What makes inequality in the area of dental and oral health in developing countries? A scoping review

Translating the determinant aspects on the study design in the dental implant field

Objective

In this article, we analyzed the important categories capable of interfering with the determinants of scientific advancement in the type of study, considering seven leading journals over a 20-year.

Methodology

A bibliometric review was performed at the website of well-established implant dentistry journals in five-time points defined to represent a 20-year period of observation. The measures associated with the type of study design were: the country of origin of the article, country income, continent of the corresponding author, inter-institutional collaboration, interdisciplinary collaboration, type of funding, and topic of research. Logistic regression was used in the multiple models to identify the exploratory factors associated with the type of study.

Results

From a total of 1,944 articles, 50.6% comprised clinical studies. High-income countries and continents stood out for developing more clinical research than others. Since research funders request more collaborative research, overall clinical studies depended upon more inter-institutional collaboration than the others. Most clinical studies were partly supported by research institutes or universities and by industry. About the research topic, the majority of the clinical and animal studies disclosed surgical procedures.

Conclusions

High-income countries and continents are more likely to develop clinical studies in the surgical procedures field. The highest collaborations in terms of the number of institutions and funding sources are more prevalent in clinical research designs. Indeed, most in vivo studies in dental implant fields are performed to evaluate new materials or even new surgical procedures.

Determinants and inequality of recurrent aphthous stomatitis in an Indonesian population: a cross sectional study

INTRODUCTION

Recurrent Aphthous Stomatitis (RAS) is the most common type of ulceration in the oral cavity which can occur due to several factors.

AIMS

To determine the factors related to the incidence of RAS and examine the social class inequality in RAS among the Indonesian population using data from the fifth wave of the Indonesian Family Life Survey (IFLS5) in 2014.

METHODS

This study is a descriptive study with a cross-sectional design using secondary data from IFLS5 data in 2014 (n = 28,410). Socio-economic position (SEP) was calculated by Adult Equivalent Scale and categorized into 4 classes. Outcome is RAS. Mediating factors were psychosocial (stress), eating behavioral (food consumption), and systemic diseases. Descriptive analysis, chi-square and a series of logistic regressions were performed to analyze the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results.

RESULTS

Only 18.39% of IFLS5 respondents experienced the incidence of recurrent aphthous stomatitis in 2014. The bivariate (chi-square) results showed that there was a relationship between the incidence of RAS and the related independent variables. Logistic regression showed the highest possibility of RAS in respondents aged 18-34 years, female, unmarried, high school education level, living in the city, having frequent stress levels, having food habits that frequently drinking soda, sweet foods, chili sauce, fried food and has systemic diseases such as, asthma, cancer, rheumatism, and digestion. The lowest SEP group had the highest probability of occurrence of RAS over the other groups among the different models.

CONCLUSIONS

There are several factors that determine the incidence of RAS. There was a monotonic gradient of inequality in RAS according to SEP group. This study might be useful to provide information regarding the relationship of determinants factors with the incidence of RAS to prevent it and promote oral health in the future.

A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research

INTRODUCTION

Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India.

METHODOLOGY

The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review.

RESULTS

In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India.

CONCLUSIONS

This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.

Dental Health Utilization in Palau: Feasibility of an Oral Cancer Screening Program

Background

Cancer is the second leading cause of death in the Western Pacific region. The prevalent tradition of chewing betel nut in Palau, an island nation in this region, is a risk factor in the development of oral cancer. Oral cancer is the fifth most common cancer in Palau, and the prognosis can be improved with early detection facilitated by visual inspection of the oral cavity by dentists. The purpose of this study is to assess the feasibility of oral cancer screening using existing dental health infrastructure in Palau.

Methods

A mixed methods approach was used to explore topics related to the use of dental care resources in Palau. Primary outcome measures were collected using an electronic survey with closed- and open-ended questions addressing dental health utilization as well as barriers and facilitators to accessing dental care. Secondary measures assessed knowledge, attitudes, and beliefs about betel nut use and oral cancer. Open-ended survey questions were analyzed and coded to develop themes based in grounded theory.

