five decayed teeth and 17.1% had six, while only 2.3% had none, reflecting untreated decay. For missing teeth, 28.8% had two and 28.3% had one, with only 12.5% reporting none. Most (84.2%) had no filled teeth; 3.9% had one, 7.5% had two, and none had more than four. The median number of decayed teeth was 5.0 (IQR\u0026thinsp;=\u0026thinsp;3.0), missing teeth 2.0 (IQR\u0026thinsp;=\u0026thinsp;2.0), and filled teeth 0.0 (IQR\u0026thinsp;=\u0026thinsp;0.0).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of DMFT Components Among Participants (n\u0026thinsp;=\u0026thinsp;385).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFrequency / Percentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Teeth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecayed Teeth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMissing Teeth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFilled Teeth\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e324 (84.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAverage DMFT scores across Classes 6\u0026ndash;10 ranged from 6.27 to 7.65, all within WHO\u0026rsquo;s \u0026ldquo;very high\u0026rdquo; category, indicating a consistently high burden of untreated caries. Overall, dental caries prevalence was 97.7% (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Average DMFT Scores Across Education Level (n\u0026thinsp;=\u0026thinsp;385).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDMFT Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWHO DMFT Category\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClass 6th\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery high\u0026thinsp;\u0026gt;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClass 7th\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery high\u0026thinsp;\u0026gt;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClass 8th\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery high\u0026thinsp;\u0026gt;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClass 9th\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery high\u0026thinsp;\u0026gt;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClass 10th\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh (4.5\u0026ndash;6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental Caries Prevalence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e97.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) The Kruskal\u0026ndash;Wallis H test showed no significant association between age groups and DMFT scores (p\u0026thinsp;=\u0026thinsp;.095). Similarly, no significant differences were observed across educational levels (p\u0026thinsp;=\u0026thinsp;.327). In contrast, a significant difference in DMFT scores was found across parental income groups, (p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and last dental visit (p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of Total DMFT with Age, Education Level, Parental Income and Last Dental visit.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables Compared with Total DMFT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep-value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal DMFT with Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal DMFT Education Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal DMFT with Parental Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal DMFT with Last Dental Visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003ea\u0026thinsp;=\u0026thinsp;p-value from the Kruskal Wallis H Test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMann\u0026ndash;Whitney U post hoc tests with Bonferroni correction (adjusted p\u0026thinsp;\u0026lt;\u0026thinsp;.005) showed adolescents from the lowest-income households (PKR 10,000\u0026ndash;50,000) had significantly higher DMFT scores than those from higher-income groups (p\u0026thinsp;\u0026le;\u0026thinsp;.003). Similarly, adolescents who had never visited a dentist had higher DMFT scores than all other visit categories (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), except between those who visited 2\u0026ndash;5 years ago and 6\u0026ndash;12 months ago, where no significant difference was observed (p\u0026thinsp;=\u0026thinsp;.841). (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMann\u0026ndash;Whitney U Post-Hoc Comparisons of DMFT with Income Groups and Last Dental Visit\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePairwise Comparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003er \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIncome Groups\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10K\u0026ndash;50K vs. 50K\u0026ndash;100K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10K\u0026ndash;50K vs. 100K\u0026ndash;150K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3960.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-7.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10K\u0026ndash;50K vs. 150K\u0026ndash;200K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2775.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10K\u0026ndash;50K vs. 200K and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e846.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50K\u0026ndash;100K vs. 100K\u0026ndash;150K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50K\u0026ndash;100K vs. 150K\u0026ndash;200K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50K\u0026ndash;100K vs. 200K and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100K\u0026ndash;150K vs. 150K\u0026ndash;200K\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1543.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100K\u0026ndash;150K vs. 200K and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e428.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150K\u0026ndash;200K vs. 200K and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLast Dental Visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever vs. \u0026gt;1\u0026nbsp;year but \u0026lt;\u0026thinsp;2 yrs ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e448.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever vs. 2\u0026ndash;5 yrs ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever vs. 6\u0026ndash;12 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever vs. \u0026lt;6 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e966.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-12.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u0026nbsp;year but \u0026lt;\u0026thinsp;2 yrs ago vs. 2\u0026ndash;5 yrs ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-6.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u0026nbsp;year but \u0026lt;\u0026thinsp;2 yrs ago vs. 6\u0026ndash;12 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u0026nbsp;year but \u0026lt;\u0026thinsp;2 yrs ago vs. \u0026lt;6 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-11.