Knowledge, attitude, and practice of dental flossing among the Saudi population: a cross-sectional study

Dental floss is essential for removing interproximal plaque and preventing periodontal disease. Despite its proven benefits, flossing is often underutilized due to factors such as limited knowledge, cultural perceptions, and behavioral habits. This study assessed knowledge, attitudes, and practices related to dental flossing among Saudi adults. A descriptive cross-sectional study was conducted using a snowball sampling approach across five regions of Saudi Arabia. Data were collected via an online questionnaire, and 990 eligible responses were analyzed. Ethical approval was obtained from the Prince Sultan Military College of Health Sciences Institutional Review Board (IRB-2023-DOH-008). Among the respondents, 23.9% reported never using dental floss, and 33.4% used it rarely. Misconceptions were common, with 43% of respondents believing that flossing creates gaps between teeth. Age ≥ 35 years was significantly associated with knowing how to use dental floss (p = 0.034) and a lower degree of difficulty with dental floss (p = 0.007). Women – compared to men - were more likely to know dental floss (p < 0.001), how to use it (p < 0.001), and actually use flossing (p = 0.013). Moreover, women tended to do flossing more frequently (p = 0.001), encountered less difficulty (p = 0.009), and were more likely to recommend it to others (p < 0.001). In addition, having a university education was significantly associated with using dental floss (p = 0.024). Multivariable logistic regression showed that women (adjusted OR = 1.45, 95% CI: 1.03 to 2.05, p = 0.035) and participants with a university degree were more likely to use floss regularly (adjusted OR = 1.51, 95% CI: 1.15 to 2.00, p = 0.003), after adjusting for age, region, and marital status. While general awareness of dental flossing is high, consistent use remains limited, especially among men and younger individuals. Barriers such as perceived difficulty and misinformation persist. Targeted educational campaigns are needed to bridge knowledge-practice gaps and promote regular flossing as part of routine oral care in Saudi Arabia.