Results

Two hundred twenty-three surveys were completed. The mean age was 42.7 years, 80% identified as female, and most (94.3%) report having seen a dentist in Palau. Dental care is seen as important (mean score 82.3/100), and 57.9% reported it was easy to access a dentist. Themes regarding facilitators include multilevel resources and transportation. Themes regarding barriers include cost and availability of dentists/appointments. Approximately half of the respondents were current users of betel nut.

Conclusion

Our results suggest facilitators are in place to promote seeking and obtaining dental care; however, existing infrastructure may not support an oral cancer screening program. These data provide important areas to address that can improve access and support the implementation of oral cancer screening through existing dental care in the future.

Smart dental materials for antimicrobial applications

Smart biomaterials can sense and react to physiological or external environmental stimuli (e.g., mechanical, chemical, electrical, or magnetic signals). The last decades have seen exponential growth in the use and development of smart dental biomaterials for antimicrobial applications in dentistry. These biomaterial systems offer improved efficacy and controllable bio-functionalities to prevent infections and extend the longevity of dental devices. This review article presents the current state-of-the-art of design, evaluation, advantages, and limitations of bioactive and stimuli-responsive and autonomous dental materials for antimicrobial applications. First, the importance and classification of smart biomaterials are discussed. Second, the categories of bioresponsive antibacterial dental materials are systematically itemized based on different stimuli, including pH, enzymes, light, magnetic field, and vibrations. For each category, their antimicrobial mechanism, applications, and examples are discussed. Finally, we examined the limitations and obstacles required to develop clinically relevant applications of these appealing technologies.

The mutual relationship of the policymakers, providers, and the community on the children's oral health; New windows for more discussions

BACKGROUND

The multidisciplinary and comprehensive nature of children`s oral health with mutual interactions among various determinants makes the area a window of more discussion among oral health policymakers, stakeholders, providers, and other interested parties. This commentary presents a triangle framework of the children`s oral health, including all the above groups, for new discussions in oral health policymaking.

MAIN BODY

Three leading influencers could be recognised in children`s oral health as a triangle despite the contextual differences among the countries. The first angle, Families and community, determine the individual background, demographic, biological, genetic, and psychological factors, as well as community-based and social background, including cultural and socioeconomic factors. The second angle, Oral health providers, includes a variety of determinants from the provider`s perception toward oral health provision of services to availability of dental services, teledentistry and digital technology, surveillance, and monitoring systems for children`s oral health. And finally, as the third angle, Oral health policymakers affect the mechanism for funding dental care and supporting schemes, affordability of oral health services, regulations and standards and public education. Macro environmental policies related to the children`s ecosystem, community water fluoridation, and social marketing for promoting probiotics products` consumption are categorized in this category.

CONCLUSION

The triangle framework of children`s oral health presents a big picture of the oral health concept at the multilevel. Although these determinant factors interact with each other, each can have a cumulative effect on children`s oral health; policymakers could try to consider them as a big picture with a systematic approach for better achievement of oral health among children considering the local and national contextual factors of the community.

National Oral Health Policy and Financing and Dental Health Status in 19 Countries

OBJECTIVE

Dental caries in permanent teeth is one of the most common health issues-despite being preventable in early stages-due to inadequate regulation of preventive dental services in many countries. This study evaluates the association between regulation of preventive dental services and oral health outcomes.

METHODS

This mixed-method study analysed data from 19 member countries of the Organisation for Economic Co-operation and Development (OECD). Oral health outcomes were measured using decayed missing and filled teeth (DMFT) indexes for children aged 12 to 18 years. Oral health expenditures were measured as a percentage of each country's gross domestic product (GDP). We conducted web-based research and systematically extracted and coded data on dental policy regarding children's preventive dental services. Preventive care was assessed based on legal policy mandating children receive preventive services, availability of free services for children, and regulation of the services provided. We assessed the relationship amongst oral health policy, outcomes, and expenditure using bivariate regression analysis.

