Oral health is an essential component of overall health and well-being. The levels of knowledge, attitudes, and behaviors related to oral health are key determinants in the prevention of dental and periodontal diseases. Assessing these aspects across different population groups is crucial for identifying specific educational needs and developing effective strategies for the promotion and maintenance of oral health.
Data from scientific publications indexed in PubMed, Hinari, SpringerLink, NCBI, and Medline databases were analyzed. The selection criteria included current evidence regarding oral health knowledge, attitudes, and practices among different population groups. Observational, cross-sectional, descriptive and quantitative studies, as well as meta-analyses published between 2005 and 2026, were included.
The vast majority of the adult population (>90%) demonstrated a high level of oral health knowledge; however, fewer than half exhibited positive attitudes and appropriate behaviors necessary for proper oral care. Among adolescents, the proportion of individuals with satisfactory oral health knowledge ranged from 59% to 77%, while positive attitudes ranged from 57% to 92%. Female adolescents showed significantly better knowledge, attitudes, and behaviors related to oral health compared with their male counterparts. Dental students demonstrated higher levels of oral health knowledge and more positive attitudes than students from other academic disciplines, with significant improvements observed alongside academic progression and increasing clinical experience. They were better trained in toothbrushing techniques, reported a higher frequency of toothbrushing, used supplementary oral hygiene products more frequently, had a lower prevalence of gingival diseases, and attended preventive dental check-ups more regularly.
Although oral health knowledge is generally satisfactory, it is not always reflected in appropriate oral health behaviors. The implementation of oral health education programs at all educational levels is essential for improving oral hygiene practices and promoting the overall health of the population.
Current evidence on oral health knowledge, attitudes, and practices is predominantly focused on individual population groups, limiting direct comparisons across different demographics. The extent to which knowledge influences attitudes and preventive oral health behaviors remains insufficiently understood. Furthermore, population-specific factors associated with oral health practices require further investigation.
The study hypothesizes that oral health knowledge, attitudes, and practices differ significantly among various population groups. It is also hypothesized that higher levels of oral health knowledge are associated with more positive attitudes and better preventive oral health behaviors.
This manuscript provides a comparative evaluation of oral health knowledge, attitudes, and practices across different population groups within a single research framework. It identifies disparities between knowledge and actual behaviors, generating evidence that can support the development of targeted oral health promotion interventions.
The assessment of knowledge, attitudes, and practices (KAP) regarding oral health in different population groups represents an important objective of contemporary dentistry, contributing to the achievement of structural and administrative changes aimed at optimizing dental care. Certain medical, biological, and social factors, personal motivation, and the frequently inadequate level of dental care significantly influence the rate of dental morbidity within the population [1, 2].
Existing studies have identified a strong and significant association between oral health knowledge and poor oral hygiene, and common dental conditions (dental caries, periodontal diseases, tooth loss). Knowledge regarding oral health can influence attitudes and oral hygiene practices – toothbrushing, the use of supplementary dental hygiene aids, and periodic dental visits [3-5]. The assessment of KAP levels regarding oral health in different population groups will provide valuable information about behaviors in this field, identify strengths and weaknesses, indicate potential barriers to the promotion of oral health, and serve as a reference point for the development and implementation of intervention programs aimed at improving oral health in the population [6].
In this context, the aim of this article is to present a synthesis of the most recent data on oral health knowledge, attitudes, and practices in the adult population, adolescents, and in young adults at the university level (dental, medical, and non-medical students).
In order to achieve the proposed objective, a preliminary search of specialized scientific publications was conducted in the following databases: PubMed, Hinari (Health Internet Work Access to Research Initiative), SpringerLink, NCBI (National Center for Biotechnology Information), and Medline. The article selection criteria included current data on knowledge, attitudes, and practices regarding oral health in the adult population, adolescents, and students, considering the following keywords: “oral health”, “adult population”, “adolescents”, and “students”, used in various combinations with the words “knowledge”, “attitudes”, “behavior”, “practices”, “risk factors”, “dental caries”, and “periodontal diseases” in order to maximize search yield.
For the advanced selection of bibliographic sources, the following filters were applied: full-text articles, articles in the English language, and articles published between 2005 and 2026. Following a preliminary analysis of titles, original articles, editorials, narrative review articles, systematic reviews, and meta-analyses containing relevant information and current concepts regarding oral health knowledge, attitudes, and practices in the adult population, adolescents, and students were selected. Additionally, a search was conducted through the reference lists of the identified sources in order to identify supplementary relevant publications not found during the initial database search.
