Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Epidemiology and Biostatistics


Gomaa, Noha

2nd Supervisor

Campbell, M. Karen



Oral health is consistently linked to physiological, psychological, and social aspects of well-being in adolescents and young adults. In this thesis, I aimed to examine the social determinants of oral health and dental care utilization. First, I conducted a scoping review of the literature, demonstrated the multifaceted nature of oral health and its connections to broader social and economic factors. Then, I conducted a cross-sectional analysis of the Canadian Community Health Survey which showed a social gradient in oral health and dental care utilization among adolescents and young adults in Ontario. When stratified by age, there was a protective association between social and living conditions with oral health for young adults but not for adolescents. Further research should focus on addressing the social determinants of oral health in comprehensive oral health promotion efforts targeting adolescents and young adults.

Summary for Lay Audience

Oral health is a critical aspect of overall well-being, particularly during adolescence and young adulthood. This age group is characterized by significant developmental changes, both physically and psychologically, as well as important transitions such as entering the workforce and establishing independence occur. Thus, the aim of this thesis is to understand oral health inequalities in this age group while uncovering the behavioural and psychosocial factors contributing to such inequalities during this transition period.

The first study, aimed to review the existing literature on the social determinants of oral health inequalities in the United States and Canada for individuals aged 12 to 24 years old. A total of 21 relevant studies were located and analyzed, revealing a multifaceted landscape of oral health inequalities in this demographic group. These inequalities were found to be influenced by a complex interplay of factors including unhealthy behaviours, psychosocial stressors such as racial discrimination, and limited access to dental care for disadvantaged individuals. This scoping review results indicate suggests the need for future research, particularly longitudinal and interventional studies, to establish causality and assess the effectiveness of oral health interventions.

The second study, analyzed community survey data and used a large population-based sample from Ontario to examine the association of annual household income with each of self-reported oral health and dental care utilization and whether these associations differed between adolescents and young adults. The findings indicated a protective association between higher household income and self-reported oral health, with young adults benefiting more than adolescents. This protective effect of income on oral health was, however, partially attenuated by psychosocial stress factors. Furthermore, the study revealed that higher-income households had a lower prevalence of infrequent dental visits, emphasizing the importance of income in dental care utilization among both adolescents and young adults. The findings underscore the importance of addressing these oral health inequalities through policy measures aimed at reducing social inequalities and improving access to oral healthcare services to enhance oral health outcomes for this age group.