RESULTS

The most common preventive policy category is the availability of free dental services for children (78.95%), and the least common is policy mandating dental services for children (26.32%). The oral health expenditure is correlated with DMFT index (-4.42, P < 0.05). The legal policy mandating dental services for children is correlated with DMFT index (-1.32, P < 0.05) and correlated with average oral health expenditure (0.16, P < 0.05).

CONCLUSIONS

A percentage increase in oral health expenditure is associated with a 4.42 reduction in DMFT. The existence of legal policy mandating dental care for children is associated with a 1.32 reduction in mean DMFT score and a 0.16% increase in oral health expenditure. These findings highlight the importance of preventive care and may aid policymaking and health system reforms.

Non-utilization of oral health services and associated factors among children and adolescents: an integrative review

OBJECTIVE

To review publications exploring non-utilization of oral health services and to identify factors associated with non-utilization of oral health services among children and adolescents.

MATERIALS AND METHODS

An integrative review design was adopted. A search was conducted for research articles published during the period from 2000 to April 2021 in five databases, Medline via Ovid, Scopus, CINAHL, Cochrane Library and Web of Science. Inclusion criteria were original articles examining non-utilization of oral health services among 0-19 years old and studies published in peer-reviewed journals in English. Thematic analysis was undertaken to identify common themes. The Newcastle-Ottawa scale was used to evaluate the quality of the studies.

RESULTS

Twenty-one geographically diverse articles were included. Nineteen studies were cross-sectional, one was a prospective cohort and one a case-control study. Non-utilization of dental health services tended to be higher in children than adolescents. There were predisposing (age, gender, ethnicity, parent's level of education), enabling (family income, dental insurance) and need factors (subjective and objective oral health related parameters) that had been shown to be associated with non-utilization of dental services among children and adolescents.

CONCLUSIONS

This integrative review found predisposing, enabling and need factors to be associated with dental health service non-utilization.

Peruvian Children's Access to Oral Health Information during the COVID- 19 Pandemic

Aim

The aim of this study was to determine the impact of COVID-19 pandemic on access to oral health information of Peruvian children.

Materials and Methods

The Demographic and Family Health Survey generates annually a national database of Peruvian children between 0 and 11 years old, which is collected through direct interviews applied in the homes of residents of the country. A cross-sectional study was applied with this information collected during 2019 and 2020, with a final sample of 39 124 subjects, 15 974 from the year 2019 (62.03%) and 7088 from the year 2020 (55.54%). The dependent variable was access to oral health information and the independent variable was year; in addition, there were considered sociodemographic and geographical covariates. Finally, there were executed descriptive, bivariate, and multivariate analyses.

Results

Access to oral health information was 59.85% (n = 23 062). For the bivariate analysis, the dependent variable showed association with year, natural region, sex, altitude, health insurance coverage, area, place of residence and wealth index. During multivariate analysis, year manifested a negative association with access to oral health information (aPR: 0.89; 95%CI: 0.85-0.92; P < 0.001), adjusted for co-variables that previously manifested association.

Conclusion

Access to oral health information for Peruvian children had a negative impact during 2020, in which COVID-19 pandemic occurred.