In order to minimize the risk of systematic errors (bias) in the study, thorough searches of the databases were performed to identify the maximum number of publications relevant to the study aim, only studies meeting validity criteria were evaluated, and reliable exclusion criteria were applied to articles.
Duplicate publications, articles whose content did not reflect the addressed topic, as well as articles that were not freely accessible or accessible through the Hinari database, or available in the medical scientific library of Nicolae Testemițanu State University of Medicine and Pharmacy, were excluded from the list.
Following the processing of information retrieved from the PubMed, Hinari, SpringerLink, NCBI, and Medline databases according to the search criteria, 235 articles addressing the topic of oral health knowledge, attitudes, and practices in different population groups were identified. Following a preliminary analysis of titles, 69 articles were selected as relevant for this review. After a further detailed review of these sources, 48 publications pertinent to the stated aim were ultimately identified. The final bibliography of the paper included 48 articles, which were considered representative of the published material in the field addressed by this review article.
A study conducted in India on a sample of 288 adults aged 18 years and older found that 97.9% of study participants had good knowledge of oral health. Nevertheless, the high level of awareness did not correspond to a positive attitude (33.3%) and adequate oral health and hygiene behaviors (48.2%). This was attributed to the minimal importance individuals attach to oral health. Women demonstrated better oral care practices than men, although knowledge and attitude were not significantly affected by gender [5].
A cross-sectional survey, published in 2025, assessed knowledge, attitudes, and behaviors among 367 adults aged 18 years and older from Saudi Arabia. Among these, 90.2% were aware of the link between tobacco use and oral cancer, and 89.1% held favorable opinions regarding the use of fluoride toothpaste to prevent dental caries. However, only 55.6% of respondents brushed their teeth twice a day, and only 44.7% visited the dentist on a regular basis. Women demonstrated significantly better oral health knowledge and attitudes than men (p = 0.0001), older individuals had broader knowledge than younger ones (p = 0.004), and participants with a higher monthly income scored higher on oral health knowledge (p = 0.003) [7].
Thus, studies among adults (>18 years) have highlighted an imbalance between attitude and behavior towards oral health, despite high levels of knowledge. The vast majority of respondents possess a high level of oral health knowledge; however, fewer than half demonstrated a positive attitude and adequate behavior – the pillars of successful long-term oral hygiene. The implementation of oral health promotion programs is essential to modify public perception and reduce the economic and medical impact of dental conditions. Health education not only improves knowledge but also creates lasting attitudes and behaviors necessary for adequate oral hygiene [5, 7].
The assessment of oral health awareness and practices among all patients attending dental outpatient clinics revealed that 35% brushed their teeth, 20% used supplementary oral hygiene aids, and 40% had no concern for oral cavity hygiene. The majority of subjects (80%) visited the dentist only in advanced stages of disease or in emergency situations. Only 15.7% of patients visited the dentist for regular preventive dental examinations [8]. Similar findings have been reported in other studies [9].
Thus, patients – particularly those from rural areas – are insufficiently informed about oral health and possess inadequate knowledge of oral hygiene practices and their effects on general well-being. There is a discrepancy between declared oral health knowledge, dietary habits, and dental practices. These results confirm the imperative need to develop oral health education programs for the general population, particularly for children and adolescents [5, 10, 11].
Childhood and adolescence are critical stages for oral health, as habits and knowledge acquired during this period tend to persist throughout life. Nevertheless, many young people exhibit suboptimal oral hygiene behaviors, contributing to the onset of oral health problems. Although genetic factors may influence the morbidity of dental and periodontal diseases, dietary behavior, preventive measures, and oral hygiene practices play a more decisive role in their development [12].
A systematic literature review, which including 12 articles assessed oral health knowledge, attitudes, and behaviors among children and adolescents aged 10–19 years in Vietnam and Sweden. Bleeding gums were recognized as a clinical sign of gingivitis by one-third of Vietnamese children and adolescents. In Sweden, knowledge levels ranged between 75% and 83%. In both Vietnam and in Sweden, the importance of bright and white teeth was emphasized. Toothbrushing twice daily or more was reported by 40–68% of participants from Vietnam and 73–82% from Sweden. The highest percentage of children and adolescents consuming sweets daily or more frequently was 59.7% in Vietnam and 2–6% in Sweden. Thus, oral health knowledge is insufficient in both Sweden and Vietnam. Attitudes toward oral health are focused more on dental aesthetics than on general health status. Oral health-related behaviors are inadequate. Both Sweden and Vietnam already have oral health programs, but these require improvement [13].
