Teeth are an integral part of the human body and reflect each individual’s health history and lifestyle. Oral health is a window into overall well-being, often revealing systemic health issues. It is defined as the absence of diseases affecting the teeth, gums, and supporting tissues. Oral hygiene practices play a crucial role in promoting dental and general health, improving appearance, and enhancing self-esteem. ¹

In recent decades, there has been a surge in chronic conditions, including dental caries, cardiovascular diseases, and cancers, all of which exert social, economic, and political pressure. Oral diseases, often lifelong and preventable, cause pain and financial burden to individuals and healthcare systems alike. ²

The World Health Organization (WHO) reports that around 3.5 billion people globally suffer from permanent dental decay. ³ Despite advancements, oral diseases remain a global concern due to the inconsistent adoption of preventive practices such as daily brushing and regular dental visits. In nations lacking established oral health initiatives, dental caries continues to be widespread. ^{4, 5}

Numerous studies within Saudi Arabia have reported a high prevalence of oral diseases. ⁶ A systematic review of research from 1988 to 2010 revealed that 62%–84% of children under six suffered from caries in primary teeth, while 58%–94% were affected in permanent teeth. ⁷ A Riyadh-based study showed only 6.3% of 12–14-year-olds were caries-free. ⁸

Oral health outcomes are influenced by both proximal factors (such as behaviour and access to dental care) and distal factors (such as socioeconomic status and home environment). ⁹ International studies among university students have shown poor oral hygiene practices, regardless of country income level. ¹⁰ Research in Nigeria and India also reported inadequate oral health knowledge and behaviour among healthcare students, with females generally outperforming males. ^{11, 12}

Barriers to regular dental care, including limited awareness, are associated with modifiable behaviour’s. A study from Qatar found a direct link between dental knowledge and healthy oral habits like brushing and dentist visits. ¹³ Studies across Arab nations have mainly focused on student populations, often comparing dental students without considering the general adult population. ^{14– 17} Understanding public knowledge and behaviour is essential to improving national health outcomes.

Oral health is often compromised by lack of knowledge or disregard for hygiene practices. Educated individuals who apply what they know tend to achieve better dental health. Acknowledging personal responsibility for oral care often leads to improved self-care. Since dentists are key in educating communities, evaluating knowledge, attitudes, and behaviour’s at the population level is vital. This study investigates these factors among adults in Al-Kharj and examines the associations between demographic factors and oral health practices.

This study was designed, conducted, and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.

Study Design: A descriptive cross-sectional survey was undertaken, involving 367 adult residents of Al-Kharj city. Data collection began in June 2024 and continued over a three-month period.

Participants: The study targeted adults who visited shopping malls, as these venues provided access to a diverse and representative sample of the city’s population across various age groups.

Sample Size: The required sample size was determined using the formula N = 4pq/l ². Drawing on pilot data that estimated the prevalence of poor oral health knowledge at 35.36% and allowing for a 5% margin of error, the final sample size was calculated as 367 participants.

Table 1 presents the demographic characteristics of the study population. The study included 367 adults, comprising 177 males and 190 females, aged between 18 and 69 years. Female participants made up a significantly larger portion of the sample compared to males. The largest age group represented was 25–34 years (38.4%), while participants aged 65 years and older formed the smallest group (1.1%). Most participants (89.6%) were Saudi nationals, and 61.6% were married. Regarding education, 51.0% held a university degree, 30.0% had completed high school, and 9.5% had finished primary school. In terms of income, 30.0% earned between 20,000 and 40,000 Saudi Riyals, while 5.4% reported incomes exceeding 100,000 Saudi Riyals. Approximately 68.6% of participants reported no systemic health conditions; diabetes mellitus was present in 14.7% of participants, followed by hypertension in 9.8%. The majority (80.1%) were non-smokers, and none reported alcohol consumption.

Table 2 details the distribution of oral health knowledge, attitudes, and behaviour’s among participants. Most participants demonstrated fair to good knowledge about oral health. Notably, 90.2% were aware that tobacco use can cause oral cancer, but only 28.6% recognized the importance of treating primary teeth. A large majority (89.1%) had a positive attitude towards the use of fluoridated toothpaste for preventing dental caries, while 56.2% showed a negative attitude towards the role of tooth brushing in preventing gum diseases. Furthermore, 65.7% believed that dentists focus not only on treatment but also on the prevention of oral diseases. However, only 44.5% exhibited good behaviour in valuing dental health equally with general health. Just 55.6% brushed their teeth twice a day, and 44.7% attended regular dental check-ups.

Table 3 illustrates the association between oral health knowledge and gender. Males demonstrated better oral health knowledge compared to females. All female participants and 40.7% of male participants displayed poor knowledge regarding the importance of treating primary teeth.