Trends in Access to Oral Health Care among Adults from the N-E Region of Romania

Aims and Objectives: To investigate the trends in access to dental services among adults from the N-E region of Romania and to evaluate the factors that influence access to dental care. Material and Methods: A self-administered questionnaire was used to evaluate the access and utilization of dental care among a sample of adults. We collected data on their demographic characteristics, their type of medical insurance, their monthly income, the type of dental office they visited, their reasons for choosing a certain type of dentist office, and their oral hygiene habits. It was found that their financial status determined by the occupation of the individual, as well as their monthly income, influenced their access to medical services. Data were analyzed using SPSS 20.0. Results: Of a total of 696 participants, 55.6% were female, 83.3% were from urban areas, 42.1% were retired, 62.3% of the subjects utilized dental emergency services, and 67.9% of the subjects self-funded their treatment. The reasons for women not attending dental offices included costs (24.3%) and dental fear (9.8%), while men's reasons were high costs (26.4%) and lack of time (5.9%). Significant differences were recorded between gender and reasons for visiting the dentist (p = 0.018), payment for dental services (p = 0.009), and preferred clinic (p = 0.010). In relation to occupation, there were significant differences for most of the variables evaluated (reasons to visit a dentist, payment for dental services, preferred dental clinic, self-rated oral health, etc.). Conclusions: Gender, occupation, and monthly income levels were found to influence access to dental medicine services of Romanians in the N-E region. Dental services were frequently accessed for emergency reasons. Dental services were found to be paid for by state insurance for those with low monthly incomes and self-funded for those with higher monthly incomes.

Periodontitis and Preeclampsia in Pregnancy: A Systematic Review and Meta-Analysis

OBJECTIVES

A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia.

METHODS

Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case-control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran's Q statistic.

RESULTS

Thirty studies including six cohort- and twenty-four case-control studies were selected. Periodontitis was significantly associated with increased risk for preeclampsia (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001), especially in a subgroup analysis including cohort studies (OR 4.19, 95% CI 2.23 - 7.87, p < 0.00001). The association was even stronger in a subgroup analysis with lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).

CONCLUSIONS

Periodontitis appears as a significant risk factor for preeclampsia, which might be even more pronounced in lower-middle-income countries. Future studies to investigate if maternal amelioration of periodontitis prevents preeclampsia might be warranted.

Oral Health Knowledge, Attitudes and Practices of People Living with Diabetes in South Asia: A Scoping Review

Diabetes increases the risk of oral health complications. This review aimed to synthesise the current evidence on the oral health knowledge, attitudes and practices of people living with diabetes in South Asian countries and provide recommendations on possible strategies for addressing the gaps in oral health care in this population, including the role of non-dental professionals. Using a scoping review framework, six electronic databases (Ovid Medline, CINAHL, ProQuest Central, Scopus, Web of Science and Embase) were searched to identify the relevant literature published between January 2000 and December 2021. The data were extracted into three main categories based on the review's aims, and further refined into sub-categories. A total of 23 studies were included. The review identified that while people with diabetes living in South Asian countries had some level of awareness about oral health and limited care practices to maintain good oral health, there were gaps in knowledge, and there were areas where their oral health practices and attitudes could be improved. The findings suggest a need for developing targeted oral health policies as well as implementing integrated oral health care interventions involving non-dental professionals to improve the oral health outcomes of people with diabetes.

Impact of Cash Transfers on the Use of Oral Health Services and Oral Health Outcomes: A Systematic Review

OBJECTIVE

The objective of the present study was to summarize the evidence available on the impact of cash transfers on the use of oral health services and oral health outcomes.

MATERIALS AND METHODS

9 databases were searched for studies on cash transfers and oral health: PubMed, Embase, The Cochrane Library, CINAHL, EconLit, Dentistry and Oral Sciences Source, Scopus, Web of Science, and LILACS. We conducted a systematic review of studies that evaluated the impact of cash transfers on the use of oral health services and other oral health outcomes.

RESULTS

Three studies with more than 13,000 participants conducted in Brazil and Argentina were included. One study from Brazil found that participants in the Bolsa Familia Program (BFP) were more likely not to use oral health services (aPR: 6.18; 95% CI: 3.07-12.45; P < 0.001) and had a higher probability of presenting dental caries (aPR: 2.00; 95% CI: 1.47-2.69) and severe caries (aRR: 1.53; 95% CI: 1.18-2.00). Another study conducted in Brazil found that the BFP was associated with fewer dental caries among those enrolled in the first 2 years of the BFP as well as after six years. On the other hand, the Argentina study found that the Universal Child Allowance program did not have a statistically significant average treatment effect (ATE = -0.05; P > 0.05) on the use of dental health services.

