10.24873/j.rpemd.2025.09.1432

Original Research

 

Oral health practices and determinants among university students – A cross-sectional study

Práticas e determinantes de saúde oral entre estudantes universitários – um estudo transversal

 

João Henrique¹ Ferreira 0009-0008-1124-6643

Maria Lurdes Pereira^1,2,3 0000-0002-4076-6014

Maeva Fonseca¹ 0009-0004-8801-6257

Leonor Frey-Furtado^1,2,3* 0000-0002-1571-0924

¹ Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal.

² EPIUnit of Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.

³ Laboratory for Integrative and Translational Research in Population Health (ITR) of Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.

 

^*Correspondence to:

 

Article history:

Received 24 October 2024

Accepted 22 July 2025

Available online 8 September 2025

 

Abstract

Objectives: A knowledge gap exists concerning how university students—a diverse and transitioning demographic—manage their oral health. This study aims to characterise the oral health practices of university students.

Methods: This cross-sectional study aimed to evaluate oral health behaviors and perceptions among students at the University of Porto, through an online survey.

Results: The findings indicate that while there are positive changes in some areas, such as a slight reduction in sugary drink consumption and increased awareness of oral health, significant areas of concern remain, particularly regarding the frequency of dental floss use and the consumption of sugary foods.

Conclusions: While university students demonstrate some positive oral health behaviors, important gaps remain that must be addressed. By implementing targeted educational and support programs that integrate mental health, dietary habits, and stress management, institutions can enhance their students’ oral health and overall well-being, as underscored by this study's comprehensive approach to oral health promotion strategies.

Keywords: Dentistry, Oral health, Oral hygiene,Students, Universities.

 

Resumo

Objetivos: Existe uma lacuna de conhecimento sobre como os estudantes universitários – um grupo demográfico diversificado e em transição – gerem a sua saúde oral. Este estudo tem como objetivo caracterizar as práticas de saúde oral dos estudantes universitários.

Métodos: Este estudo transversal teve como objetivo avaliar os comportamentos e perceções de saúde oral entre estudantes da Universidade do Porto, através de um inquérito online.

Resultados: Os resultados indicam que embora existam mudanças positivas em algumas áreas, como uma ligeira redução no consumo de bebidas açucaradas e uma maior sensibilização para a saúde oral, continuam a existir áreas significativas de preocupação, particularmente no que diz respeito à frequência do uso do fio dentário e ao consumo de alimentos açucarados.

Conclusões: Embora os estudantes universitários demonstrem alguns comportamentos positivos em matéria de saúde oral, permanecem lacunas importantes que precisam de ser abordadas. Ao implementar programas educativos e de apoio direcionados que integram a saúde mental, os hábitos alimentares e a gestão do stress, as instituições podem melhorar a saúde oral e o bem-estar geral dos seus alunos, conforme sublinhado pela abordagem abrangente deste estudo às estratégias de promoção da saúde oral.

Palavras-chave: Medicina Dentária, Saúde oral, Higiene ora,lEstudantes, Universidades.

 

Introduction

Oral health is a critical component of both physical and psychological well-being, influenced by various social determinants such as education, socioeconomic status, and personal beliefs.¹

Despite extensive research on these influences, a knowledge gap remains concerning how university students — a diverse and transitioning demographic — manage their oral health.

The transition to university life often introduces students  to a culture where nightlife, alcohol, and tobacco use are normalized.² For many, this period marks the first experience of significant independence, which can lead to behavioral changes associated with this newfound freedom. This exposure frequently results in neglecting areas such as sleep³and diet.⁴ In particular, displaced students tend to rely on cheaper, less nutritious food options because of financial constraints and ease of preparation.⁴ These lifestyle changes and stressors associated with higher education can lead to detrimental oral health practices.^{1, 5 - 7}Such behaviors are risk factors for oral diseases, which can adversely affect students’ systemic health and academic performance.^{8, 9}

This study aims to characterize the oral health practices of university students. By gaining a deeper understanding of these determinants, we can develop targeted strategies to promote better oral health within this population, ultimately enhancing their overall well-being and academic success.

Material and methods

The eligible population for this cross-sectional study was 36,982 undergraduate and postgraduate students enrolled in the 2022/2023 academic year. A required sample size of 381 participants was calculated using a 95% confidence interval and a 5% margin of error.

Data were collected from January 23 to March 4, using an online questionnaire via Google Forms. The questionnaire was distributed through the university’s email system and social media platforms (WhatsApp, Facebook Messenger, Instagram) in two rounds spaced 14 days apart. However, we established that we would use all the answers obtained and not limit the number of participants to the required sample size.

The questionnaire consisted of 33 questions divided into four sections:

1. Demographic information: Age, gender , residence, displacement status, faculty, field of study, study cycle, and parents’ educational qualifications.

2. Oral health behaviors: Dietary habits (frequency and timing of sugary food/drink consumption), smoking habits (tobacco use, quantity, perceived increase), alcohol habits (frequency, perceived increase), oral hygiene practices (tooth brushing frequency and timing, use of dental floss, tongue brushing habits).

