Preventive dentistry competence and self-care behaviors among dentists in Armenia, Moldova, and Belarus: a cross-sectional study

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Their own oral hygiene behaviors and self-perceived competence in preventive care can influence their clinical practice. This study assessed personal oral hygiene habits, preventive knowledge, and competence among dentists in the capital cities of Armenia, Moldova, and Belarus. Methods A cross-sectional questionnaire survey was conducted among 1,316 practicing dentists in Yerevan, Chisinau, and Minsk. The 40-item structured questionnaire collected information on sociodemographic and professional characteristics, oral hygiene and dietary behaviors, knowledge of caries prevention, and preventive clinical practices. Data were analyzed using descriptive statistics, Chi-square tests, and one-way ANOVA. Results Participants had a mean age of 39.9 ± 11.4 years, and 65.6% were women. Most dentists reported brushing their teeth twice daily or more (90.9%) and using interdental cleaning aids daily (77.3%). Daily use of fluoride toothpaste was reported by 48.3% of respondents. However, daily use of fluoridated toothpaste varied markedly across countries: 22.5% in Armenia, 19.0% in Moldova, and 71.9% in Belarus (p < 0.001). Nearly all participants felt competent to provide preventive dental care (91.8%) and oral health education (94.3%), while over half agreed that more training in preventive dentistry should be provided in undergraduate curricula. The majority demonstrated sound knowledge of preventive measures such as fluoride use, sugar reduction, and sealants, and most reported routinely advising patients on oral hygiene, diet, and regular check-ups (mean knowledge scores of 37.7 ± 5.3, 40.2 ± 4.7, and 40.8 ± 4.3 for Armenia, Moldova, and Belarus, respectively, (p < 0.001)). Belarusian dentists reported the highest adherence to preventive recommendations for patients, including fluoride advice and dietary counseling (p < 0.001). Tobacco use was reported by 13.8% of participants, mainly among men. Conclusions Dentists in Armenia, Moldova, and Belarus generally showed favorable oral hygiene habits, high self-reported competence, and positive attitudes toward preventive dentistry. Continued emphasis on preventive oral health education and reinforcement of evidence-based practices—particularly regarding fluoride use and patient counseling—can further enhance the preventive role of dental professionals in this region. Dentists Preventive dentistry Oral hygiene Caries prevention Fluoride Sealants Oral health education Eastern Europe Cross-sectional study Introduction Dental caries remains one of the most prevalent chronic diseases, affecting 2.5 billion people worldwide [ 1 ]. The disease is characterized by progressive destruction of tooth enamel and dentin due to acid-producing bacteria metabolizing fermentable carbohydrates [ 2 ]. Although initially reversible, untreated caries can lead to pain, infection, and tooth loss, significantly impairing the quality of life [ 3 ]. Fortunately, caries progression can be halted at any stage, even after enamel or dentin loss (cavitation), provided that sufficient biofilm is removed [ 4 ]. Despite advances in preventive dentistry, the global burden of caries persists, particularly in low- and middle-income countries [ 5 ]. Dentists play a crucial role in caries prevention through patient education, application of preventive measures such as fluoride and dental sealants, and dietary counseling, including sugar reduction [ 6 – 8 ]. However, the success of these measures depends on dentists’ own knowledge, competence, and adherence to recommended oral hygiene practices [ 9 , 10 ]. Indeed, healthcare providers who engage in healthy behaviors themselves are more likely to promote such behaviors in their patients [ 11 ]. Although many dentists are familiar with evidence-based preventive strategies, their implementation in clinical practice is often inconsistent. This inconsistency is influenced by factors such as limited emphasis on prevention in dental education, time constraints during patient care, inadequate resources, especially in underfunded health systems, and perceived patient disinterest [ 9 , 10 , 12 , 13 ]. Understanding dentists’ personal oral hygiene habits alongside their competence in caries prevention is therefore critical for enhancing patient outcomes and improving dental curricula [ 6 ]. To our knowledge, there is a dearth of data exploring dentists’ oral hygiene practices and preventive competence in Eastern European and post-Soviet contexts. This study aims to fill that gap by assessing the competencies of dentists in caries prevention and their personal oral hygiene routines in Armenia, Moldova, and Belarus. By evaluating self-reported knowledge, behaviors, and clinical practices, we aim to highlight areas for improvement in preventive dentistry education and practice, contributing to better oral health care in these three countries. Methods Study design and settings The study design has been previously described [ 14 ]. Briefly, this cross-sectional study was conducted from June 2018 to September 2019 among actively practicing dentists in both public and private dental clinics across Chisinau (Moldova), Minsk (Belarus), and Yerevan (Armenia), using a structured, self-administered questionnaire. Ethical approval was obtained from ethical committees in Moldova (Comitetului de Etica a Cercetarii, Nicolae Testemitanu, application number 29, date: 20.12.2017), Belarus (Belarusian State Medical University, Protocol number: 10, Date: 20.05.2019), and Armenia (Ethics Committee of Yerevan State Medical University, protocol number: 12–15/2019). The project was registered at the Norwegian Centre for Research Data (Project Numbers 471282 and 57451). Participation was voluntary and anonymous, with written informed consent obtained from all respondents. Questionnaire The questionnaire used in this study comprised 40 items, divided into five thematic sections ( Supplemental File 1 ): (1) demographic and professional characteristics; (2) oral hygiene habits, dietary behavior, and use of dental services; (3) self-assessed competence in caries prevention; (4) knowledge of preventive dentistry; and (5) clinical preventive practices for patients. It was first prepared in English, and then translated into Armenian, Romanian (for Moldova), and Russian (for Belarus), following a standardized forward–backward procedure. The questionnaire was pretested for clarity and cultural appropriateness prior to implementation. All questions utilized standardized response formats, such as Likert-type scales ranging from "Strongly disagree" to "Strongly agree" and "Not at all" to "Always". Section 1 (items 1–8) captured age, sex, years of professional experience, type of employment (public or private), specialization, and whether participants worked with children. Section 2 (items 9–18) addressed tooth brushing frequency, use of interdental aids, fluoride toothpaste use, sugar intake, dental attendance patterns, self-perceived oral health, and tobacco use. Section 3 (items 19–23) assessed self-perceived competence in delivering clinical care and oral health education, and perceptions of undergraduate training in preventive dentistry. Section 4 (items 24–33) evaluated knowledge of evidence-based caries prevention strategies, including the effectiveness of fluoride (toothpaste, fluoridated water, supplements, and topical applications), sealants, and dietary counseling related to sugar intake. Section 5 (items 34–40) examined the frequency of advising patients on caries-preventive behaviors such as fluoride use, diet counselling, tobacco cessation, and regular check-ups. Statistical analysis All data curation and analysis in this study was performed in Statistical Package for the Social Sciences (SPSS version 29.0.2.0). The country of the study participants