Knowledge, attitude, and practice regarding oral health among college students in Eastern China

doi:10.21203/rs.3.rs-1493993/v1

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Knowledge, attitude, and practice regarding oral health among college students in Eastern China

https://doi.org/10.21203/rs.3.rs-1493993/v1

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Background: People are increasingly concerned about the impact of oral health on the whole. College students represent the future trend of oral health in China. The purpose of this study was to investigate the status, influencing factors and differences in oral health knowledge, attitude, practice (KAP) between dental and non-dental students in Anhui Province, Eastern China.

Methods: A cross-sectional survey was conducted on 1,822 college students in Anhui Province. The Mann-Whitney test and the Kruskal-Wallis test were used to test for differences in oral health KAP scores by different demographic factors and lifestyle habits. The Spearman test was used to determine the association between oral health knowledge, attitude and practice. The Person chi-square test was used to analyse the differences in oral health KAP between dental students and non-dental students.

Results: The oral health KAP scores of dental, medical, and non-medical college students in Anhui Province decreased in the order. Gender, age, major, grade, place of birth, parents’ education, annual household income, and smoking status all had a difference on oral health KAP

scores among college students. Positive correlations existed between oral health knowledge, attitude, and practice. Dental students had a better overall oral health KAP than non-dental students.

Conclusions: The oral health knowledge and attitude of college students in Anhui Province were generally good. However, oral health practice was unsatisfactory. Our study has implications for targeted improvement of factors influencing oral health KAP.

Oral health

Knowledge

Attitude

Practice

Students

Oral health serves as an essential component of overall health and well-being. The fourth national oral health epidemiological survey showed that, compared with a decade ago, the level of oral health literacy and health behaviors of Chinese residents have improved to varying degrees [1]. As the successors of a new era, it’s important for college students to develop lifelong oral health behaviors during their college years [2].

Health status is largely determined by an individual’s knowledge, attitude, and practice (KAP) in the area [3]. The KAP has developed as an important tool for assessing various health seeking behaviors today [4]. The better oral health KAP contributes to oral health status [3, 5].

Some lifestyles, such as dietary habits, smoking and hygiene standards can also lead to oral health progressing in different directions [6, 7]. In the adolescent population, family characteristics have subtle implications for adolescent oral health perception [8]. Previous studies have shown variability in oral health KAP scores by education level and professional differences [9, 10].

There has been insufficient research on the status of oral health KAP among college students in Eastern China. There are no more studies on the specific differences of oral health KAP between dental major and other majors. Therefore, this study aimed to investigate the status and differences in oral health KAP between dental and non-dental students in Anhui Province, Eastern China.

Study design

We cordially invited students from 22 comprehensive colleges in Anhui Province, Eastern China, to conduct this cross-sectional study from October 2019 to January 2020. Electronic questionnaires were distributed via the Internet. We received a total of 1,822 valid responses. Incomplete questionnaires were excluded from the study.

Ethical Approval

This study has been approved by the Medical Ethics Committee of Bengbu Medical College, China (process 2021/199). Participants were informed about the study’s purpose. Each participant gave informed consent and participated voluntarily.

Questionnaire design

We designed the questionnaire based on previous research. The questionnaire had a reliability (Cronbach’s a) of 0.997.

The questionnaire consisted of 4 sections. The first section was demographic information and personal habits.

The second section was the oral health knowledge, including 13 questions. The participants’ knowledge is assessed through a series of questions on the causes, preventive measures and treatment of oral diseases.

The third section was the oral health attitude with 9 questions. Participants made decisions based on their own health care awareness.

The fourth section was about the participants’ oral health practice responses according to their daily behaviors and consisted of 9 questions.

The responses of oral health KAP were rated on a 2-point Likert scale, ‘0 = No’ and ‘1 = Yes’, with higher scores representing higher levels of oral health KAP.

