Oral Health Status and Associated Factors in a Stratified Cluster Sample of Marginalized Palestinian Schools: A Cross-sectional Study

Purpose: To assess factors related to the prevalence of dental caries among adolescent schoolchildren attending marginalised schools in the West Bank area of Palestine. Materials and Methods: A cross-sectional study was conducted in schools participating in the School Support Program (SSP). Fifty schools identified as marginalised by the SSP were stratified by district, student gender and grade level to select a random sample of 20 schools. Students in the 6th and 9th grades were screened by senior dental students to collect data about their weight, height, gingival health and caries experience. In addition, a structured in-person questionnaire was used to collect data about students' oral hygiene practices, dietary habits, mother's education and father's employment. Results: In total, 1282 students completed interviews and clinical screenings. The mean number of Decayed, Missing and Filled Teeth (DMFT) was 6.4 +/- 4.4. Sixty-four percent had moderate gingivitis and 73% had fair oral hygiene. 'Recent visit to the dentist' was associated with mother's level of education (X-2 = 22.06, p < 0.001) and father's employment (X-2 = 24.02, p < 0.001). The final regression model showed that grade (beta = 0.31, p < 0.001), gender (beta = 0.06, p < 0.03), recent visit to the dentist (beta = -0.06, p < 0.03) and drinking fresh juices (beta = -0.05, p < 0.05) were statistically significant in explaining the high level of caries in this sample. Conclusions: This study indicates that Palestinian adolescents in marginalised governmental schools suffer the highest burden of dental disease and are disproportionally impacted when compared to other same-age students in the region. A high burden of disease was directly associated with unfavourable dietary habits, poor oral hygiene practices and challenges to accessing dental care services, and was indirectly associated with father's employment and mother's level of education.