Table 4 presents the relationship between oral health attitude and gender. A majority (80.7%) of males strongly agreed on the importance of brushing twice daily, and all male participants strongly agreed that sticky sweets contribute to dental decay. However, 90.4% of males exhibited a negative attitude toward the dentist’s role in preventing dental diseases. Additionally, 90.9% of males strongly agreed that bleeding gums can be prevented through professional dental cleaning.

Table 5 outlines the relationship between oral health behaviour and gender. Most participants did not view dental health as equally important as overall body health. Only 43% of female participants brushed their teeth twice daily. Approximately 7.4% of males reported using their teeth to open bottle caps, and 23.2% of males experienced tooth pain while chewing food. A majority of males (68.9%) reported bleeding gums during brushing. In comparison to males, a greater proportion of females (64.7%) attended routine dental check-ups.

Table 6 identifies the predictors of oral health knowledge scores. Males demonstrated significantly better oral health knowledge compared to females (p = 0.0001). Older individuals exhibited greater knowledge than younger adults (p = 0.004). Additionally, participants with an income exceeding 10,000 SR showed higher levels of oral health knowledge (p = 0.003).

Socio-demographic factors were not significant predictors of behaviour and attitude about oral health among our participants.

This cross-sectional study investigated the oral health knowledge, attitudes, and behaviour’s of 367 adult residents of Al-Kharj, recruited from shopping malls. The findings revealed that female participants demonstrated significantly higher levels of oral health knowledge, more positive attitudes, and better behavioural practices compared to males. Specifically, women showed greater awareness regarding the causes of gum bleeding and the importance of tooth brushing in maintaining gingival health. This may be attributed to a heightened aesthetic awareness among females, which encourages more frequent dental visits and greater exposure to oral health information. ¹⁸

Oral health attitudes are influenced by a range of factors, including individual experiences, family and cultural traditions, religious beliefs, and life circumstances, all of which shape behavioural outcomes. ¹⁹ In the current study, women reported superior oral hygiene practices, particularly in terms of tooth brushing frequency and regular dental visits—findings consistent with prior research. ^{20– 24} These positive behaviour’s may be linked to a stronger concern for personal appearance, prompting women to seek dental advice and education more regularly. Routine dental visits are essential not only for disease prevention but also for reinforcing good hygiene habits and providing patient education. ^{25– 27}

In this study, 77.7% of participants acknowledged that maintaining healthy teeth contributes to overall health. This aligns with results from other regions, including 81% in Manipur, 76% among Nepalese children, and 93% of Iranian children who recognized the same connection. ^{28, 29} Interestingly, the current study found no significant association between education level and oral hygiene knowledge or behaviour. While higher education is generally linked to improved oral health awareness, knowledge alone may not translate into practice. Factors such as socioeconomic status, cultural norms, and resource availability also play critical roles in shaping oral health behaviour’s.

Oral health concerns are closely related to individual attitudes. In our study, influences stemming from cultural, religious, and familial beliefs were apparent. Notably, 90% of male participants perceived that dentists focus primarily on treatment rather than prevention, reflecting a reactive approach to dental care, often sought only during pain or discomfort. This perception reduces opportunities for preventive care. Dentists, along with mass media, have the potential to significantly influence public behaviour’s by effectively communicating oral health information. ^{30, 31} Our results further showed that participants who received brushing technique demonstrations from their dentists exhibited improved oral hygiene knowledge.

This study has several strengths, including the use of a validated and pilot-tested questionnaire and a sample drawn from diverse community settings. However, it is important to note several limitations. The sample size was relatively small, and participants were recruited from public venues such as malls and parks, which may introduce social desirability bias. Additionally, time constraints in these settings may have affected the accuracy of responses. Nevertheless, data collection in these areas allowed access to a broad and varied segment of the population, providing real-time insights. Another limitation was the absence of clinical oral examinations, which could have provided objective measures of oral health. Including clinical assessments would have strengthened the analysis by correlating self-reported knowledge, attitudes, and behaviour’s with actual oral health status.

This population-based study involving adults aged 18 years and older revealed that women demonstrated superior oral health knowledge and more favourable attitudes toward dental care, with statistically significant gender differences. Around two-thirds of participants reported brushing their teeth twice daily, with women showing a greater appreciation for the importance of primary teeth and regular dental checkups compared to men. Based on these findings, we recommend the introduction of evidence-based and targeted oral health awareness initiatives to promote improved hygiene practices among adults in this age group.

The study had obtained ethical clearance from Institutional Review Board and Ethical Approval Committee from Prince Sattam bin Abdulaziz University, Al Kharj. The Committee on Research Ethics adhered to international guidelines for human subject protection, including the Declaration of Helsinki, The Belmont Report, and CIOMS guidelines. All participants received an explanation of the study and gave informed consent before completing the self-administered questionnaire. The consent form clearly outlined the survey’s purpose, the estimated time required to complete the questionnaire, and used simple, understandable language. Participants were informed that they could withdraw from the survey at any time, and that their personal information would be kept confidential.