Among 287 adolescents aged 10–18 years, 66.5% brushed their teeth daily. This indicator showed a significant gender difference (p = 0.001) – girls, compared to boys, demonstrated better dental practices, were more aware of gum bleeding (P<0.001), the effects of oral health on general health (p = 0.004), the importance of periodic dental check-ups (p<0.001), and tooth color (p = 0.05). Thus, approximately two-thirds of children brush their teeth, a proportion similar to that reported 10 years ago. Evidence-based, effective dental health awareness programs are needed to improve dental practices [14]. Similar results among students aged 9–18 years were also obtained in the study conducted by Kaleem et al. [15].
A descriptive cross-sectional study assessed KAP regarding oral health and examined their association with sociodemographic factors. The study included 395 students (56.7% boys and 43.3% girls) aged 11–18 years (mean age 14.24 years) from a high school in Nepal. Although the majority of students demonstrated good oral health knowledge (305 – 77.2%) and positive attitudes (363 – 91.9%) toward oral hygiene, there was reluctance regarding dental visits. Additionally, only 162 (41%) practiced adequate oral hygiene methods, with issues including suboptimal brushing technique, low use of dental floss, and excessive chocolate consumption. Oral hygiene practices ranged from many instances of brushing once a day (194 – 49.5%) to low rates of dental floss use (39 – 9.9%). Significant associations were found between knowledge and age group (p = 0.02) or students' grade (p<0.001). Oral health practices were significantly associated with gender (p = 0.008), age group (p<0.001), and students' class (p<0.001). Despite holding satisfactory attitudes, boys and younger individuals demonstrated lower knowledge levels and poorer practices. Overall, regardless of adequate knowledge and attitudes, adolescents exhibited unsatisfactory oral health practices. The study highlights the importance of improving oral health behaviors through specific interventions – educational programs, counseling, and parental involvement. These efforts are crucial for translating good knowledge and positive attitudes into consistent and effective oral hygiene behaviors [16].
The objective of another descriptive cross-sectional study was to assess KAP levels regarding oral hygiene in a total of 461 students (251 – 54.4% boys and 210 – 45.6% girls) aged 5–19 years from a government school in Pakistan. The majority of children (446 – 97%) demonstrated regular oral hygiene practices. Soft toothbrushes were used by 234 (50.8%) participants, and the brushing technique adopted by the majority of students (210 – 45.6%) was the traditional horizontal method, while 75 (16.3%) used a combination of brushing movements. A toothbrushing duration of 2 minutes was practiced by 156 (33.8%) respondents, while 54 (11.7%) brushed for less than one minute. Knowledge outcomes were good, although a predominance of unhealthy dietary habits was observed. The study authors concluded that oral hygiene behavior and knowledge outcomes were good (380 – 82.4%); however, only 146 (31.7%) children had visited the dentist, and the concept of regular dental check-ups was almost nonexistent (0.4–0.7%). For change to be lasting and to progress from mere attitude to rigorous practice, ongoing and tailored oral health education programs are required [17].
The conclusions of the studies highlight those various factors – insufficient oral health knowledge, poor attitudes toward dental hygiene, dietary habits, lack of confidence in toothbrushing technique, and dental phobia – complicate healthy oral behavior in adolescents. In general, high-school students demonstrated satisfactory knowledge, positive attitudes, and inadequate practices regarding oral hygiene and dental and periodontal disease prevention. Female students, particularly those in higher grades, adolescents with educated parents, and those with prior oral health information demonstrated significantly better oral health KAP. The main reason for dental problems is neglect of oral health and dental visits [14, 15, 18-21].
Motivational interviewing, by stimulating awareness, motivation, and the desire for change, has shown superior results in improving oral health knowledge, status, and behaviors. The personalized, person-centered approach of motivational interviewing enables participants to develop a deeper understanding of the importance of oral health [22-24].