Statistical analysis

We used IBM SPSS Statistics v.20.0 for data analysis. When the p value is less than 0.05, it’s considered statistically significant. Due to the skewed distribution of our data, we used the Mann-Whitney test and Kruskal-Wallis test to examine the variability of different demographic factors and lifestyle habits regarding oral health KAP scores. The analysis uses M (P25, P75) to describe the KAP scores. Spearman test was used to analyze the degree of relevance of oral health knowledge, attitude, and practice. We divided the students into dental and non-dental students according to majors. Analyzed the difference in the scores of each question in KAP between different groups by the Person Chi-square test.

Demographic characteristics and one-way ANOVA associated with oral health KAP

A total of 1,822 study participants were surveyed, of whom 802 (44%) were males. Other demographic characteristics are shown in Table 1.

Table 1. Demographic characteristics of subjects participated in the survey (n = 1,822)

Variables	Frequency (n) /Percentage (%)	Knowledge/P50 (P25, P75)	Attitude/P50 (P25, P75)	Practice/P50 (P25, P75)	KAP/P50 (P25, P75)
Gender
Male	802/44.0	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	23.00 (20.00, 25.00)
Female	1020/56.0	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 5.00)	24.00 (22.00, 26.00)
Z		-4.576	-5.317	-5.102	-7.000
P		0.000	0.000	0.000	0.000
Major
Dental major	286/15.7	13.00 (12.00, 13.00)	9.00 (8.00, 9.00)	5.00 (3.00, 7.00)	26.00 (23.00, 28.00)
Medical majors	976/53.6	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.25, 5.00)	24.00 (21.25, 26.00)
Non-medical majors	560/30.7	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	23.00 (20.00, 25.00)
χ²		51.789	58.631	108.277	164.149
P		0.000	0.000	0.000	0.000
Grade
Freshman	476/26.1	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	23.00 (21.00, 25.00)
Sophomore	265/14.5	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 4.50)	23.00 (21.00, 25.00)
Junior	503/27.6	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	23.00 (21.00, 25.00)
Senior	214/11.8	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 6.00)	24.00 (22.00, 26.00)
Graduate	180/9.9	13.00 (11.00, 13.00)	8.00 (7.00, 9.00)	5.00 (3.00, 7.00)	25.00 (23.00, 27.00)
Postgraduate	184/10.1	13.00 (11.00, 13.00)	8.00 (7.25, 9.00)	4.00 (3.00, 6.00)	25.00 (22.00, 27.00)
χ²		17.047	19.828	82.295	88.144
P		0.004	0.001	0.000	0.000
Birthplace
Rural	1253/68.8	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.00, 5.00)	23.00 (21.00, 25.00)
Urban	569/31.2	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 5.00)	24.00 (22.00, 26.00)
Z		-1.676	-2.490	-3.760	-4.229
P		0.094	0.013	0.000	0.000
Father’s education
Primary school or below	352/19.3	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	23.00 (20.00, 25.00)
Middle school	835/45.8	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.00, 5.00)	24.00 (21.00, 26.00)
High school	321/17.6	13.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.00, 5.00)	24.00 (21.00, 26.00)
Junior college	174/9.6	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 6.00)	24.00 (22.00, 27.00)
Undergraduate or above	140/7.7	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 6.00)	24.00 (21.00, 27.00)
χ²		5.963	10.079	24.168	23.146
P		0.202	0.039	0.000	0.000
Mother’s education
Primary school or below	722/39.6	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	24.00 (21.00, 26.00)
Middle school	681/37.4	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.00, 5.00)	23.00 (21.00, 25.00)
High school	207/11.4	13.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 5.00)	24.00 (22.00, 26.00)
Junior college	143/7.8	13.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 6.00)	24.00 (22.00, 27.00)
Undergraduate or above	69/3.8	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	5.00 (3.00, 7.00)	25.00 (21.50, 27.00)
χ²		13.624	2.205	30.738	25.962
P		0.009	0.698	0.000	0.000
Annual household income
Less than ¥50, 000	781/42.9	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	3.00 (2.00, 5.00)	23.00 (21.00, 25.00)
¥50, 000 to ¥120, 000	745/40.9	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.00, 5.00)	24.00 (22.00, 26.00)
More than ¥120, 000	296/16.2	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (3.00, 6.00)	24.00 (21.25, 27.00)
χ²		7.838	13.462	20.155	22.077
P		0.020	0.001	0.000	0.000
Cigarette use
Yes	66/3.6	11.00 (9.00, 12.00)	7.00 (5.00, 8.00)	4.00 (2.00, 5.25)	22.00 (17.00, 24.25)
No	1756/96.4	12.00 (11.00, 13.00)	8.00 (7.00, 9.00)	4.00 (2.00, 5.00)	24.00 (21.00, 26.00)
Z		-4.272	-5.970	-0.206	-3.998
P		0.000	0.000	0.837	0.000