was considered the independent variable in most of the analyses. Gender was also used as an independent variable when analyzing the tobacco use behavior. The variable age was categorized into decades, and years of experience were categorized into three groups (Table 1 ), but both variables were also used as continuous data in some of the analyses (Supp. Table 1 ). In addition to analyzing the data for frequencies, combined scores of the different categories in the questionnaire were generated by addition, as explained in the respective sections under results (Supp. Table 1 ). For example, Questions 5 through 19 were added to each other, and the resulting score was used to compare the self-assessment of personal oral hygiene of the study participants in the three countries. Differences between categorical variables were investigated for statistical significance using the Chi-squared test. While differences between continuous variables between the three countries were investigated by one-way ANOVA with Bonferroni correction. In all statistical tests, the level of significance was set to 0.05. Results Study cohort characteristics: In total, 1,316 dentists participated in the study, with the majority of participants (53%) being from Belarus. Female dentists represented the majority (65.6%) of the study participants from all the three countries combined, leading to a female to male ratio of 2:1 (Table 1 ), with data from Belarus exhibiting significantly higher (p < 0.001, Chi 2 test) female representation (79.6%) as compared to Armenia (50.3%) and Moldova (48.7%). The mean age of study participants was found to be 39.91 ± 11.42 (Suppl. Table 1), and the mean age of participants from Armenia (38.2 ± 11.27) was found to be significantly less (p-value = 0.01, one-way ANOVA) than Moldova (40.27 ± 11.99) and Belarus (40.56 ± 11.20). Years of experience of the study participants (Suppl. Table 1) ranged from 1 to 50 years (16.12 ± 11.09). Mean years of experience for dentists from Belarus (17.2 ± 10.75) was significantly higher (p-value < 0.001, one-way ANOVA) than for dentists from Armenia (14.28 ± 10.86) or Moldova (15.30 ± 11.92). The percentage of dentists employed by public/university clinics (Table 1 ) was found to be significantly higher (p < 0.001, Chi 2 test) in Belarus (60.9%) as compared to Armenia (11.7%) or Moldova (27.1%). General dental practitioners comprised the majority of the study participants from Armenia (69.5%) and Moldova (70.1%), compared to only 25.9% of dentists from Belarus (Table 1 ), reflecting a higher frequency of specialized dentists in the Belarusian sample. Dentists working exclusively with children comprised only 11.5% of the study participants from all three countries. Daily cigarette smoking was reported by 19.5% in Armenia, 12.5% in Moldova, and 11.6% in Belarus (p < 0.001, Chi 2 test). As expected, the vast majority of daily cigarette smokers (Chi2 test, p-value < 0.001) were found to be males (70.7%) when all three countries were taken together (data not shown). When data were analyzed by country, a similar trend was observed in Armenia and Moldova, where male dentists comprised 90.8% and 94.1% of the daily smokers. On the contrary, male dentists in Belarus comprised only 45.1% of daily smokers. Daily use of other tobacco products, such as water-pipe or smokeless tobacco, was far less prevalent than cigarette smoking (Table 1 ). Further details about the characteristics of the study participants and their tobacco use behavior are listed in Table 1 . Table 1: Characteristics of the study participants. Data presented as % (n). Supp. Table 1 : Descriptive statistics of the study participants in terms of age, years of experience, hygiene, competence, knowledge, and practice scores. Self-assessment of personal oral hygiene Questions nine to 15 were used to assess the oral hygiene behavior of the study participants (Table 2 ). As expected, the majority of the study participants reported brushing teeth twice a day or more (90.9%) and daily use of dental floss or interdental brushes (77.3%). However, daily use of fluoridated toothpaste was reported by only 48.3% of the total number of study participants. Differences in the use of fluoride toothpaste were observed between the three countries (Chi2 p < 0.001), with 22.5% from Armenia and 19% from Moldova reporting daily use compared to 71.9% in Belarus. Consumption of sugar-containing snacks was prevalent among dentists in all three countries, with only 22.6% answering “rarely or never”. The majority of the study participants reported visiting a dentist at least once a year (83%), and when asked about the reason for the last dental visit, 75.4% answered “regular check-up” compared to 8% answering “acute/pain driven”. A significantly high proportion of the study participants described their teeth's condition as “good” (55%) or “quite good” (23.1%). Questions related to personal oral hygiene (questions 9 to 15) were combined in one score (Suppl. Table 1). Comparing this score between the three countries using one-way ANOVA with Bonferroni correction revealed that the mean scores of self-assessment of personal oral hygiene were different between the three countries (p < 0.001, 22.90 ± 3.01 for Armenia, 23.99 ± 2.58 for Moldova, and 25.47 ± 2.27 for Belarus). Table 2: Self-assessment of personal oral hygiene. Data presented as % (n) Self-assessment of competence in caries prevention Questions 19 through 23 were used to assess the self-perceived competence of the study participants in delivering preventive care to their patients. The majority of the study participants agreed (56.5%) or strongly agreed (34%) that they feel competent to provide clinical care to their patients (Table 3 ); however, 18% of the dentists from Armenia answered “I do not know” to this statement (Table 3 ). The majority also agreed or strongly agreed that they are competent in delivering preventive care (91.8%) and giving oral health education to patients (94.3%). Additionally, a significant percentage (50.7%) of the study participants agreed that more theoretical and preclinical training on preventive dentistry in undergraduate education is needed (Table 3 ). A combined score of these five questions was generated (Suppl Table 1). Comparing this score across the three countries showed significant differences in competence to deliver preventive care between the mean scores of Armenia (19.78 ± 2.96), Moldova (21.51 ± 2.19), and Belarus (20.27 ± 2.34) by using one-way ANOVA (p < 0.001). Table 3: Self-assessment of competence. Data presented as % (n) Self-assessment of knowledge on preventive dentistry Questions 24 through 33 were used to assess the knowledge of the study participants on preventive dentistry. In general, participants from all three countries showed good knowledge of preventive dentistry by agreeing or strongly agreeing to positive statements about oral health-promoting measures (Table 4 ). Of note, 32.2% of the dentists from Armenia answered “I do not know” to the statement that sealants are effective in the prevention of pit and fissure caries. Again, a score was made by combining all questions in this section. There were slight differences between the scores of knowledge on preventive dentistry among the three countries (suppl. Table 1) (p < 0.001) as revealed by a one-way ANOVA test (37.74 ± 5.28 for Armenia, 40.18 ± 4.70 for Moldova, and 40.82 ± 4.29 for Armenia. Table 4: Self-assessment of knowledge Self-assessment of preventive practices Questions 34 through 40 were used to assess to which extent the study participants give advice on caries prevention to patients in their clinical practice. In general, dentists from Belarus showed more adherence to patient education on caries prevention measures when we looked at individual questions in this section (Table 5 ). For example, 57.3% of the Belarusian dentists answered “always or almost always” when asked about recommending fluoride