CONCLUSION

There is a lack of evidence about the impact of CT on the use of oral health services and oral health outcomes. The evidence suggests that cash transfers might not have a positive impact on the use of oral health services. The results regarding the impact of receiving cash transfers on dental caries are contradictory. However, more evidence is needed to draw stronger conclusions for policy taking.

REGISTRATION

The protocol was registered in PROSPERO (CRD42021268234).

Cross-Sectional Analysis of Oral Healthcare vs. General Healthcare Utilization in Five Low- and Middle-Income Countries

Oral health is integral to overall health and is often neglected, especially in low- and middle-income countries (LMICs). Oral disease, including untreated dental caries, affects nearly 3.5 billion people globally, contributing to poor health and quality of life. To examine the relationship between the utilization of general healthcare and oral healthcare, we conducted an exploratory cross-sectional study of first-visit interview data collected from a convenience sample of 3,422 low-income mothers and 4,324 children aged 6 months through 6 years participating in a community-based oral health and nutrition program in five LMICs (Ecuador, El Salvador, India, Nepal, and Vietnam) from 2006–2015. We used descriptive and exploratory association analysis to identify patterns of oral healthcare utilization for mothers and children compared to medical care utilization, specifically maternal prenatal care and child immunizations. Overall, 89.6% of the mothers had received prenatal care for at least one child, but only 76.4% had ever received dental care and 50% were currently suffering from oral health symptoms, primarily oral pain. Mothers who received prenatal care were significantly more likely to have accessed dental care compared to those who had not received prenatal care (OR = 2.62, 95% CI: 2.06, 3.32). Overall, 95.4% of the children had current immunizations, but only 30.1% had ever received dental care, and 32.4% were currently suffering from oral pain. Children whose immunizations were up-to-date were more likely to have received dental care, with a significant association in Ecuador (OR = 3.29, 95% CI: 2.06, 5.30). Compared to utilization of general healthcare, oral healthcare was under-utilized by mothers and children in our sample from five LMICs. Integration of prevention- and treatment-oriented oral healthcare into primary medical care services, particularly prenatal care and child immunizations, could help increase access to oral healthcare and improve women's and children's oral health.

Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries

Introduction: Collective evidence on risk factors for dental caries remains elusive in low- and middle-income countries (LMICs). The objective was to conduct a systematic review and meta-analysis on risk factors for dental caries in deciduous or permanent teeth in LMICs. Methods: Studies were identified electronically through databases, including Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, and CINAHL, using “prevalence, dental caries, child, family, socioeconomic, and LMIC” as the keywords. A total of 11 studies fit the inclusion criteria. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale (NOS). The MedCalc software and Review Manager 5.4.1 were used. Results: From 11,115 participants, 38.7% (95% CI: 28.4−49.5%) had caries and 49.68% were female. Among those with caries, 69.74% consumed sugary drinks/sweets (95% CI: 47.84−87.73%) and 56.87% (95% CI: 35.39−77.08%) had good brushing habits. Sugary drinks had a two times higher likelihood of leading to caries (OR: 2.04, p < 0.001). Good oral hygiene reduced the risk of caries by 35% (OR: 0.65, p < 0.001). Concerning maternal education, only secondary education reduced the likelihood of caries (OR: 0.96), but primary education incurred 25% higher risks (OR: 1.25, p = 0.03). A 65% reduction was computed when caregivers helped children with tooth brushing (OR: 0.35, p = 0.04). Most families had a low socioeconomic status (SES) (35.9%, 95% CI: 16.73−57.79), which increased the odds of caries by 52% (OR: 1.52, p < 0.001); a high SES had a 3% higher chance of caries. In the entire sample, 44.44% (95% CI: 27.73−61.82%) of individuals had access to dental services or had visited a dental service provider. Conclusion: Our findings demonstrate that high sugar consumption, low maternal education, and low and high socioeconomic status (SES) increased the risk of dental caries in LMICs. Good brushing habits, higher maternal education, help with tooth brushing, and middle SES provided protection against caries across LMIC children. Limiting sugars, improving oral health education, incorporating national fluoride exposure programs, and accounting for sociodemographic limitations are essential for reducing the prevalence of dental caries in these settings.