Table 1 shows the results of one-way ANOVA for oral health knowledge, attitude, and practice by different demographic characteristics. The results showed that the differences in oral health knowledge, attitude, practice and KAP scores of college students by gender, major, grade and annual household income were statistically significant (p < 0.05), the differences in oral health knowledge, attitude and KAP scores of college students by cigarette use were statistically significant (p < 0.05), the differences in oral health knowledge, practice and KAP scores of college students by mother’s education were statistically significant (p < 0.05), and the differences in oral health knowledge, practice and KAP scores of college students by birthplace and father’s education were statistically significant (p < 0.05).

In contrast, the differences of birthplace and father’s education on oral health knowledge, mother’s education on oral health attitude scores and cigarette use on oral health practices scores were not statistically significant (p > 0.05).

Oral health KAP of college students in Anhui Province

A total of 1,822 college students had a median oral knowledge score of 12.00 (11.00, 13.00) and a passing rate of 92.26%, a median attitude score of 8.00 (7.00, 9.00) and a passing rate of 89.30%, a median practice score of 4.00 (2.00, 5.00) and a passing rate of 19.65%, and a median KAP score of 24.00 (21.00, 26.00) and a passing rate of 87.10%. Table 2 shows the oral health KAP scores of the respondents.

Table 2. Oral health KAP scores of college students in Anhui Province (n = 1,822)

	P50 (P25，P75)	Total score	Pass Rate
Knowledge	12.00 (11.00, 13.00)	13	92.26%
Attitude	8.00 (7.00, 9.00)	9	89.30%
Practice	4.00 (2.00, 5.00)	9	19.65%
KAP	24.00 (21.00, 26.00)	31	87.10%

Correlation analysis of oral health knowledge, attitude, and practice among college students in Anhui Province.

As shown in Table 3, students’ oral health knowledge and attitude were positively correlated (r = 0.430, p < 0.01), oral health knowledge and practice were positively correlated (r = 0.109, p < 0.01), and oral health attitude and practice were positively correlated (r = 0.090, p < 0.01).

Table 3. Spearman’s two-by-two analysis between oral health knowledge, attitude, and practice (n = 1,822)

Project	Knowledge	Attitude	Practice
Knowledge	1.000	-	-
Attitude	0.430**	1.000	-
Practice	0.109**	0.090**	1.000

**P value < 0.01: statistically significant difference

Oral health KAP cardinality test for dental and non-dental college students in Anhui Province

As shown in Table 4, dental students’ overall oral health KAP mastery was significantly better than that of non-dental students, with a statistically significant response from both majors.

Table 4. Differences in correct oral health KAP scores between dental and non-dental students (n = 1,822)