toothpaste to patients (Table 5 ) as compared to 12.7% in Armenia and 11.2% in Moldova (p < 0.001, Chi 2 test). When asked about giving oral hygiene instruction or diet counselling, a significantly higher percentage of Belarusian dentists answered, “always or almost always”, as compared to the two other countries (p < 0.001, Chi 2 test). A similar trend was observed for the question about the use of topical fluoride and recommending regular check-ups to patients, but not for the question about tobacco cessation (Table 5 ). Analysis of the combined score of questions in this section showed significant differences (p < 0.001) of preventive practices by using the ANOVA test (suppl. Table 1) between the countries (21.58 ± 3.4 for Armenia, 19.89 ± 3.46 for Moldova, and 22.56 ± 3.32 for Belarus). Table 5: Self-assessment of preventive practice Discussion This questionnaire-based study offers novel insights into the oral hygiene practices, knowledge on preventive measures, and clinical competence of dentists in Armenia, Moldova, and Belarus, revealing generally favorable self-reported oral health behaviors and high self-perceived competence in preventive care and oral health education. The sociodemographic characteristics of our multinational study cohort revealed interesting patterns in the dental workforce across Armenia, Moldova, and Belarus. The predominance of female dentists (65.6%) across all three countries, particularly in Belarus (79.6%), reflects the global trend of increasing feminization of the dental profession [ 15 ]. This gender distribution may have implications for oral health care delivery, as previous research suggests female dentists have a greater orientation toward caries prevention compared to their male counterparts [ 16 , 17 ]. Additionally, the participating dentists had a mean of 16.12 years of professional experience, indicating a mature workforce well-positioned to adopt and implement preventive care strategies. The daily cigarette smoking prevalence among participating dentists was, however, 13.8% (mostly males), reaching 19.5% in Armenia, which exceeds rates reported in countries such as Ireland [ 18 ] and Australia [ 19 ], where the reported smoking prevalence among dentists is below 10%. This finding underscores the need for targeted tobacco cessation programs tailored specifically for oral health professionals, particularly for males, as well as dental students to reinforce their role as advocates for tobacco-free lifestyles. This finding is especially relevant given that, in our previous study, 15.5% of dental students from Moldova, Armenia, and Belarus reported smoking daily, with most of them being male [ 20 ]. Regarding oral hygiene practices, the high prevalence of twice-daily toothbrushing (90.9%) and daily use of dental floss or interdental brushes (77.3%) among participating dentists aligns with previous studies demonstrating that dentists typically maintain better oral hygiene than the general population [ 21 , 22 ]. In addition, the high proportion of dentists reporting dental visits at least once a year (83%), with preventive check-ups as their primary reason for attendance (75.4%), suggests that dental professionals generally model good oral health behaviors for their patients. However, daily use of fluoride toothpaste was markedly low in Armenia (22.5%) and Moldova (19%) compared to Belarus (71.9%), which is concerning, given fluoride's well-established role in caries prevention [ 7 ]. As of 2021, neither Moldova nor Armenia had an active national oral health action plan, suggesting that the dentists in both countries may not have received systematic training on the preventive benefits of fluoride toothpaste [ 23 , 24 ]. It is also worth noting that some areas of Moldova have naturally high concentrations of fluoride in groundwater [ 25 ], exceeding the WHO guideline limit of 1.5 mg/L [ 26 ]. However, in Chisinau —the area from which the present study collected data —the fluoride concentration in drinking water does not exceed this limit and, in fact, remains below optimal levels (average < 0.5 mg/L) [ 27 ]. A similar pattern is observed in Armenia, where measured fluoride concentration ranges from 0.099 to 0.407 mg/L [ 28 ]. These findings highlight the need for stronger public health campaigns in Armenia and Moldova, alongside increased awareness among both dental professionals and the general public about the benefits of fluoride for dental health [ 29 , 30 ]. Our results also demonstrate that while the vast majority of participating dentists reported feeling competent in providing preventive care (91.8%) and oral health education (94.3%), notable gaps persist in the clinical implementation of evidence-based strategies. For example, although 57.3% of Belarusian dentists always or almost always recommended fluoride toothpaste to their patients, only 12.7% of dentists in Armenia and 11.2% in Moldova reported doing the same. Additionally, 18.6% of Armenian dentists responded “I do not know” when asked whether they felt competent to provide clinical care, and 32.2% were unsure about the effectiveness of sealants in preventing pit and fissure caries. The finding that nearly one-third of Armenian dentists were uncertain about sealant efficacy aligns with a Japanese cross-sectional study of practicing dentists, in which only 16%–26% recommended sealants depending on caries severity, and the median percentage of patients who received sealants was 13%, indicating the underuse of sealants in clinical practice [ 31 ]. This is worrisome, given the strong evidence supporting dental sealants as a safe and effective method to prevent pit-and-fissure occlusal caries in both primary and permanent molars [ 32 ]. Overall, these findings highlight potential weaknesses in undergraduate and continuing education and underscore the need for targeted professional development to strengthen preventive dentistry competencies. Indeed, over 65% of participating dentists agreed that undergraduate training in preventive dentistry should be enhanced. This is in line with global calls, including those from the World Health Organization, to modernize dental curricula by integrating robust training in health promotion, disease prevention, evidence-informed decision-making, and patient-centered care [ 33 ]. The study's findings should be interpreted in light of some limitations. The reliance on self-reported data may introduce recall bias and social desirability bias, potentially leading dentists to overreport favorable behaviors. The present study is also limited by its cross-sectional design, precluding causal inferences. Additionally, the focus on urban practitioners based in the capital cities of Armenia, Moldova, and Belarus may limit the generalizability of results to rural areas, where practice environments and patient populations may differ substantially. Despite these limitations, the study has several strengths, including a large multinational sample from diverse settings spanning both public and private sectors, representation of multiple dental specialties, and inclusion of both solo and group practices. This diversity enhances the relevance and generalizability of the findings across the dental workforce in Armenia, Moldova, and Belarus. Additionally, the study provides a comprehensive assessment of multiple domains (knowledge, attitudes, and practices), using a standardized questionnaire consistently applied across all three countries. Conclusion In conclusion, this cross-sectional study of 1,316 dentists from Armenia, Moldova, and Belarus revealed overall good oral hygiene practices and high self-reported competence in delivering preventive dental care. Continuous educational interventions must be regularly provided and made equally accessible to dentists in both public and private practice settings, with particular emphasis on practical training in fluoride applications and sealant techniques, where implementation gaps were pronounced. Country-specific strategies should be developed, with national dental associations taking the lead in establishing evidence-based practice guidelines, organizing continuing education seminars, and promoting the consistent application of preventive protocols. Undergraduate dental education should place greater emphasis on preventive dentistry to ensure that future dentists are well-equipped with the knowledge and skills required for effective caries prevention. Declarations Ethics approval and consent to participate Ethical approval was obtained from ethical committees in Moldova (Comitetului de Etica a Cercetarii, Nicolae Testemitanu, application number 29, date: 20.12.2017), Belarus (Belarusian State Medical University, Protocol number: 10, Date: 20.05.2019), and Armenia (Ethics Committee of Yerevan State Medical University, protocol number: 12–15/2019). The project was registered at the Norwegian Centre for Research Data (Project Numbers 471282 and 57451). Participation was voluntary and anonymous, with written informed consent obtained from all respondents. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests Funding The study was funded by Norwegian Centre for International Cooperation in Education, grant number: CPEA-LT-2016/10106. The Norwegian Research Council (Norges Forskningsråd), grant number 22325, and the Health Authority of Western Norway (HelseVest), grant number: F13105. Author Contribution O.G., MH. H., G.M., I. V., M. M., N. S., D. U., collected the data. TA. O. performed the data analysis and prepared the tables. D. S., B. S., TM. S., DE. C., interpreted the data. TA. O., DE. C., O. G., wrote the main manuscript text. DE. C., recruited the fund. All authors reviewed the manuscript Acknowledgement The authors would like to thank the study participants for agreeing to participate Data Availability Data is available through reasonable request to the corresponding authors References Kassebaum NJ, Smith AGC, Bernabé E, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990–2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017;96(4):380–7. Featherstone JD. 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Questionnaire used in this study Personal data. Additional Declarations No competing interests reported. Supplementary Files SupplementalFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 21 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 26 Nov, 2025 Editor assigned by journal 21 Nov, 2025 Submission checks completed at journal 21 Nov, 2025 First submitted to journal 13 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Osman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYJCCA1Ca8QGDwQE86qCAB0kLswHRWmCATQKhHQ+wZz/78OAXBht73fazx6p5Cu4wmLM3ELCFJ93gsAxDWuK2M3lpt3kMnjFY9hCwiYchjeGwBMPhBLMDOWZALYcZDG4kENDC/wysxd7s/BuzYuK0SKQxHPzAcJhx240cM2bitNwA2sJgAPTLjTfGknMMnvEYnCHgF/b+NOaPPypsgA7LMfzw5s8dOYPjDfi1gADQPUjWElYPBIw/iFI2CkbBKBgFIxYAADdgQyTHvNGxAAAAAElFTkSuQmCC","orcid":"","institution":"University of Bergen","correspondingAuthor":true,"prefix":"","firstName":"Tarig","middleName":"Al-Hadi","lastName":"Osman","suffix":""},{"id":570686732,"identity":"2a24c178-29dc-4793-b664-c197dfbddddb","order_by":1,"name":"Maria Helene Hagen","email":"","orcid":"","institution":"University of Bergen","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Helene","lastName":"Hagen","suffix":""},{"id":570686733,"identity":"fa423594-04c1-4f3b-96c7-b87bd38aab80","order_by":2,"name":"Gayane Manrikyan","email":"","orcid":"","institution":"Yerevan State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gayane","middleName":"","lastName":"Manrikyan","suffix":""},{"id":570686734,"identity":"c51237fb-f241-4277-9411-9d725b9e45dd","order_by":3,"name":"Izabella Vardanian","email":"","orcid":"","institution":"Yerevan State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Izabella","middleName":"","lastName":"Vardanian","suffix":""},{"id":570686736,"identity":"7095e6d4-027e-4660-b79f-1e8f03de8996","order_by":4,"name":"Christoffer Andresen","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Christoffer","middleName":"","lastName":"Andresen","suffix":""},{"id":570686737,"identity":"b13b5c43-eb52-4949-a594-934dc92fc41a","order_by":5,"name":"Bhavdeep Singh","email":"","orcid":"","institution":"University of Oslo","correspondingAuthor":false,"prefix":"","firstName":"Bhavdeep","middleName":"","lastName":"Singh","suffix":""},{"id":570686738,"identity":"c4ca0b6f-f65d-424e-9334-8c106a5e6655","order_by":6,"name":"Marina Markaryan","email":"","orcid":"","institution":"Yerevan State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Marina","middleName":"","lastName":"Markaryan","suffix":""},{"id":570686740,"identity":"74b63c13-504d-4c32-99e9-2ead301b3a4a","order_by":7,"name":"Natalia Shakavets","email":"","orcid":"","institution":"Republican Clinical Dental Center","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"","lastName":"Shakavets","suffix":""},{"id":570686741,"identity":"cfcda0de-a4f8-4de7-bc7c-75c6971efffc","order_by":8,"name":"Dipak Sapkota","email":"","orcid":"","institution":"University of 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11:20:32","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":132538,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8106824/v1/2a06cb4f74d93e9a46b4a6a4.html"},{"id":100356157,"identity":"69c4e774-d6f3-485b-96e6-e481b4c7bd73","added_by":"auto","created_at":"2026-01-16 06:54:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1246950,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8106824/v1/355b9afd-173b-4b07-929f-8046d0ff8f9f.pdf"},{"id":99784594,"identity":"6544b992-df76-4608-8cdc-a8465ae76ad1","added_by":"auto","created_at":"2026-01-08 11:20:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26974,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8106824/v1/9a74352599f2d965bdffd0bb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preventive dentistry competence and self-care behaviors among dentists in Armenia, Moldova, and Belarus: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental caries remains one of the most prevalent chronic diseases, affecting 2.5\u0026nbsp;billion people worldwide [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The disease is characterized by progressive destruction of tooth enamel and dentin due to acid-producing bacteria metabolizing fermentable carbohydrates [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although initially reversible, untreated caries can lead to pain, infection, and tooth loss, significantly impairing the quality of life [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Fortunately, caries progression can be halted at any stage, even after enamel or dentin loss (cavitation), provided that sufficient biofilm is removed [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite advances in preventive dentistry, the global burden of caries persists, particularly in low- and middle-income countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDentists play a crucial role in caries prevention through patient education, application of preventive measures such as fluoride and dental sealants, and dietary counseling, including sugar reduction [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the success of these measures depends on dentists\u0026rsquo; own knowledge, competence, and adherence to recommended oral hygiene practices [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Indeed, healthcare providers who engage in healthy behaviors themselves are more likely to promote such behaviors in their patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough many dentists are familiar with evidence-based preventive strategies, their implementation in clinical practice is often inconsistent. This inconsistency is influenced by factors such as limited emphasis on prevention in dental education, time constraints during patient care, inadequate resources, especially in underfunded health systems, and perceived patient disinterest [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Understanding dentists\u0026rsquo; personal oral hygiene habits alongside their competence in caries prevention is therefore critical for enhancing patient outcomes and improving dental curricula [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo our knowledge, there is a dearth of data exploring dentists\u0026rsquo; oral hygiene practices and preventive competence in Eastern European and post-Soviet contexts. This study aims to fill that gap by assessing the competencies of dentists in caries prevention and their personal oral hygiene routines in Armenia, Moldova, and Belarus. By evaluating self-reported knowledge, behaviors, and clinical practices, we aim to highlight areas for improvement in preventive dentistry education and practice, contributing to better oral health care in these three countries.