3. Oral healthcare visits: Dental visit history (last visit, regularity, barriers), impact of displacement on seeking care, awareness of oral health initiatives and services.

4. Self-perception of oral health: Signs and symptoms in the past year, attitudes toward oral health, self-assessment, importance of healthy teeth, concern for teeth vs. other body parts, influence of university attendance on self-perception.

Data were stored in Microsoft® Excel and analyzed using IBM® SPSS® Statistics 29. Descriptive statistics summarized all variables. Nominal and ordinal variables were reported as absolute and relative frequencies, while continuous variables were described using central tendency and dispersion measures.

The McNemar-Bowker test assessed changes in oral health behaviors before and after university entry, with a significance level of 0.05.

The study received approval from the Ethics Committee for Health of the Faculty of Dental Medicine (23/2023) and the Data Protection Unit of the University of Porto (A-10/2024). Participants provided informed consent in accordance with the Declaration of Helsinki guidelines. Participation was voluntary, confidential, and without cost or risk.

Results

The sample of 616 students consisted predominantly of females (70.0%), with ages ranging from 17 to 74 years (Table 1). Most participants (70.3%) were born in urban areas, and 47.6% reported displacement from their usual residence. Regarding education, 62.3% were enrolled in non-health-related courses. Most were in the early stages of higher education, with 33.6% in undergraduate programs and 38.3% in integrated master’s programs. Parental education levels were generally low, especially among fathers.

 

Table 1. Sociodemographic data characterization of participants (n = 616)

 

The study assessed soft drink and sugary food consumption, as well as brushing habits, before and after participants entered the university (Table 2). No significant changes were observed in soft drink consumption frequency (p > 0.05). The proportion of students who never consumed soft drinks increased from 6.7% to 10.1%, those who rarely consumed them rose from 40.1% to 48.1%, while those consuming them sometimes decreased from 47.4% to 36.4%. The timing of soft drink consumption also remained unchanged (p > 0.05), with 65.1% consuming them during meals before university and 62.2% after. Similarly, no significant changes were noted in sugary food consumption frequency (p > 0.05), with stable percentages across all categories. The timing of sugary food consumption remained consistent (p > 0.05).

 

Table 2. Characterization of oral health-related habits of participants before and after entering the university (n = 616)

Statistical test: McNemar-Bowker. Significance level: p < 0.05.

 

Brushing frequency showed a slight increase in twice-daily brushing from 58.0% to 59.4% and in brushing three or more times a day from 26.3% to 28.7%. Brushing at breakfast and before bed increased slightly, from 87.8% to 89.3% and 73.4% to 75.5%, respectively, with no significant overall changes. Furthermore, there were significant improvements in both the use of dental floss/brushes and tongue brushing. Before entering university, 43.0% of individuals never used dental floss/brushes, but this dropped to 29.1% after entering university (p < 0.001). The percentage of individuals who always used dental floss/brushes increased from 10.2% to 20.6%. Similarly, those who never brushed their tongue decreased from 26.1% to 17.5% (p < 0.001).

Our study revealed diverse addictive behaviors (Table 3). In terms of tobacco habits, 82.6% of the students were non-smokers, 7.1% were ex-smokers, and 10.2% were smokers. Regarding changes in tobacco consumption during higher education, only 12.7% had increased their usage. Concerning alcohol habits, 38.8% did not consume alcohol, while 61.2% did. Changes in alcohol consumption during higher education indicated that 39.3% had increased their intake.

 

Table 3. Characterization of addictive behaviors of the participants (n = 616)

 

Participants reported various oral health conditions over the previous 12 months (Table 4). The most common issues included gum bleeding (39.1%), toothache (27.9%), TMJ pain (18.0%), bad breath (25.0%), tartar build-up (30.5%), and bruxism (18.2%). While 97.9% of students acknowledged the importance of good aesthetics and oral health, only 69.6% considered oral health equally important as the rest of the body. After entering higher education, 64.1% of students reported no change in their self-perception of oral health, while 35.9% noted an improvement.

 

Table 4. Participants’ self-perception regarding oral health (n = 616)

TMJ – Temporomandibular joint

 

The study also assessed the frequency of dentist visits, obstacles to seeking oral health care, changes in seeking oral health care among displaced students, and awareness of access to oral healthcare at FMDUP by University of Porto Social Services (SASUP) (Table 5). Economic reasons were cited as the most significant barrier by 32.8% of participants, followed by the perception of not needing care (23.1%).

 

Table 5. Characterization of the demand for oral healthcare (n = 616)

SASUP – Social Action Porto University Services; FMDUP – Faculty of Dental Medicine of the University of Porto

 

Discussion

This study investigates the impact of transitioning to higher education on the oral health habits of university students. While there have been positive changes, such as reduced sugary drink consumption and increased oral health awareness, areas of concern persist.

