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Oral Health Knowledge and Behaviour among School Children in Al-Bab City, Syria

This cross-sectional study of 369 schoolchildren in conflict-affected Al-Bab City, Syria, reveals significant gaps between general awareness of oral health importance and actual knowledge or behaviors, particularly regarding fluoride, plaque, and professional dental visits, underscoring the urgent need for targeted public health education initiatives.

Original authors: Fares Alshadidi, Mehmet Enes Gökler, Nimetcan Mehmet Orhun

Published 2026-07-01

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Fares Alshadidi, Mehmet Enes Gökler, Nimetcan Mehmet Orhun

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a group of 369 middle school students in Al-Bab, Syria, a city that has been heavily impacted by years of conflict. Researchers decided to take a "snapshot" of these children's teeth, not just by looking at them, but by asking them what they know and how they take care of their mouths. Think of this study as a health check-up for the community's dental habits, revealing a story where knowing the rules doesn't always mean following them.

Here is the breakdown of what the paper found, using simple comparisons:

1. The "Know-It-All" vs. The "Do-It" Gap

Most of the kids (over 90%) know that having healthy teeth is important, kind of like how everyone knows that eating vegetables is good for you. However, there is a big gap between knowing and doing.

The Analogy: Imagine a driver's ed class where 54% of the students can recite the rule "brush twice a day," but only 40% actually do it. It's like knowing you should wear a seatbelt but forgetting to click it every time you get in the car.
The Reality: While almost everyone uses a toothbrush, very few use the "secret weapons" of dental care. Only about 3% use floss (like a tiny rope to clean between teeth), and only 2% use mouthwash. It's as if they are cleaning the outside of a house but ignoring the cracks in the foundation.

2. The "Mystery Ingredient" (Fluoride)

The study found that the children are largely in the dark about a key ingredient in toothpaste called fluoride.

The Analogy: If oral health were a recipe for a cake, fluoride is the special spice that makes the cake last longer. But in this study, only 1 out of every 20 kids had even heard of this spice, and only 1 out of 60 knew what it actually does.
The Context: The researchers suggest that because of the war and economic struggles, supplies are hard to get. It's like trying to bake a cake when the grocery store shelves are empty; even if you know the recipe, you can't get the ingredients.

3. The "Pain-Only" Dentist Rule

When it comes to visiting a dentist, the children's behavior is driven by pain, not prevention.

The Analogy: Imagine only calling a mechanic to fix your car when the engine is smoking and the car won't start, rather than bringing it in for a regular oil change.
The Reality: Nearly 60% of the kids said they only go to the dentist when their tooth hurts. Worse, nearly 24% have never been to a dentist at all. This is a "firefighter" approach (putting out fires) rather than a "fire prevention" approach.

4. The "School and Wallet" Factor

The study looked at how a child's background affects their habits, finding that money and school type matter a lot for behavior, but not for knowledge.

The Analogy: Think of knowledge as a map and behavior as the actual journey. Both public and private school students have the same "bad map" (they don't know much about fluoride or plaque). However, the students in private schools (who likely have more family resources) are better at actually taking the trip to the dentist.
The Dad Factor: The father's education level was a huge predictor. If a father had a college degree, his child was very likely to have visited a dentist. If a father had only elementary education, the child was five times more likely to have never visited a dentist. It's like having a guide who knows the path to the dentist; without that guide, the path remains untraveled.

5. The "Broken Tooth" Lesson

Interestingly, the study found that having bad teeth didn't necessarily mean a child knew more about how to fix them.

The Twist: In fact, children who had already lost a tooth were less likely to believe that regular visits prevent problems. It's a sad cycle: they lost a tooth, didn't know how to prevent it, and now they don't believe prevention works. It's like losing a game and deciding the rules of the game don't matter anymore.

The Bottom Line

The researchers conclude that these children in Al-Bab are like sailors who know the ocean is dangerous but don't know how to steer the ship. They know they need to brush, but they lack the advanced tools (floss, fluoride) and the routine (regular dentist visits) to stay safe.

The paper suggests that to fix this, we can't just give them more information (since they already know the basics); we need to:

Teach better: Make school lessons more hands-on and practical.
Make it accessible: Work with aid groups to get fluoride toothpaste and floss into their hands.
Involve families: Help parents understand that healthy teeth are a team effort, not just the child's job.

This study is the first time anyone has looked specifically at this group of children in this specific city, providing a clear picture of where the gaps are so that future help can be targeted exactly where it's needed.

Technical Summary: Oral Health Knowledge and Behaviour among School Children in Al-Bab City, Syria

Problem Statement
Oral health remains a critical yet often neglected public health concern, particularly in conflict-affected regions where health systems are disrupted and access to preventive care is limited. While oral diseases are linked to systemic conditions and affect billions globally, the burden is disproportionately high in low- and middle-income countries. In Syria, specifically in Al-Bab City, a region significantly impacted by ongoing armed conflict, there is a lack of empirical data regarding the oral health status, knowledge, and behaviors of school-aged children. The disruption of educational and health infrastructure, combined with economic hardship, creates a unique environment where the acquisition of healthy oral hygiene habits may be compromised. This study addresses the gap in literature by assessing these factors in Al-Bab, a setting where no prior academic study has directly examined the oral health knowledge and behaviors of schoolchildren.

