Abstract
<title>Abstract</title> <p>Background Oral diseases represent a significant and growing public health burden in rural India. In Lucknow district, rural communities face a convergence of high disease prevalence, limited infrastructure, financial hardship, and entrenched socio-cultural barriers that collectively restrict access to timely dental care. Objectives This study aimed to assess oral health practices, service utilization, economic burden, and barriers to dental care among rural residents of Lucknow, Uttar Pradesh, and to explore strategies for strengthening oral health systems through community and stakeholder engagement. Methods A convergent mixed-methods design was employed, integrating a cross-sectional quantitative survey (n = 400) with Focus Group Discussions (2 FGDs, n = 12 participants) and clinical examination using the WHO Oral Health Assessment Form (2013). Results Clinical caries prevalence was 81.8% and periodontal disease was found in 55.8% of participants. A total of 60.8% of participants had never visited a dentist. Key barriers included high treatment cost (40.3%), perceived lack of need (19.5%), and transport difficulties (48%). Qualitative findings, mapped onto the 5 A's framework, confirmed structural, financial, socio-cultural, and system-level barriers across all five access dimensions. Conclusions Oral healthcare utilization in rural Lucknow is low, inequitable, and predominantly reactive. Integrated, affordable, community-based interventions are urgently needed, alongside systemic reforms to primary healthcare infrastructure and health insurance coverage.</p>