Question (recommended answer)	Dental major(n)/Percentage (%)	Non-dental major(n)/Percentage (%)	χ²	P
Knowledge
Plaque can cause tooth decay and periodontal disease (K1)	276 (96.5)	1372 (89.3)	14.392	0.000
Use of fluoride toothpaste can prevent caries (K2)	257 (89.9)	1190 (77.5)	22.630	0.000
Effective brushing removes plaque and maintains healthy teeth and periodontal tissue (K3)	269 (94.1)	1408 (91.7)	1.879	0.170
Too much sugary sweets can lead to caries (K4)	275 (96.2)	1423 (92.6)	4,685	0.030
Smoking can be harmful to oral health (K5)	256 (89.5)	1320 (85.9)	2.636	0.104
Drinking alcohol can be harmful to oral health (K6)	255 (89.2)	1319 (85.9)	2.217	0.136
Oral health check-ups at least once a year can detect oral diseases (K7)	267 (93.4)	1350 (87.9)	7.214	0.007
Regular oral cleanings at least once a year will keep your teeth strong and periodontal healthy (K8)	268 (93.7)	1292 (84.1)	18.017	0.000
Earlier stages of gingivitis may include bleeding gums when brushing teeth or biting on hard objects (K9)	267 (93.4)	1365 (88.9)	2.203	0.023
Acute pulpitis occurs with severe spontaneous and nocturnal pains (K10)	268 (93.7)	1377 (89.6)	4.526	0.033
Caries often manifests as discomfort from hot or cold stimuli, discomfort from biting or pain (K11)	260 (90.9)	1377 (89.6)	0.420	0.517
Bad breath is caused by 80% to 90% of oral diseases (K12)	255 (89.2)	1269 (82.6)	7.546	0.006
Vulcanization protects teeth and prevents tooth decay (K13)	267 (93.4)	1248 (81.2)	25.223	0.000
Attitude
Oral diseases can be detrimental to general health (A1)	269 (94.1)	1163 (75.7)	48.204	0.000
Frequent consumption of carbonated drinks can lead to tooth decay (A2)	195 (68.2)	968 (63.0)	2.782	0.095
Good or bad teeth are not natural and have a lot to do with protection (A3)	249 (87.1)	1273 (82.9)	3.071	0.080
Regular oral cleanings are good for your oral health (A4)	265 (92.7)	1304 (84.9)	12.147	0.000
Regular oral check-ups are good for your oral health (A5)	269 (94.1)	1361 (88.6)	7.594	0.006
Oral diseases can be prevented (A6)	254 (88.8)	1282 (83.5)	5.210	0.022
Oral health is important for your health and quality of life (A7)	267 (93.4)	1350 (87.9)	7.214	0.007
Oral health education can improve an individual’s oral health literacy (A8)	271 (94.8)	1353 (88.1)	11.072	0.001
Oral problems should be treated promptly in hospital (A9)	273 (95.5)	1354 (88.2)	13.457	0.000
Practice
Regular oral health check-ups (P1)	107 (37.4)	172 (11.2)	127.769	0.000
Brush teeth ≥ 2 times a day (P2)	241 (84.3)	1108 (72.1)	18.458	0.000
Brushing time ≥ 3 minutes per session (P3)	188 (65.7)	859 (55.9)	9.492	0.002
Regular use of fluoride toothpaste (P4)	169 (59.1)	618 (40.2)	34.939	0.000
Replace a toothbrush every three months or so (P5)	247 (86.4)	1182 (77.0)	12.621	0.000
Regular flossing to assist in cleaning between teeth (P6)	113 (39.5)	281 (18.3)	64.035	0.000
Brushing method the ‘horizontal tremor brushing method’ recommended by the Chinese Stomatological Association (P7)	165 (57.7)	534 (34.8)	53.596	0.000
Rinse mouth regularly after meals (P8)	138 (48.3)	598 (38.9)	8.697	0.003
Regular oral cleanings (P9)	99 (34.6)	230 (15.0)	62.863	0.000

Oral health knowledge

As shown in Figure 1, college students in Anhui Province had a relatively good grasp of oral health knowledge, with correct rates above 90% for both majors in the answers to questions K3 and K4, and non-dental students whose correct rate of answers to K2 was below 80%. The non-dental students were significantly behind the dental students in terms of oral health knowledge. On the questions K3, K5, K6, and K11, there was no statistical difference between the responses of the two majors (p > 0.05).