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5 yrs ago vs. 6\u0026ndash;12 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;5 yrs ago vs. \u0026lt;6 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-6.813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;12 months ago vs. \u0026lt;6 months ago\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-9.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003ea\u0026thinsp;=\u0026thinsp;r\u003c/b\u003e: Effect Size, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:r=\\frac{z}{\\sqrt{N}}\\)\u003c/span\u003e\u003c/span\u003e (z= z-score from test statistic, N= total number of observations)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eb\u0026thinsp;=\u003c/b\u003e\u0026thinsp;p- value from Mann Whitney U Post-Hoc Comparison with Bonferroni Correction\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed adolescent oral health using the DMFT index within Andersen\u0026rsquo;s Behavioral Model. Oral health was significantly associated with socio-demographic, enabling, and behavioral factors, while age showed no significant association (p\u0026thinsp;=\u0026thinsp;0.095), despite reported increases: 5.19 to 8.90 at 14\u0026ndash;20 vs. 21\u0026ndash;25 years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], from 0.6 at 9 to 1.23 at 11 years in Iran [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and from 2.32 at 12 to 4.09 at 15 years in Serbia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Gender was skewed (83% males); prior studies show higher female DMFT in the UK (IRR 1.28\u0026ndash;1.16; mean 6.37 vs. 4.66) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and similar findings in Pakistan, India, Saudi Arabia, and the Philippines [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Education showed no association (p\u0026thinsp;=\u0026thinsp;0.327), whereas studies in Norway [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Italy (DMFT 4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] found higher caries with lower education. Longer intervals between visits corresponded to poorer oral health, consistent with Quetta [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], while a China study linked more visits to higher caries due to symptom-driven care (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Oral hygiene was suboptimal (30.1% brushed once, 8.6% twice, 9.1% never), aligning with Brazil (40% higher caries with twice vs. \u0026ge;3 times brushing), China (32.6% brushed twice) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], Sweden/Denmark (26\u0026ndash;33%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and Pakistan (76% suboptimal; OR\u0026thinsp;=\u0026thinsp;1.86; p\u0026thinsp;=\u0026thinsp;0.04) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Toothpaste use was 58.4%, compared with 91% in China (77.8% fluoridated) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; Pakistani daily fluoride users had 20% caries vs. 50% in occasional and 40% in non-users (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Smoking (6.5%) remained harmful, with Lithuanian adolescents showing higher caries and poorer periodontal health (p\u0026thinsp;=\u0026thinsp;0.023) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and Pakistani smokers demonstrating higher DMFT, periodontal disease (45%), lesions (15%), and increased odds of caries (OR\u0026thinsp;=\u0026thinsp;2.8) and periodontal disease (OR\u0026thinsp;=\u0026thinsp;3.5) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Self-rated oral health reflected clinical need: 44.7% rated their teeth as average, 5.7% as poor, and 41% reported discomfort, consistent with Northwest China (11% poor, 53% moderate, 36% good) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Pakistan (59.1% average) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Caries prevalence was 97.7%, with median scores of 5.0 decayed, 2.0 missing, and 0.0 filled teeth; most had 5\u0026ndash;6 decayed teeth, and 84.2% had no restorations, indicating substantial unmet need. International prevalence ranges from 72.9%\u0026ndash;88.6% in Saudi Arabia and Poland (DMFT 4\u0026ndash;5) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], while an Indian review reported 54.2% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Pakistani studies report 69.4%\u0026ndash;76% prevalence, confirming widespread untreated decay [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Most adolescents (66.2%) belonged to households earning PKR 10,000\u0026ndash;50,000, and DMFT scores varied significantly by income (p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The lowest-income group had the highest mean rank (227.80), while higher-income households (PKR 100,000\u0026ndash;200,000) had lower ranks, confirming socioeconomic gradients in caries. Similar findings were reported in Korea (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and a meta-analysis of 493,360 European adolescents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In Pakistan, low-SES children show poorer oral health [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], though data specific to ages 13\u0026ndash;18 remain limited. Geographic barriers were substantial: 44.2% reported no facility nearby; 50.6% were unsure of travel time; 27.5% travelled over an hour, and only 8.1% had access within 30 minutes. Similar disparities exist in the U.S., where 1.7\u0026nbsp;million lack a clinic within 30 minutes and 24.7\u0026nbsp;million live in shortage areas (1 dentist per 5,000) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and in Malaysia and Saudi Arabia, where only\u0026thinsp;~\u0026thinsp;40% access clinics within 30 minutes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The main barriers to dental visits were service unavailability (41.6%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], cost (20.5%) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], fear (14.3%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], time constraints (10.4%) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], lack of perceived need (6.8%) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and other reasons (6.5%).This study highlights how predisposing, enabling, and need-based factors shape adolescent oral health in rural Pakistan, underscoring the need for targeted public health interventions. Much of the information was self-reported, which may introduce recall or reporting bias. The sample was predominantly male and limited to a single district, so the findings may not fully represent all adolescents. Additionally, we did not collect objective measures of access such as travel time or mapping of nearby facilities. A high burden of untreated dental decay was observed. To address these gaps, efforts must focus on expanding access, affordability, and raising awareness for underserved populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are deeply thankful to the participating schools, students, and their families for their cooperation and support throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Clinical trial number\u003c/strong\u003e: not applicable.