Dental practitioners and dental students play a crucial role in public health through specific preventive, diagnostic, and therapeutic actions, reducing the incidence of dental and periodontal diseases. They contribute to educating the population regarding correct oral hygiene, a healthy diet, and periodic dental check-ups, thereby influencing quality of life and reducing risk factors. The perceptions, attitudes, and practices regarding oral health of dental students have a significant impact on treatment competencies, reflect the importance of promoting preventive measures against dental and periodontal diseases, and indicate a responsibility for improving patients' oral health [25-28].
A comparative study on oral health KAP included a total of 487 undergraduate dental students, of whom 372 (76.4%) were women, 271 (55.6%) were in preclinical years, and 68 (14%) smoked at least once a week. The mean score on the Hiroshima University Dental Behavioral Inventory (HU-DBI) questionnaire in the overall student cohort was 8.18±1.80, a figure comparable to previously reported scores of dental students in Nordic and Western European countries. Czech students had a statistically significantly higher HU-DBI score compared to their Slovak counterparts (9.34±1.29 and 7.56±1.73, respectively; p<0.001). In the Czech Republic, significant increases in HU-DBI questionnaire scores occurred after the first university year when students took courses in preventive dentistry. Thus, it can be argued that the early integration of preventive elements into undergraduate dental curricula yields greater and more durable gains in students' oral health behavior [29].
Riad et al., in a descriptive cross-sectional study, assessed oral health-related KAP among dental students in Estonia by distributing a paper-based questionnaire. Of the 124 students included in the analysis, 98 (79%) were women and 26 (21%) were men. The mean HU-DBI questionnaire score of the students was 8.09±1.22 – one of the highest scores recorded in Europe. Although there was a trend toward a higher mean HU-DBI score in women (8.16 and 7.81, respectively; p>0.05), this difference did not reach statistical significance [30].
Another descriptive cross-sectional study, using a self-administered questionnaire, assessed oral health-related KAP among dental students in Germany. Among the 508 students included in the analysis, 377 (74.2%) were women, 197 (38.7%) were clinical students, 58 (11.4%) smoked at least once a week, and 135 (26.6%) consumed alcohol at least once a week. The mean HU-DBI questionnaire score of the students was 7.67±1.32. Although there was a trend towards a higher mean HU-DBI score in women (7.70±1.33 and 7.59±1.29, respectively; p>0.05), this difference did not reach statistical significance. Clinical-year students had a significantly higher HU-DBI questionnaire score, particularly in the domain of oral health behaviors, compared to preclinical students (7.88±1.26 and 7.53±1.34, respectively; p=0.003) [31].
The aim of a study conducted in Romania was to assess the attitudes and behaviors of dental faculty students toward their own oral health. The HU-DBI questionnaire and a clinical examination to assess the prevalence of dental caries were administered to 110 students in the final year of undergraduate studies, including 70 (63.6%) females and 40 (36.4 %) males, with a mean age of 24.1 years. The prevalence of dental caries was 66 (60%), and only 8 (7.3%) students had a caries index of 0. The mean HU-DBI index value ranged from 6 to 12, with a mean of 9.8. Subjects with a low prevalence of dental conditions had appropriate attitudes and practices. Thus, the correct attitude of future dental practitioners toward their own dental and periodontal health status represents an important determinant of their general health status, and as medical training advances, a favorable development in attitude toward it can be observed [32].
An assessment of oral health knowledge, attitudes, and behaviors was carried out in a quantitative cross-sectional study among dental students at a university in Palestine. The study included 366 students, comprising 211 (57.7%) women and 155 (42.3%) men, 199 (54.4%) clinical students (years IV–V), and 167 (45.6%) preclinical students (years I–III). The mean HU-DBI questionnaire score was 7.23±1.77. Female students, compared to their male counterparts, obtained significantly higher total scores (7.54 and 6.83, respectively; p=0.0001) and behavior scores (2.29 and 1.81, respectively; p=0.0001). No significant differences (p>0.05) were found by gender with regard to oral health knowledge and attitudes. Compared to preclinical students, clinical students obtained statistically significantly higher total scores (7.70 and 6.68, respectively; p<0.0001), knowledge scores (3.60 and 3.25, respectively; p=0.0168), and behavior scores (2.46 and 1.65, respectively; p<0.0001), with no significant differences regarding attitudes (p>0.05). The study authors concluded that dental faculty students generally demonstrated positive oral health awareness. Female students and preclinical students had significantly better preventive behaviors and higher overall HU-DBI questionnaire scores. These findings underscore the major role of consolidating preventive dentistry concepts and practical oral hygiene training from the preclinical years onward in sustaining consistent personal care [28].