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and settings\u003c/h2\u003e \u003cp\u003eThe study design has been previously described [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Briefly, this cross-sectional study was conducted from June 2018 to September 2019 among actively practicing dentists in both public and private dental clinics across Chisinau (Moldova), Minsk (Belarus), and Yerevan (Armenia), using a structured, self-administered questionnaire. Ethical approval was obtained from ethical committees in Moldova (Comitetului de Etica a Cercetarii, Nicolae Testemitanu, application number 29, date: 20.12.2017), Belarus (Belarusian State Medical University, Protocol number: 10, Date: 20.05.2019), and Armenia (Ethics Committee of Yerevan State Medical University, protocol number: 12\u0026ndash;15/2019). The project was registered at the Norwegian Centre for Research Data (Project Numbers 471282 and 57451). Participation was voluntary and anonymous, with written informed consent obtained from all respondents.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eThe questionnaire used in this study comprised 40 items, divided into five thematic sections (\u003cb\u003eSupplemental File 1\u003c/b\u003e): (1) demographic and professional characteristics; (2) oral hygiene habits, dietary behavior, and use of dental services; (3) self-assessed competence in caries prevention; (4) knowledge of preventive dentistry; and (5) clinical preventive practices for patients. It was first prepared in English, and then translated into Armenian, Romanian (for Moldova), and Russian (for Belarus), following a standardized forward\u0026ndash;backward procedure. The questionnaire was pretested for clarity and cultural appropriateness prior to implementation. All questions utilized standardized response formats, such as Likert-type scales ranging from \"Strongly disagree\" to \"Strongly agree\" and \"Not at all\" to \"Always\".\u003c/p\u003e \u003cp\u003eSection 1 (items 1\u0026ndash;8) captured age, sex, years of professional experience, type of employment (public or private), specialization, and whether participants worked with children. Section 2 (items 9\u0026ndash;18) addressed tooth brushing frequency, use of interdental aids, fluoride toothpaste use, sugar intake, dental attendance patterns, self-perceived oral health, and tobacco use. Section 3 (items 19\u0026ndash;23) assessed self-perceived competence in delivering clinical care and oral health education, and perceptions of undergraduate training in preventive dentistry. Section 4 (items 24\u0026ndash;33) evaluated knowledge of evidence-based caries prevention strategies, including the effectiveness of fluoride (toothpaste, fluoridated water, supplements, and topical applications), sealants, and dietary counseling related to sugar intake. Section 5 (items 34\u0026ndash;40) examined the frequency of advising patients on caries-preventive behaviors such as fluoride use, diet counselling, tobacco cessation, and regular check-ups.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll data curation and analysis in this study was performed in Statistical Package for the Social Sciences (SPSS version 29.0.2.0). The country of the study participants was considered the independent variable in most of the analyses. Gender was also used as an independent variable when analyzing the tobacco use behavior. The variable age was categorized into decades, and years of experience were categorized into three groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), but both variables were also used as continuous data in some of the analyses (Supp. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In addition to analyzing the data for frequencies, combined scores of the different categories in the questionnaire were generated by addition, as explained in the respective sections under results (Supp. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For example, Questions 5 through 19 were added to each other, and the resulting score was used to compare the self-assessment of personal oral hygiene of the study participants in the three countries. Differences between categorical variables were investigated for statistical significance using the Chi-squared test. While differences between continuous variables between the three countries were investigated by one-way ANOVA with Bonferroni correction. In all statistical tests, the level of significance was set to 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy cohort characteristics:\u003c/h2\u003e\n \u003cp\u003eIn total, 1,316 dentists participated in the study, with the majority of participants (53%) being from Belarus. Female dentists represented the majority (65.6%) of the study participants from all the three countries combined, leading to a female to male ratio of 2:1 (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e), with data from Belarus exhibiting significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Chi\u003csup\u003e2\u003c/sup\u003e test) female representation (79.6%) as compared to Armenia (50.3%) and Moldova (48.7%). The mean age of study participants was found to be 39.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42 (Suppl. Table 1), and the mean age of participants from Armenia (38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.27) was found to be significantly less (p-value\u0026thinsp;=\u0026thinsp;0.01, one-way ANOVA) than Moldova (40.27\u0026thinsp;\u0026plusmn;\u0026thinsp;11.99) and Belarus (40.56\u0026thinsp;\u0026plusmn;\u0026thinsp;11.20). Years of experience of the study participants (Suppl. Table 1) ranged from 1 to 50 years (16.12\u0026thinsp;\u0026plusmn;\u0026thinsp;11.09). Mean years of experience for dentists from Belarus (17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.75) was significantly higher (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, one-way ANOVA) than for dentists from Armenia (14.28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86) or Moldova (15.30\u0026thinsp;\u0026plusmn;\u0026thinsp;11.92). The percentage of dentists employed by public/university clinics (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) was found to be significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Chi\u003csup\u003e2\u003c/sup\u003e test) in Belarus (60.9%) as compared to Armenia (11.7%) or Moldova (27.1%). General dental practitioners comprised the majority of the study participants from Armenia (69.5%) and Moldova (70.1%), compared to only 25.9% of dentists from Belarus (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e), reflecting a higher frequency of specialized dentists in the Belarusian sample. Dentists working exclusively with children comprised only 11.5% of the study participants from all three countries.