Our results show that 88.1% of students brush their teeth at least twice daily, aligning with findings from Dias et al.¹⁰ and Almeida et al.¹¹ However, only 20.6% of students use dental floss daily, a crucial practice for preventing oral health diseases.⁵ Regarding the frequency of cleaning interproximal spaces, despite the statistically significant increase in the transition from secondary to higher education, 29.1% of students reported never using dental floss, compared to 39.7% in the general Portuguese population.¹² The same phenomenon was observed regarding tongue cleaning: tongue brushing frequency increased significantly compared to the pre-university period, but still, 17.5% of higher education students reported never doing it. Our findings suggest neglected behavioral aspects in comprehensive oral hygiene practices. Additionally, there was lower adherence to brushing after lunch, possibly due to the inconvenience of carrying dental supplies. Institutions could address this by offering hygiene kits in vending machines and placing reminders in cafeterias and restrooms.

Even though the results indicate no significant changes in the frequency of soft drink and sugary food consumption, 62.2% of students consumed sugary foods between meals, which significantly increases the risk of dental caries.¹³

These findings are similar to those of Almeida et al.¹¹ and Fortes et al.⁵ The consistency of these habits from secondary to higher education, despite efforts to reduce sugary intake, highlights the difficulty in altering behaviors established during childhood and adolescence.¹⁴ To address this, dietary education interventions are needed to reduce sugar intake and promote healthier eating habits, such as providing healthier food options on campus and educational workshops on nutrition.

The transition to university often brings increased stress and peer influence for some addictive behaviors, which negatively impact oral health.^{15, 16} Studies have linked stress to higher rates of smoking and alcohol consumption,¹⁷ a finding supported by our study, where 12.7% of students reported increased tobacco use after entering university. Additionally, 61.2% of students reported alcohol consumption, with 39.3% noting an increase since starting university.

Risk factors for dental caries and periodontal disease, such as smoking, alcohol consumption, and a diet rich in sugars, also increase the risk of other leading non-communicable diseases like diabetes, heart disease, cancer, and stroke.¹⁸ Therefore, effective mental health support, stress management programs, awareness campaigns on addictive behaviors, and a healthy lifestyle are crucial for comprehensive oral health improvement.

Only 69.6% of the participants were equally concerned about the importance of oral health as the rest of the body, and 23.1% did not see the need to visit a dentist, showing a lack of literacy. However, there is a bidirectional relationship between oral and general health, impacting one’s quality of life.^{19 - 21} A study by Ying et al.22 found that only 19.1% of healthy students regularly visited the dentist every 6-12 months, while 51.1% only sought dental care when in pain. Health literacy has a big impact on one’s health decisions, so universities should enhance educational programs.

A third of the participants (32.8%) mentioned economic barriers to accessing oral healthcare. In Portugal, dental care is primarily provided by the private sector and paid for

through direct payments or a voluntary social insurance scheme. However, the government-funded “Cheque Dentista” initiative does not cover young adults over 18 years. To address this barrier, the Faculty of Dental Medicine of the University of Porto (FMDUP) and its Social Action Services provide dental care at reduced rates to university students.

Still, more than half of the participants (66.1%) were unaware. Universities often have health-promoting support structures, but community awareness may be hindered by poor communication and inefficient promotion.²³ A possible solution is to invest in digital marketing on student community websites and to implement awareness campaigns and screenings at the faculties at the beginning and throughout the academic year.

The findings of this study have implications for public health initiatives targeting university students. Institutions should implement comprehensive oral health education programs that include stress management and dietary advice.

Additionally, providing resources such as hygiene kits and educational materials on the importance of flossing could significantly improve oral health outcomes among students.

This study has limitations. The cross-sectional design limits our ability to establish causality between university life and changes in oral health behaviors. Future research should aim to include a more balanced gender distribution and employ longitudinal designs to understand the causal relationships better. Future studies should also explore the long-term impacts of university life on oral health, focusing on identifying effective interventions to promote healthy behaviors, particularly among students from diverse cultural and socioeconomic backgrounds. Investigating the role of mental health support in maintaining good oral hygiene practices would also be valuable.

Moreover, research should consider the specific needs of different student populations, including those from various cultural and socioeconomic backgrounds.

Conclusions

Although university students exhibit some positive oral health behaviors, such as increased use of dental floss and brushing their tongues, notable behavior gaps still exist. They frequently consume sugary foods and often lack thorough oral hygiene routines. Economic obstacles and a lack of knowledge about available services hinder access to oral healthcare. To effectively tackle these issues, institutions should develop comprehensive educational strategies that combine mental health resources, dietary guidance, and enhancements in accessibility

 

References

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^*Corresponding author:

Leonor Frey-Furtado

E-mail address: lfurtado@fmd.up.pt

 

CRediT authorship contribution statement

João Henrique Ferreira: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft. Maria Lurdes Pereira: Data curation, Investigation, Supervision, Validation, Writing – original draft. Maeva Fonseca: Writing – review & editing. Leonor Frey-Furtado: Data curation, Writing – original draft, Writing – review & editing.

 

Conflict of interest

The authors have no conflicts of interest to declare.

 

Ethical disclosures

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data. The authors declare that they have followed their work center protocols on access to patient data and for its publication.

Right to privacy and informed consent. The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

 

1646-2890/© 2025 Sociedade Portuguesa de Estomatologia e Medicina Dentária. Published by SPEMD.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).