Oral health knowledge, attitudes, and practices across four communities in the Western Cape, South Africa: A cross-sectional study

Background: Oral health conditions are preventable, but frequently neglected because of limited knowledge, negative attitudes, and misconceptions within communities. Aim: This study aimed to determine the oral health knowledge, attitudes, and practices and factors associated with these outcomes and self-reported oral pain among community members across four communities (two urban and two semi-rural) in the Western Cape, South Africa. Setting: Two urban and two semi-rural communities in the Western Cape, South Africa. Methods: A cross-sectional survey using a researcher-administered questionnaire with validated instruments (The World Health Organization [WHO] Oral Health Assessment and the Rustvold Scale) was conducted among 776 adults, with knowledge, attitudes, and practices measured using composite scores. Data were analysed using descriptive and multivariable analyses to identify socio-demographic factors associated with knowledge, attitudes, and practices, as well as factors associated with self-reported oral pain. Results: Most respondents were female (n = 567, 73.1%) with a mean age of 42.3 ± 14.2 years. Overall knowledge was moderate (mean score: 68.4%, 6.84, ± 1.4). While most respondents reported daily toothbrushing and using fluoride toothpaste, only 13.8% used dental floss, and fewer than 20% had visited a dentist in the past year, primarily for pain. In multivariable logistic regression analysis, semi-rural residence (adjusted odds ratio [aOR]: 2.1; 95% confidence interval [CI]: 1.4–3.1), female gender (aOR: 1.6; 95% CI: 1.2–2.3), and poor self-reported health status aOR: 1.8; 95% CI: 1.2–2.7 were associated with higher odds of self-reported oral pain. Conclusion: Despite moderate knowledge and positive attitudes, gaps in oral health practices persist, with higher odds of oral pain among semi-rural residents and those with poorer health. Contribution: Findings support targeted oral health promotion and improved access to preventive care in semi-rural communities.