The oral health knowledge, attitudes, and practices held by dental students serve as benchmarks in oral health education and community health promotion. Since men and women have different physiological and psychological characteristics, oral health KAP differ between them [33, 34]. Female students, including those at dental faculties, have statistically significantly better oral health KAP than their male counterparts. Female students practiced appropriate dental hygiene techniques, brushed their teeth with greater frequency (p<0.001), and used toothpaste during brushing (p<0.01) more frequently than male students. Approximately 47% of male students brushed their teeth less than twice a day, compared to 21% of female students. On the other hand, smoking was far more prevalent among men than among women (31% vs. 4%; p<0.001) [35, 36].
The positive oral health behaviors and attitudes of women can be explained by their greater emphasis on dental aesthetic treatments. Women are more interested in their oral health status, undergo regular dental check-ups, recognize that sugar-containing foods and carbonated beverages can damage teeth, and understand the negative impact of smoking on oral health. Women tend to perceive dental health as an essential component of quality of life, physical appearance, and general well-being [29, 35, 36].
The knowledge and behaviors of dental students are not consistent across preclinical and clinical years of undergraduate studies. Furthermore, the attitudes and behaviors of dental students toward oral health may differ according to country, region, and culture [27, 37, 38].
Reports from many countries (Syria, India, Turkey, Iraq) suggest that clinical-level students, compared to preclinical-level students, tend to obtain higher HU-DBI questionnaire scores, indicating superior oral health KAP. The oral health-related behaviors and attitudes of dental students improve with the progression of the academic years, that is, with the level of dental education. Several authors have found a statistically significant improvement in knowledge, attitudes, and behaviors among final-year students compared to first-year students, attributed to increased professional knowledge and patient contact. Thus, concomitantly with advancing levels of education and professional performance, clinical-level students (compared to preclinical-level students) and female students (compared to male students) demonstrate a better perception of their knowledge, improved attitudes, and the adoption of preventive behaviors toward oral health [27, 37, 39-41].
Nevertheless, some studies from Syria and Pakistan found no statistically significant differences between students in clinical and preclinical training regarding oral health KAP. It is possible that the integration of oral health education into the preclinical curriculum contributed to the improvement of KAP in this field. Gender differences were consistently observed – female students demonstrated significantly higher HU-DBI scores, reflecting greater concern for oral hygiene and preventive practices [39, 42, 43].
There is a difference between dental students and their peers from other faculties. Dental students exhibit better oral hygiene practices and more favorable attitudes toward oral health. They are better trained in toothbrushing techniques, brush their teeth more frequently, use supplementary oral hygiene products, have a lower incidence of periodontal diseases, and visit the dentist more frequently than their peers from other faculties. KAP scores are significantly higher among dental students than among medical students. Although dental students have better oral health knowledge and attitudes, their adoption of adequate practices remains insufficient. Women, in both dentistry and medicine, have better oral health knowledge and practices than their male counterparts [36, 44-46].
In general, the oral health knowledge, attitudes, and behaviors of dental students are better than those of medical students, as oral health constitutes a significant part of their curriculum and consequently positively influences their attitudes and behaviors. Furthermore, dental students possess more theoretical knowledge about the aesthetics of oral structures than medical students. Nevertheless, all future healthcare providers must hold a positive attitude toward oral health. Therefore, comprehensive oral health awareness programs must be incorporated into the curriculum for all health sciences students throughout their training [4, 45, 47, 48].
Knowledge, attitudes, and practices regarding oral health constitute essential components of preventive health behaviors and play a significant role in maintaining oral health across different population groups. A comparative analysis of these dimensions provides a broader understanding of the specific characteristics and needs of each population group, contributing to the identification of priority areas for public health interventions. This study makes a meaningful contribution to the existing literature by providing an integrated perspective on oral health and supporting the development of educational and preventive programs tailored to the characteristics of these diverse groups.
None declared
AB made a substantial contribution to the conception and design of the work, data acquisition, and the analysis and interpretation of data. DU and LS contributed to drafting the article and critically revising it for important intellectual content.
No external funding.
Not commissioned, externally peer-reviewed.
Adela Băișanu – https://orcid.org/0009-0003-4417-1469
Larisa Spinei – https://orcid.org/0000-0002-5370-9801
Diana Uncuta – https://orcid.org/0000-0001-8172-2854