Retention of dental practitioners in rural health services in Iran: Experiences from Kerman province

Background

In Iran, the inequitable distribution of health-care staff, especially dental practitioners between rural and urban areas has a major impact on the delivery of care for those living in rural communities. This study investigated the factors affecting the retention of dental practitioners to stay in the rural areas.

Materials and Methods

This is a cross-sectional study conducted in 2019. All dental practitioners working in health services centers covering a population lower than 20,000 people in Kerman province participated in this study (n = 81). A researcher-designed questionnaire was used for the data collection. The data were analyzed using the descriptive statistics and logistic regression through the SPSS software.

Results

The mean age of the participants was 29.2 ± 6.5 and 39.5% were female. The results showed that about two-thirds of native dentists (with local origin), 73.3% of married dentists, and all dental practitioners who had no children or had a child under the age of six were willing to continue working with their current Comprehensive centers of health services compared to other dentists. Univariate and multivariate logistic regression showed that there was a significant relationship among dentists' age, monthly salary, and facilities available in the area (place of residence, availability of vehicles, etc.), view of dental practitioners on living in a rural area, and view of dentists' families on living and working in the area (p < 0.05).

Conclusion

More than half of the dental practitioners declared their willingness to stay in rural areas, although, in practice, this amount of presence in rural areas does not meet the needs of residents. Financial issues, amenities, and facilities in the rural areas can have a positive impact on the retention of dental practitioners.

The triangle of inequality in dental services: arguments for a new conceptual framework

This short communication paper aimed to compile the main determinants of inequality in dental services by distinguishing between access, utilisation, and provision of dental services. Recent findings integrated, and a dedicated conceptual framework entitled “Triangle of inequality in dental services” has been suggested. These can contribute a rich knowledge in this area and open a new window for policymakers and researchers to seek applied interventions to decrease inequality and improve access and utilisation in communities. This paper aims to synthesise the available evidence and add value to the scope. It highlights a dedicated concept for inequality in dental services beyond other areas of public health.

Online oral health information seeking experience and knowledge, attitudes and practices of oral health among iranian medical students: an online survey

Background

The internet is increasingly used as a source of health information. This study aimed to explore the online oral health information seeking experience, to determine the knowledge, attitudes and practices (KAP) of oral health, and to investigate the associations between online oral health information seeking experience and oral health KAP of participants.

Methods

A cross-sectional online survey was conducted. Three hundred and ninety-five university students participated in the study. Required data were gathered using two valid questionnaires eHIQ (e-Health Information Questionnaire) and Oral Health Knowledge, Attitude and Behavior Questionnaire. eHIQ was a 2-part instrument with 37 items. eHIQ-Part 1 includes 11 items related to general views of using the internet in relation to health. eHIQ-Part 2 includes 26 items related to the consequences of using specific health-related online sources. The second questionnaire includes 30 items as a combination of multiple-choice and yes/no type questions. The data were analyzed using the statistical analysis software SPSS version 20. Mean scores, standard deviation, and frequency distribution were obtained. Independent T-test, correlation coefficients and analysis of variance (ANOVA) were used in the analysis.

Results

Participants had good KAP of oral health. The between-group differences tests showed that oral health knowledge and attitudes were significantly different between gender and years of study groups, but the differences of oral health practices were significant only based on years of study. Participants had moderate scores regarding all sub-scales of eHIQ-Parts 1 and 2. Findings revealed that online oral health information seeking behavior was associated with oral health KAP (p < 0.05).

Conclusion

According to the results the general views of using the internet in relation to health and the consequences of using specific health-related online sources were in a moderate level among the participants. Such results can emphasize the need for more planning, education and empowerment of the population`s health literacy. The present study also provides good insights for the latter and has practical and policy implications besides its research values.