Oral health is an important part of maintaining overall health, which is related to the occurrence and development of cardiovascular disease, diabetes, stroke and other diseases [1] [2] . The Global Oral Health Report released by WHO in 2022 pointed out that oral diseases are a common non communicable disease, affecting approximately 3.5 billion people worldwide [3] . This data shows the severity of oral health issues on a global scale, emphasizing the importance of understanding the oral health status of individuals of different genders, races, ages, and socio-economic levels, as well as taking more measures to prevent and treat oral diseases. The 74th World Health Assembly of the World Health Organization also passed a resolution on oral health, calling on countries to strengthen the provision of oral health services and promote the integration of oral health and primary healthcare systems at the household and school levels to promote the improvement of oral health [4] . As the main force of future health services, medical students can serve as role models for patients, family members, and friends to emulate in their oral health attitudes and behaviors [5] . Therefore, understanding the oral health status, knowledge, attitudes, and behaviors of medical students is necessary for both patients and students themselves. This study conducted a questionnaire survey on oral health knowledge, attitude, and behavior (KAP) among college students at Fuzhou Medical College, in order to understand the current situation of KAP in the oral health of medical students at the school and provide some reference for implementing oral health intervention measures for medical students.

SPSS 26.0 statistical software was used for data analysis, and the quantitative data were expressed as mean ± standard deviation ( $\bar{x}\pm s$); The count data is expressed as a percentage, and the comparison between groups is conducted using the chi square test. The correlation analysis is conducted using Spearman correlation analysis, with a p < 0.05 indicating statistical significance.

Oral disease is a global public health problem, which not only reduces the quality of life of patients, but also has a high incidence rate [11] - [14] . Multiple studies have shown that the oral health status of college students is not optimistic [15] [16] . Therefore, this study takes medical students as the research object, explores the current situation of KAP in oral health of medical students, and analyzes potential related factors that affect their oral health, aiming to provide some reference for oral health care and prevention of oral problems for college students.

Note: Significance: *: p < 0.05, **: p < 0.01.

This survey found that the oral health knowledge level of medical students in our school is good, their attitude is positive, and their behavior is above average. This result is similar to the survey conducted by KAREM et al. [17] among Iraqi dental students, but opposite to the oral health survey conducted by KOMABAYASHI et al. [18] in 2005 involving Chinese dental students. This may be related to China’s increased promotion of oral health promotion in recent years.

Insufficient oral hygiene, smoking, excessive alcohol consumption, and unhealthy dietary habits all increase the risk of oral diseases [12] . Smoking is the second leading cause of bad breath, leading to serious damage and imbalance of the oral microbiota [19] . Periodontitis is a chronic tissue destructive inflammation of teeth caused by bacteria [20] . Research has shown that compared to individuals without alcohol exposure, individuals who consume alcohol have a higher total amount of Porphyromonasgingivalis and Candida nucleata bacteria in the subgingival microbiota [21] . In this survey, the vast majority of medical students believe that drinking alcohol and smoking affect oral health (96.4%), but only 62.3% of students are aware of dental plaque. This indicates that the awareness of dental plaque among medical students in our school is not sufficient, and it is necessary to strengthen the popularization and promotion of oral health knowledge among college students.

This survey found that some medical students still fear dental examination, and their parents have insufficient understanding and learning of oral health-related knowledge, failing to recognize the importance of oral health for overall health, thus neglecting the importance of oral health in their children. The World Dental Union proposed to include perinatal oral health care in policies promoting maternal and child health, and to encourage all women of childbearing age to start oral health care as early as possible [22] . The study by SOWMIYA et al. [23] showed that parental participation in oral health programs significantly improved the oral health status of 8 - 10 year old school-age children. It can be seen that improving the KAP level of oral health among students and strengthening family oral health education may be an effective breakthrough.

This survey also found that some medical students still do not realize the importance of fluoride toothpaste or medicated toothpaste in oral health, and most medical students survive in the phenomenon of unilateral chewing. Studies have shown that regular use of fluoride toothpaste helps reduce the incidence of cavities [24] . The study by GRUBA et al. [25] showed that fluoride toothpaste combined with trisodium phosphate mouthwash can effectively reduce enamel demineralization. Oral and facial pain is one of the most severe pain issues worldwide [26] , and a significant association has been found between a preference for chewing on one side and oral and facial pain [27] [28] .

This survey also found that the scores of oral health knowledge, attitudes, and behaviors among medical students are related to gender, major, smoking status, and oral health status. Female students cleaned their teeth more frequently than male students, with a statistically significant difference (p < 0.05), which is consistent with the results of the oral health survey conducted by FARSI et al. [29] on 1177 senior college students at the University of Aziz; But girls brush their teeth and change their toothbrushes less frequently before bedtime than boys, and the difference is statistically significant (p < 0.05). The reason may be that girls pay more attention to appearance but are more frugal in life. Comparing the oral hygiene habits of medical students from different majors, it was found that there was a statistically significant overall difference in postprandial mouthwash habits and toothbrush replacement frequency (p < 0.05), but there was no statistically significant difference in pairwise comparison between different majors (p > 0.05). The analysis of the reasons may be related to the uneven distribution of classes in various majors of our school. Students with intermittent hot and cold eating habits brush their teeth more times a day, and the difference is statistically significant (p < 0.05); There were more students in the non-smoking group who had a habit of brushing their teeth before bedtime and changing their toothbrush compared to the smoking group, and the difference was statistically significant (p < 0.05). The frequency of fluoride toothpaste use, unilateral chewing, and toothbrush replacement in the group with existing oral problems was higher than that in the group without oral problems, and the difference was statistically significant (p < 0.05). The above results all suggest that students with different genders, dietary and smoking habits, and oral health status have different oral health behavior habits. Establishing a school-based oral health education plan is the primary task for current adolescent oral health management and oral disease prevention.

In summary, it can be seen that the medical students in this school have rich knowledge of oral health, good attitudes, and moderate to above average behavior. Strengthening oral health education and promoting oral hygiene behavior habits is of great significance for early intervention in the oral health of medical students. It should be pointed out that due to the small number of classes in medical majors such as prevention, dentistry, and laboratory in our school, it is inevitable that there will be a shortage of students in related majors during the random sampling survey process. Therefore, the differences in oral health behavior among medical students still need further research and confirmation to expand the sample size. Finally, we suggest incorporating content related to oral health into university courses to further promote awareness of oral health among college students and cultivate good oral hygiene habits.

This study was funded by research grants from the National Natural Science Foundation of China (32260926), the Science and Technology Research Project of Jiangxi Provincial Department of Education (GJJ218113), and the School-level Science and Technology Project of Fuzhou Medical College of Nanchang University (fykj202212).

*Corresponding author.