\u003c/p\u003e\n \u003cp\u003eDaily cigarette smoking was reported by 19.5% in Armenia, 12.5% in Moldova, and 11.6% in Belarus (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Chi\u003csup\u003e2\u003c/sup\u003e test). As expected, the vast majority of daily cigarette smokers (Chi2 test, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were found to be males (70.7%) when all three countries were taken together (data not shown). When data were analyzed by country, a similar trend was observed in Armenia and Moldova, where male dentists comprised 90.8% and 94.1% of the daily smokers. On the contrary, male dentists in Belarus comprised only 45.1% of daily smokers. Daily use of other tobacco products, such as water-pipe or smokeless tobacco, was far less prevalent than cigarette smoking (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Further details about the characteristics of the study participants and their tobacco use behavior are listed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eTable 1: Characteristics of the study participants. Data presented as % (n).\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767870787.png\" style=\"width: 650px;\"\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eSupp. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e: Descriptive statistics of the study participants in terms of age, years of experience, hygiene, competence, knowledge, and practice scores.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767870835.png\" style=\"width: 770px;\"\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSelf-assessment of personal oral hygiene\u003c/h2\u003e\n \u003cp\u003eQuestions nine to 15 were used to assess the oral hygiene behavior of the study participants (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). As expected, the majority of the study participants reported brushing teeth twice a day or more (90.9%) and daily use of dental floss or interdental brushes (77.3%). However, daily use of fluoridated toothpaste was reported by only 48.3% of the total number of study participants. Differences in the use of fluoride toothpaste were observed between the three countries (Chi2 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 22.5% from Armenia and 19% from Moldova reporting daily use compared to 71.9% in Belarus. Consumption of sugar-containing snacks was prevalent among dentists in all three countries, with only 22.6% answering \u0026ldquo;rarely or never\u0026rdquo;. The majority of the study participants reported visiting a dentist at least once a year (83%), and when asked about the reason for the last dental visit, 75.4% answered \u0026ldquo;regular check-up\u0026rdquo; compared to 8% answering \u0026ldquo;acute/pain driven\u0026rdquo;. A significantly high proportion of the study participants described their teeth\u0026apos;s condition as \u0026ldquo;good\u0026rdquo; (55%) or \u0026ldquo;quite good\u0026rdquo; (23.1%).\u003c/p\u003e\n \u003cp\u003eQuestions related to personal oral hygiene (questions 9 to 15) were combined in one score (Suppl. Table\u0026nbsp;1). Comparing this score between the three countries using one-way ANOVA with Bonferroni correction revealed that the mean scores of self-assessment of personal oral hygiene were different between the three countries (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 22.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01 for Armenia, 23.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58 for Moldova, and 25.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27 for Belarus).\u003c/p\u003e\n \u003cp\u003eTable 2: Self-assessment of personal oral hygiene. Data presented as % (n)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767870874.png\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-assessment of competence in caries prevention\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eQuestions 19 through 23 were used to assess the self-perceived competence of the study participants in delivering preventive care to their patients. The majority of the study participants agreed (56.5%) or strongly agreed (34%) that they feel competent to provide clinical care to their patients (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e); however, 18% of the dentists from Armenia answered \u0026ldquo;I do not know\u0026rdquo; to this statement (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The majority also agreed or strongly agreed that they are competent in delivering preventive care (91.8%) and giving oral health education to patients (94.3%). Additionally, a significant percentage (50.7%) of the study participants agreed that more theoretical and preclinical training on preventive dentistry in undergraduate education is needed (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA combined score of these five questions was generated (Suppl Table\u0026nbsp;1). Comparing this score across the three countries showed significant differences in competence to deliver preventive care between the mean scores of Armenia (19.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96), Moldova (21.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19), and Belarus (20.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34) by using one-way ANOVA (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eTable 3: Self-assessment of competence. Data presented as % (n)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767870921.png\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eSelf-assessment of knowledge on preventive dentistry\u003c/h3\u003e\n\u003cp\u003eQuestions 24 through 33 were used to assess the knowledge of the study participants on preventive dentistry. In general, participants from all three countries showed good knowledge of preventive dentistry by agreeing or strongly agreeing to positive statements about oral health-promoting measures (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Of note, 32.2% of the dentists from Armenia answered \u0026ldquo;I do not know\u0026rdquo; to the statement that sealants are effective in the prevention of pit and fissure caries. Again, a score was made by combining all questions in this section. There were slight differences between the scores of knowledge on preventive dentistry among the three countries (suppl. Table\u0026nbsp;1) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as revealed by a one-way ANOVA test (37.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28 for Armenia, 40.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70 for Moldova, and 40.82\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29 for Armenia.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003eTable 4: Self-assessment of knowledge\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767870971.png\"\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSelf-assessment of preventive practices\u003c/h2\u003e\n \u003cp\u003eQuestions 34 through 40 were used to assess to which extent the study participants give advice on caries prevention to patients in their clinical practice. In general, dentists from Belarus showed more adherence to patient education on caries prevention measures when we looked at individual questions in this section (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). For example, 57.3% of the Belarusian dentists answered \u0026ldquo;always or almost always\u0026rdquo; when asked about recommending fluoride toothpaste to patients (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e) as compared to 12.7% in Armenia and 11.2% in Moldova (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Chi\u003csup\u003e2\u003c/sup\u003e test). When asked about giving oral hygiene instruction or diet counselling, a significantly higher percentage of Belarusian dentists answered, \u0026ldquo;always or almost always\u0026rdquo;, as compared to the two other countries (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Chi\u003csup\u003e2\u003c/sup\u003e test). A similar trend was observed for the question about the use of topical fluoride and recommending regular check-ups to patients, but not for the question about tobacco cessation (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). Analysis of the combined score of questions in this section showed significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) of preventive practices by using the ANOVA test (suppl. Table\u0026nbsp;1) between the countries (21.