Oral health knowledge and behaviour among middle school children in Al-Bab City, Syria: a cross-sectional study

Abstract Background Oral health problems among children remain a major public health concern, particularly in conflict-affected settings where disrupted health systems and limited access to preventive care may negatively influence oral health knowledge and behaviours. This study aimed to assess oral health knowledge and behaviours among middle school children in Al-Bab City, Syria, a region significantly affected by ongoing armed conflict. Methods A cross-sectional study was conducted between October and December 2022 among middle school children aged 12–14 years in Al-Bab City, Syria. Of 384 eligible students, 369 consented and completed the questionnaire (response rate: 96.1%). Participants were selected using a stratified cluster sampling approach, in which schools were stratified by type (public/private) and randomly selected from each stratum. Data were collected through face-to-face interviews using a structured Arabic-language questionnaire assessing oral health knowledge, behaviours, awareness, and self-reported oral health status. Responses to knowledge items were classified as correct, incorrect, or ‘do not know’; no composite knowledge score was calculated. The questionnaire was content-validated by an expert panel and pilot-tested with 30 students prior to main data collection. Descriptive statistics and chi-square tests were performed using IBM SPSS Statistics version 26, with statistical significance set at p < 0.05. Results A total of 369 participants were enrolled (out of 384 approached; response rate: 96.1%), with 45.0% male and 55.0% female and a mean age of 13.21 ± 0.72 years. Although most participants (90.5%) recognized the importance of dental health, awareness of fluoride was notably limited; only 5.7% had heard of fluoride, and just 1.6% correctly identified its role in oral health. Knowledge of dental plaque was also poor, with only 2.4% of participants correctly identifying it. While 54.7% reported that teeth should be brushed twice daily, only 51.2% adhered to this practice (as reported in Table 3; this figure refers to those brushing ‘twice daily or more,’ compared with 39.6% who reported brushing exactly twice daily). Less than half (44.5%) had visited a dentist within the past year, whereas 23.8% had never visited a dentist. The use of adjunct oral hygiene measures was uncommon, with only 11.7% reporting dental floss use (daily or sometimes) and 2.4% reporting mouthwash use. Socioeconomic factors, specifically school type (χ²=14.372, p = 0.013) and father’s educational level (χ²=40.546, p = 0.026), were significantly associated with oral health behaviours but showed no significant association with oral health knowledge. Conclusion This study revealed substantial gaps in oral health knowledge and behaviours among middle school children in Al-Bab city, despite a general awareness of basic oral hygiene practices. These findings highlight the need to strengthen oral health education through school- and community-based public health initiatives.