Methodology
The research employed a cross-sectional study design to collect data at a specific point in time.

Population and Sampling: The target population consisted of middle school students aged 12–14 years in Al-Bab City. A stratified cluster sampling approach was used, selecting schools from both public and private sectors. The final sample included 369 participants (45.0% male, 55.0% female), with a mean age of 13.21 ± 0.72 years.
Data Collection: Data were gathered through face-to-face interviews using a structured, Arabic-language questionnaire. The instrument was adapted from previous studies and validated via a pilot study. It comprised five sections: demographic background, oral health knowledge, oral health behaviors, awareness/education, and self-reported oral health status.
Statistical Analysis: Data were analyzed using IBM SPSS Statistics version 26. Descriptive statistics characterized the sample, while chi-square ( $\chi^2$ ) tests were utilized to examine relationships between categorical variables (e.g., school type, father's education level, and oral health outcomes). Statistical significance was set at $p < 0.05$ .

Key Results
The study revealed a significant disparity between oral health knowledge and actual behaviors, alongside strong socioeconomic influences on access to care.

Knowledge Gaps: While 90.5% of participants recognized the general importance of dental health, specific knowledge was critically low. Only 5.7% had heard of fluoride, and merely 1.6% could correctly identify its protective role. Knowledge of dental plaque was similarly poor, with only 2.4% correctly identifying it. Although 80.2% knew that hygiene prevents cavities, understanding of gum disease symptoms was limited.
Behavioral Discrepancies: A gap exists between theoretical knowledge and practice. While 54.7% of students knew teeth should be brushed twice daily, only 39.6% adhered to this. The use of adjunctive hygiene measures was rare: only 3.3% reported using dental floss, and 2.4% used mouthwash. However, 96.7% reported using a toothbrush and toothpaste.
Dental Visits: Access to professional care was low. Only 44.5% had visited a dentist in the past year, and 23.8% had never visited a dentist. The majority (59.1%) sought care only when experiencing pain, rather than for regular checkups.
Socioeconomic Correlations:
- School Type: Private school students were significantly more likely to have visited a dentist in the last six months (42.6% vs. 29.8%) and to have received school-based oral hygiene education (36.9% vs. 25.4%) compared to public school students. However, knowledge gaps regarding fluoride and plaque persisted at similarly low levels in both groups.
- Parental Education: A clear socioeconomic gradient was observed regarding dental visits. Children of fathers with higher education had a 7.1% rate of never having visited a dentist, compared to 38.0% for children of fathers with elementary education and 36.8% for those with preschool education.
- Clinical Status: The relationship between knowledge and self-reported clinical status (caries, fillings, tooth loss) was generally weak. Notably, children with tooth loss showed significantly lower awareness of the importance of teeth for chewing and the preventive role of regular dental visits compared to those without tooth loss.

Key Contributions
This study provides the first baseline evidence on oral health knowledge and behaviors among schoolchildren in Al-Bab City. Its primary contributions include:

Documenting the Knowledge-Behavior Gap: It highlights that while basic awareness of hygiene exists, specific knowledge (fluoride, plaque) is insufficient, and this knowledge does not consistently translate into practice.
Socioeconomic Impact in Conflict Zones: It quantifies how socioeconomic factors, specifically parental education and school type, significantly influence access to dental services and health behaviors, even in a conflict-affected setting.
Evidence for Intervention: The findings identify specific deficits (e.g., fluoride awareness, preventive care utilization) that can inform the development of targeted public health initiatives.

Significance and Claims
The authors assert that this study is the first academic investigation to directly address oral health knowledge and behaviors in Al-Bab. The significance of the work lies in its ability to provide an evidence base for intervention development in a region where such data was previously absent. The study concludes that while general awareness of basic hygiene is present, substantial gaps remain in advanced knowledge and preventive behaviors.

The paper claims that socioeconomic factors significantly influence oral health behaviors but do not necessarily dictate knowledge levels, suggesting that the quality and methodology of current health education need improvement rather than just increased access. The authors recommend three specific implementation strategies:

Developing targeted, school-based programs with interactive elements integrated into the curriculum.
Strengthening collaboration with humanitarian aid systems to improve access to essential products like fluoride toothpaste and floss.
Implementing community-based initiatives to support healthy habits within the home environment.

The study modestly acknowledges its limitations, noting that the cross-sectional design prevents causal inferences and that reliance on self-reported data for clinical status and behaviors may introduce reporting bias. Consequently, the authors call for future research utilizing clinical examinations and longitudinal designs to further validate these findings and develop sustainable oral health strategies for conflict-affected populations.