Suppose $K = \mathbb{Q}(\alpha)$ with $[K:\mathbb{Q}] = n > 1.$ Then must its ring of integers $\mathcal{O}_K$ contain $\alpha$? I think it must, and here is my reasoning: suppose it did not. Now $K$ is the field of fractions of $\mathcal{O}_K$ and $\mathbb{Q} \cap \mathcal{O}_K = \mathbb{Z},$ so this means $\mathcal{O}_K = \mathbb{Z},$ hence $K = \mathbb{Q},$ a contradiction as the degree of the extension is greater than $1.$ Is this correct?
Also, I was also wondering if the converse holds, i.e. if $\mathcal{O}_K = \mathbb{Z}[\alpha],$ then is $K = \mathbb{Q}(\alpha)?$ I believe the same reasoning (that $K$ is the field of fractions of $\mathcal{O}_K$) gives us this result again?
If $K = \mathbb{Q}(\alpha)$ for some $\alpha \in K$, then you can multiply or divide $\alpha$ by elements $c \in \mathbb{Z}$ so that the result is or is not in $\mathcal O_K$, as you wish. You can see this by combining four facts:
So, you can always write $K = \mathbb{Q}(\alpha)$ for some $\alpha \in \mathcal O_K$. For such $\alpha$, you always have $\mathcal O_K \supseteq \mathbb{Z}[\alpha]$. A more interesting question is whether it is always possible to choose $\alpha$ so that these rings are equal (e.g. for quadratic extensions this is possible, the Gaussian integers satisfy $\mathcal O_{\mathbb{Q}[i]} = \mathbb{Z}[i]$). The answer is surprisingly no!
To your second question (as I indicate in the previous paragraph, this is not a true converse: if $\alpha \in \mathcal O_K$, then you only have $\mathbb{Z}[\alpha] \subseteq \mathcal O_K$, not necessarily equal), the answer is yes.
In general, if $R$ is an integral domain with quotient field $K$, and $x$ is an element in a field $L$ containing $K$, then the quotient field $E$ of $R[x]$ is $K(x)$. Certainly $E$ must contain the inverses of elements of $R$ as well as the inverse of $x$, so $K(x) \subseteq E$. On the other hand, $R[x] \subseteq K[x]$, so we have $E = \textrm{quot } R[x] \subseteq \textrm{quot } K[x] = K(x)$.