# Oral Health Knowledge, Oral Health–Seeking Behavior, and Associated Factors Among the Rural Population of Ernakulam District: A Cross-Sectional Study

## TL;DR

This study explores oral health knowledge and behavior in rural Kerala, finding that better knowledge and socioeconomic factors are linked to improved oral health practices.

## Contribution

The study provides new insights into the determinants of oral health knowledge and behavior in rural Ernakulam district, India.

## Key findings

- Adequate oral health knowledge was found in 48.12% of participants.
- Higher education and socioeconomic status were significant predictors of positive oral health-seeking behavior.
- Tooth pain was the most common reason for dental visits, and many avoided care due to perceived mild issues.

## Abstract

Introduction: Oral diseases affect over 3.5 billion people globally, with a disproportionate burden in low- and middle-income countries such as India. Oral health knowledge (OHK) strongly influences oral health-seeking behavior (OHSB), yet data from rural Kerala are scarce. This study aims to assess OHK and OHSB, examine their association, and identify their determinants among rural adults in Ernakulam district.

Materials and methods: A community-based cross-sectional study was conducted among 160 adults aged 18-60 years in Njarakkal Panchayat, Kerala, using multistage cluster sampling. Data were collected through a pretested, validated interview schedule assessing OHK (37 items) and OHSB (7 items). Chi-square tests and multivariable log-binomial regression were used to identify predictors of adequate OHK and positive OHSB.

Results: Adequate OHK and OHSB were found in 48.12% (95% confidence interval (CI): 38.58-57.80) and 41.25% (95% CI: 32.15-51.10) of participants, respectively. Younger age (<45 years) (adjusted odds ratio (AOR) (CI) (1.46 (1.15-2.12)), higher education (AOR (CI) (5.31 (3.97-6.66)), employment (AOR (CI) (1.69 (0.97-2.40)), and above-poverty-line status (AOR (CI) (3.30 (2.41-4.19)) were significantly associated with adequate OHK. Adequate OHK (AOR (CI) (3.35 (2.46-4.25)), younger age (AOR (CI) (1.27 (1.04-1.54)), higher education (AOR (CI) (4.84 (3.34-6.33)), and higher socioeconomic status(AOR (CI) (2.34 (1.54-3.13)) independently predicted positive OHSB. Tooth pain was the most common reason for dental visits (61.3%), while 72.9% avoided care, perceiving mild issues as self-manageable. Nearly half preferred private clinics due to poor accessibility of government services.

Conclusion: OHK emerged as a key predictor of OHSB in rural Kerala. Strengthening public dental services, integrating oral health education into primary care, and developing community-based programs can improve preventive practices, reduce delays in care-seeking, and narrow rural-urban disparities.