\u003cbr\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e: No Funding.\u003cbr\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The datasets generated and analyzed during the current study are not publicly available due to ethical and confidentiality considerations involving human participants, particularly minors. All participant identifiers were removed, and data were anonymized prior to analysis. Due to these ethical restrictions, public data deposition is not possible; however, anonymized datasets are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoin M, Maqsood A, Haider MM, Asghar H, Rizvi KF, Shqaidef A, Sharif A, Suleman R, Das G, Alam G MK, et al. The Association of Socioeconomic and Lifestyle Factors with the Oral Health Status in School-Age Children from Pakistan: A Cross-Sectional Study. Healthcare. 2023;11(5):756.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandrashekar P, Rene SJ. Preventive Oral Healthcare Programs Worldwide: A Narrative Review. J Sci Dent. 2023;13(1):25\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbodunrin OR, Olagunju MT, Alade OT, Fol\u0026aacute;yan MO. Relationships between Oral Health and the Sustainable Development Goals: A Scoping Review. 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Saudi Dent J. 2018;30(3):214\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMilona M, Janiszewska-Olszowska J, Szmidt M, Kłoda K, Olszowski T. Oral Health Related Behaviors in Relation to DMFT Indexes of Teenagers in an Urban Area of North-West Poland\u0026mdash;Dental Caries Is Still a Common Problem. Int J Environ Res Public Health. 2021;18(5):2333.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShad S, Anee Q-U-A, Liaquat S, Khattak F, Basit K, Waheed U. DENTAL CARIES PREVALENCE AND ORAL HEALTH STATUS IN 3 TO 15 YEARS OLD SCHOOL STUDENTS IN ABBOTTABAD CITY, PAKISTAN: AN ASSESSMENT SURVEY. J Khyber Coll Dent. 2023;13(2):16\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShahid F, Habib MF, Masood M, Naseem A, Mahmood H. 2024 Mar 31. Evaluation of Oral Health Status and Dietary Habits in School Children among age 12\u0026ndash;14 years; A Cross-Sectional Study: Oral Health Status and Dietary Habits in Children. Pak J Health Sci:17\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahman MS, Blossom JC, Kawachi I, Tipirneni R, Elani HW. Dental Clinic Deserts in the US: Spatial Accessibility Analysis. JAMA Netw Open. 2024;7(12):e2451625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaider SS, Martins RS, Ali R, Rizvi NA, Mustafa MA, Aamdani SS, Rehman AA, Pervez A, Nadeem S, Siddiqui HK et al. 2024. Primary Care Clinical Practice Guidelines and Referral Pathways for Oral and Dental Diseases in Pakistan. Oral 4(3):343\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShubayr MA, Kruger E, Tennant M. Geographic accessibility to public dental practices in the Jazan region of Saudi Arabia. BMC Oral Health. 2022;22(1):249.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJessani A, Quadri MFA, Lefoka P, El-Rabbany A, Hooper K, Lim HJ, Ndobe E, Brondani M, Laronde DM. Oral Health Status and Patterns of Dental Service Utilization of Adolescents in Lesotho, Southern Africa. Children. 2021;8(2):120.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Aring;str\u0026oslash;m AN, Agdal ML, Sulo G. Exploring avoidance of dental care due to dental fear and economic burden \u0026ndash;A cross-sectional study in a national sample of younger adults in Norway. Int J Dent Hyg. 2024;22(1):148\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastillo KB, Echeto L, Schentrup D. Barriers to dental care in a rural community. J Dent Educ. 2023;87(5):625\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrouch E, Nelson J, Merrell MA, Martin A. The oral health status of America\u0026rsquo;s rural children: An opportunity for policy change. J Public Health Dent. 2021;81(4):251\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescents, Andersen Model, DMFT, Oral Health, Pakistan","lastPublishedDoi":"10.21203/rs.3.rs-8441003/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8441003/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Poor dental health is a public health problem in Pakistan, particularly in underserved regions such as Mohmand Agency, Khyber Pakhtunkhwa, where oral health is neglected compared to infectious diseases, maternal and child health, and nutrition. Limited awareness and inadequate dental facilities have worsened the situation, though improving oral health aligns with SDG3. This study assessed the oral health status of school-going adolescents and identify determinants of dental caries using Andersen’s Behavioral Model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional survey among 385 adolescents aged 13–18 years was conducted through multistage cluster random sampling. Oral health was measured using DMFT index, while a structured questionnaire collected information on predisposing, enabling, need-based, and behavioral factors. Data were analyzed using SPSS v20.0 with Kruskal-Wallis H and Mann-Whitney U tests with Bonferroni correction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Most participants were male (83%), early adolescents (53.2%), and from low-income households (66.2%),39% had never visited a dentist. The prevalence of dental caries was 97.7%. DMFT was not associated with age (p = 0.095) and education (p = 0.327), but parental income and last dental visit were significantly related to DMFT (p \u0026lt; 0.001). Post hoc tests revealed higher DMFT scores among those from the lowest income group and those who had never visited a dentist. \u003cstrong\u003eConclusion\u003c/strong\u003e: Adolescents exhibited high burden of untreated dental caries, influenced by financial barriers and lack of dental care. The findings underscore the need for oral health promotion, improved service accessibility, and policy interventions to address disparities in underserved regions.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Oral Health status and Dental Service Utilization among school adolescents of Mohmand Agency, Pakistan using Anderson Model. A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 19:46:17","doi":"10.21203/rs.3.rs-8441003/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6425dd11-d067-4399-bd18-a96c10849cf5","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T10:27:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 19:46:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8441003","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8441003","identity":"rs-8441003","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}