Oral health attitude

As shown in Figure 2, the percentage of correct answers for dental students in A1 (94.1%) was much higher than that of non-dental students (75.7%) (p < 0.001), but both had a better grasp of the questions except for A2, where the percentage of correct answers was less than satisfactory, and the percentage of correct answers was greater than 80%. On the questions A2 and A3, there was not statistically difference between the responses of the two majors (p > 0.05).

Oral health practice

As shown in Figure 3, dental students had much higher correct rates on P1, P4, P6, P7, P9 than non-dental students (p < 0.05), but both had lower correct rates. All other oral health practice questions were not so good in terms of correctness.

This study analyzed the oral health knowledge, attitude and practice of college students in Anhui as well as their influencing factors, and compared the oral health KAP of dental and non-dental students. It’s known that there are fewer studies on dental students. The study aimed to identify the factors affecting oral health KAP in advance and to carry out prevention.

The results showed that the pass rate of oral health KAP among college students was 87.10%. Knowledge and attitude were good, with pass rates of 92.26% and 89.30% respectively. The oral health practice was less favourable, with a pass rate of 19.65%. Similar to previous study [11], the oral health practice of college students in Anhui were also not promising. As future medical professionals, it is more important for medical students to acquire correct oral health practice.

It indicates that the oral health KAP scores gradually decreases for dental (26.00), medical (24.00) and non-medical (23.00) majors. Previous study on the oral health of different majors’ students supports our results [12]. Dental students have systematically studied oral expertise and have a more correct and profound grasp of oral health KAP. Their oral health knowledge, attitude and practice are quite important for later clinical work applications [12]. Non-dental students should consider their patients’ oral health to provide comprehensive care [13]. Meanwhile, the oral health KAP of college students increased with grade level. This is similar to previous study [14]. Increasing grade level represents an increase in age and education, and with the adult personality stability, college students will gradually follow a more disciplined lifestyle and become more concerned with appearance [15]. As they seek ways to maintain a pleasant mouth, their oral health KAP will naturally increase.

We found that the oral health practice scores of female college students were higher than those of males. This is similar to the Scottish study on gender differences in oral health behavior [16]. The results of the fourth national oral health epidemiology survey showed that twice daily brushing was higher among females than males in all age groups [1]. Compared to male students, female college students may be more expected to improve their personal image through proper oral health practice [17].

The study showed that urban-born college students had higher oral health KAP scores (24.00) than rural-born students (23.00). It’s found that affordability and accessibility to dental services is more difficult in rural communities due to their lower economic levels and poorer dental services, thus urban residents have better oral health KAP than rural residents [18]. However, our study group was limited to college students who all received higher education, so there was no difference.

It’s showed that children with more educated parents and an annual household income more than ¥12,000 had higher oral health KAP scores. A study by Vanobbergen J et al. supports our results [19]. Parental education, occupation and income are considered to be the main influencing factors on children’s oral health [19]. While more educated parents can provide effective oral health guidance for their children, and mothers be critical in influencing their children’s oral health [20]. Parents with higher levels of education are likely to have more knowledge of oral health and a greater understanding of early oral interventions and potential risk factors [21]. Thus, it is more helpful for children to have better oral health KAP. Higher household income has a more positive impact on children’s oral health practice [16].

It’s found that smokers oral health knowledge and attitude scores were relatively low for non-smokers. This is consistent with previous study [22]. The majority of people with a smoking habit aren’t well aware of oral health and have inadequate knowledge about maintaining oral health. The result showed no significant difference in oral health practice. This may be due to the fact that our participants were all college students, and the smoking group (3.6%) was relatively small and not sufficiently representative for the results to differ. In the future we will conduct more in-depth research on this group.

The correlation analysis of this study showed that oral health knowledge, attitude and behavior were positively correlated and influenced each other. Previous studies have shown that there is a correlation between knowledge and attitude, and that college students with better oral health knowledge have better oral health practice [23, 24]. Oral health practice has a direct impact on oral health conditions, and good oral health practice has a significant role in the prevention of oral diseases [15, 25]. Oral health knowledge and attitude are important factors influencing oral health practice [26]. When people show improved attitude after gaining knowledge, they may engage in better oral health practice [24].