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 for Armenia, 19.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46 for Moldova, and 22.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32 for Belarus).\u003c/p\u003e\n \u003cp\u003eTable 5: Self-assessment of preventive practice\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1767871006.png\" style=\"width: 746px;\"\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis questionnaire-based study offers novel insights into the oral hygiene practices, knowledge on preventive measures, and clinical competence of dentists in Armenia, Moldova, and Belarus, revealing generally favorable self-reported oral health behaviors and high self-perceived competence in preventive care and oral health education.\u003c/p\u003e \u003cp\u003eThe sociodemographic characteristics of our multinational study cohort revealed interesting patterns in the dental workforce across Armenia, Moldova, and Belarus. The predominance of female dentists (65.6%) across all three countries, particularly in Belarus (79.6%), reflects the global trend of increasing feminization of the dental profession [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This gender distribution may have implications for oral health care delivery, as previous research suggests female dentists have a greater orientation toward caries prevention compared to their male counterparts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, the participating dentists had a mean of 16.12 years of professional experience, indicating a mature workforce well-positioned to adopt and implement preventive care strategies. The daily cigarette smoking prevalence among participating dentists was, however, 13.8% (mostly males), reaching 19.5% in Armenia, which exceeds rates reported in countries such as Ireland [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and Australia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], where the reported smoking prevalence among dentists is below 10%. This finding underscores the need for targeted tobacco cessation programs tailored specifically for oral health professionals, particularly for males, as well as dental students to reinforce their role as advocates for tobacco-free lifestyles. This finding is especially relevant given that, in our previous study, 15.5% of dental students from Moldova, Armenia, and Belarus reported smoking daily, with most of them being male [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding oral hygiene practices, the high prevalence of twice-daily toothbrushing (90.9%) and daily use of dental floss or interdental brushes (77.3%) among participating dentists aligns with previous studies demonstrating that dentists typically maintain better oral hygiene than the general population [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, the high proportion of dentists reporting dental visits at least once a year (83%), with preventive check-ups as their primary reason for attendance (75.4%), suggests that dental professionals generally model good oral health behaviors for their patients. However, daily use of fluoride toothpaste was markedly low in Armenia (22.5%) and Moldova (19%) compared to Belarus (71.9%), which is concerning, given fluoride's well-established role in caries prevention [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As of 2021, neither Moldova nor Armenia had an active national oral health action plan, suggesting that the dentists in both countries may not have received systematic training on the preventive benefits of fluoride toothpaste [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. It is also worth noting that some areas of Moldova have naturally high concentrations of fluoride in groundwater [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], exceeding the WHO guideline limit of 1.5 mg/L [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, in Chisinau \u0026mdash;the area from which the present study collected data \u0026mdash;the fluoride concentration in drinking water does not exceed this limit and, in fact, remains below optimal levels (average\u0026thinsp;\u0026lt;\u0026thinsp;0.5 mg/L) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A similar pattern is observed in Armenia, where measured fluoride concentration ranges from 0.099 to 0.407 mg/L [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These findings highlight the need for stronger public health campaigns in Armenia and Moldova, alongside increased awareness among both dental professionals and the general public about the benefits of fluoride for dental health [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results also demonstrate that while the vast majority of participating dentists reported feeling competent in providing preventive care (91.8%) and oral health education (94.3%), notable gaps persist in the clinical implementation of evidence-based strategies. For example, although 57.3% of Belarusian dentists always or almost always recommended fluoride toothpaste to their patients, only 12.7% of dentists in Armenia and 11.2% in Moldova reported doing the same. Additionally, 18.6% of Armenian dentists responded \u0026ldquo;I do not know\u0026rdquo; when asked whether they felt competent to provide clinical care, and 32.2% were unsure about the effectiveness of sealants in preventing pit and fissure caries. The finding that nearly one-third of Armenian dentists were uncertain about sealant efficacy aligns with a Japanese cross-sectional study of practicing dentists, in which only 16%\u0026ndash;26% recommended sealants depending on caries severity, and the median percentage of patients who received sealants was 13%, indicating the underuse of sealants in clinical practice [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This is worrisome, given the strong evidence supporting dental sealants as a safe and effective method to prevent pit-and-fissure occlusal caries in both primary and permanent molars [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOverall, these findings highlight potential weaknesses in undergraduate and continuing education and underscore the need for targeted professional development to strengthen preventive dentistry competencies. Indeed, over 65% of participating dentists agreed that undergraduate training in preventive dentistry should be enhanced. This is in line with global calls, including those from the World Health Organization, to modernize dental curricula by integrating robust training in health promotion, disease prevention, evidence-informed decision-making, and patient-centered care [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study's findings should be interpreted in light of some limitations. The reliance on self-reported data may introduce recall bias and social desirability bias, potentially leading dentists to overreport favorable behaviors. The present study is also limited by its cross-sectional design, precluding causal inferences. Additionally, the focus on urban practitioners based in the capital cities of Armenia, Moldova, and Belarus may limit the generalizability of results to rural areas, where practice environments and patient populations may differ substantially. Despite these limitations, the study has several strengths, including a large multinational sample from diverse settings spanning both public and private sectors, representation of multiple dental specialties, and inclusion of both solo and group practices. This diversity enhances the relevance and generalizability of the findings across the dental workforce in Armenia, Moldova, and Belarus. Additionally, the study provides a comprehensive assessment of multiple domains (knowledge, attitudes, and practices), using a standardized questionnaire consistently applied across all three countries.