We found that dental students have higher oral health KAP than non-dental students. College students had a better grasp of oral health knowledge. For oral health knowledge, non-dental students significantly lagged behind dental students. This is in line with the previous finding [27]. Over 90% of college students in both majors knew that effective brushing removes plaque and keeps teeth and periodontal tissues healthy as well as excessive sugary sweets that cause dental caries. Only 77.5% of non-dental students knew that using fluoride toothpaste can prevent dental caries, which is lower compared to the dental students in this study (89.9%), and previous finding (81%) [14]. Due to the advantage of fluoride, medical students should have sufficient knowledge to facilitate guidance on the appropriate use of fluoride in the future [28].

In terms of oral health attitude, dental students are more aware than non-dental students that oral disease can be detrimental to general health. All the other oral health attitude questions were well mastered, with a correct response rate of over 80%. Oral health attitude reflects college students’ understanding of the importance of oral disease prevention [29]. However, both had a less favourable response rate on whether regular consumption of carbonated beverages would lead to tooth decay. Carbonated drinks left on the surface of tooth enamel may lead to caries formation [28], and should be consumed as little as possible.

Students from both majors were not ideal in terms of oral health practice. Compared to non-dental students, more dental students have regular oral health check-ups, use fluoride toothpaste, floss, use the ‘horizontal tremor brushing method’ recommended by the Chinese Stomatological Association, and have regular oral cleanings. This suggests better oral hygiene practice among dental students, which is coherent with research on Indian college student [27]. However, the implementation rates for both majors are very low. Dental students should have good oral health practice in order to play an active role in the dental field later on.

Limitations

This study has some limitations. Firstly, our study population is limited to college students in Anhui Province and is not representative of the national population. Secondly, this study is a cross-sectional study and does not allow for the elaboration of causal relationships.

The results and analysis of this study showed that college students had good oral health knowledge and attitude, but unsatisfactory oral health practice. Gender, major, grade, place of birth, parents’ education level and annual household income all had a difference on oral health KAP scores. Smoking made a difference to oral health KAP scores. There was a positive correlation between oral health knowledge, attitude and practice. In addition, oral health KAP was better in dental students than in non-dental students, but oral health practice needs to be improved in both majors. The results of our study may provide insights for the improvement of oral health among college students.

KAP: knowledge, attitude, practice

Ethics approval and consent to participate

The protocol of this study was approved by the Medical Ethics Committee of Bengbu Medical College, China (project code 2021/199). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Before data collection, all participants read the consent information, and provided verbal informed consents by clicking "Continue" to take this online survey. The informed consent protocol was approved by the Medical Ethics Committee of Bengbu Medical College, China.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study were available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was funded by the National Innovation and Entrepreneurship Training Program for college students of China (No. 201910367045), Key projects of Humanities and Social Sciences of Bengbu Medical College (No. 2020byzd224sk), Innovation and Entrepreneurship Training Program for college Students in Anhui Province, China (No. S202010367051).

Authors' contributions

SHZ and SKL gave substantial contributions to conception and design of this study. SHZ made critical revisions of the manuscript and supervised the whole process. WHL and NY performed the statistical analysis and drafted the initial manuscript. WD, WZ, HYZ, YYZ, HG, SHZ and SKL all collected the data. All authors have read and approved the final manuscript.

Acknowledgments

We thank all respondents for their invaluable contribution to this study.

Authors' Information

¹School of Stomatology, Bengbu Medical College, Bengbu, Anhui, China,

²School of Public Health, Bengbu Medical College, Bengbu, Anhui, China,

³School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China,

⁴Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Anhui, China.

Corresponding Author:

Shunhua Zhang, Professor, School of Medical Imaging, Bengbu Medical College, Bengbu 233030, Anhui, China, E-mail: [email protected]

Shengkai Liao, Professor Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui, China, E-mail: [email protected]

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Knowledge, attitude, and practice regarding oral health among college students in Eastern China

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