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this cross-sectional study of 1,316 dentists from Armenia, Moldova, and Belarus revealed overall good oral hygiene practices and high self-reported competence in delivering preventive dental care. Continuous educational interventions must be regularly provided and made equally accessible to dentists in both public and private practice settings, with particular emphasis on practical training in fluoride applications and sealant techniques, where implementation gaps were pronounced. Country-specific strategies should be developed, with national dental associations taking the lead in establishing evidence-based practice guidelines, organizing continuing education seminars, and promoting the consistent application of preventive protocols. Undergraduate dental education should place greater emphasis on preventive dentistry to ensure that future dentists are well-equipped with the knowledge and skills required for effective caries prevention.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eEthical approval was obtained from ethical committees in Moldova (Comitetului de Etica a Cercetarii, Nicolae Testemitanu, application number 29, date: 20.12.2017), Belarus (Belarusian State Medical University, Protocol number: 10, Date: 20.05.2019), and Armenia (Ethics Committee of Yerevan State Medical University, protocol number: 12\u0026ndash;15/2019). The project was registered at the Norwegian Centre for Research Data (Project Numbers 471282 and 57451). Participation was voluntary and anonymous, with written informed consent obtained from all respondents.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study was funded by Norwegian Centre for International Cooperation in Education, grant number: CPEA-LT-2016/10106. The Norwegian Research Council (Norges Forskningsr\u0026aring;d), grant number 22325, and the Health Authority of Western Norway (HelseVest), grant number: F13105.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eO.G., MH. H., G.M., I. V., M. M., N. S., D. U., collected the data. TA. O. performed the data analysis and prepared the tables. D. S., B. S., TM. S., DE. C., interpreted the data. TA. O., DE. C., O. G., wrote the main manuscript text. DE. C., recruited the fund. All authors reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the study participants for agreeing to participate\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is available through reasonable request to the corresponding authors\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKassebaum NJ, Smith AGC, Bernab\u0026eacute; E, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990\u0026ndash;2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017;96(4):380\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeatherstone JD. Dental caries: a dynamic disease process. 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J Am Dent Assoc. 2016;147(8):631\u0026ndash;e645618.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Global strategy and action plan on oral health 2023\u0026ndash;2030. 2024. [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/bitstream/handle/10665/376623/9789240090538-eng.pdf]\u003c/span\u003e\u003cspan address=\"https://iris.who.int/bitstream/handle/10665/376623/9789240090538-eng.pdf]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Supplemental File 1. Questionnaire used in this study Personal data.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dentists, Preventive dentistry, Oral hygiene, Caries prevention, Fluoride, Sealants, Oral health education, Eastern Europe, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8106824/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8106824/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDentists play a key role in preventing dental caries through patient education and implementation of evidence-based strategies. Their own oral hygiene behaviors and self-perceived competence in preventive care can influence their clinical practice. This study assessed personal oral hygiene habits, preventive knowledge, and competence among dentists in the capital cities of Armenia, Moldova, and Belarus.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional questionnaire survey was conducted among 1,316 practicing dentists in Yerevan, Chisinau, and Minsk. The 40-item structured questionnaire collected information on sociodemographic and professional characteristics, oral hygiene and dietary behaviors, knowledge of caries prevention, and preventive clinical practices. Data were analyzed using descriptive statistics, Chi-square tests, and one-way ANOVA.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants had a mean age of 39.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 years, and 65.6% were women. Most dentists reported brushing their teeth twice daily or more (90.9%) and using interdental cleaning aids daily (77.3%). Daily use of fluoride toothpaste was reported by 48.3% of respondents. However, daily use of fluoridated toothpaste varied markedly across countries: 22.5% in Armenia, 19.0% in Moldova, and 71.9% in Belarus (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Nearly all participants felt competent to provide preventive dental care (91.8%) and oral health education (94.3%), while over half agreed that more training in preventive dentistry should be provided in undergraduate curricula. The majority demonstrated sound knowledge of preventive measures such as fluoride use, sugar reduction, and sealants, and most reported routinely advising patients on oral hygiene, diet, and regular check-ups (mean knowledge scores of 37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3, 40.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7, and 40.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 for Armenia, Moldova, and Belarus, respectively, (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)). Belarusian dentists reported the highest adherence to preventive recommendations for patients, including fluoride advice and dietary counseling (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Tobacco use was reported by 13.8% of participants, mainly among men.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDentists in Armenia, Moldova, and Belarus generally showed favorable oral hygiene habits, high self-reported competence, and positive attitudes toward preventive dentistry. Continued emphasis on preventive oral health education and reinforcement of evidence-based practices\u0026mdash;particularly regarding fluoride use and patient counseling\u0026mdash;can further enhance the preventive role of dental professionals in this region.\u003c/p\u003e","manuscriptTitle":"Preventive dentistry competence and self-care behaviors among dentists in Armenia, Moldova, and Belarus: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 11:20:25","doi":"10.21203/rs.3.rs-8106824/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-21T16:51:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289656970689279549785259120455690328691","date":"2026-01-13T07:32:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T06:36:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-26T11:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-21T12:21:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-21T12:20:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-11-13T14:34:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7675e54e-b3cb-4604-91d1-1d298fb3f9dd","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T11:20:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 11:20:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8106824","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8106824","identity":"rs-8106824","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}