Oral health is an integral component of general health and well-being, yet it remains one of the most neglected aspects of public health worldwide. Among oral diseases, dental caries continues to be the most prevalent chronic condition affecting individuals across all age groups, irrespective of geographic or socio-economic boundaries. Despite being largely preventable, dental caries imposes a significant burden on individuals, families, and healthcare systems due to pain, infection, tooth loss, impaired mastication, reduced quality of life, and increased economic costs.1-3 Dental caries is a multifactorial, biofilm-mediated disease resulting from the interaction of fermentable carbohydrates, acidogenic microorganisms, host susceptibility, and time. The disease process begins with enamel demineralization and, if left untreated, progresses to dentinal and pulpal involvement. Although advances in preventive dentistry and restorative care have significantly reduced caries incidence in developed countries, its prevalence remains high in developing regions, largely due to inadequate awareness, poor oral hygiene practices, dietary habits rich in sugars, and limited access to preventive dental services.4-9 In India, dental caries is a major public health concern, with studies reporting prevalence rates ranging from 50% to over 80% in different population groups. Rapid lifestyle changes, increased consumption of refined sugars, irregular dental visits, and misconceptions regarding oral health have contributed to this persistent burden. Alarmingly, dental caries often remains untreated until it reaches advanced stages, reflecting a gap between awareness and preventive practice among the general population.10-15 Himachal Pradesh, a predominantly hilly state with unique geographic, climatic, and socio-cultural characteristics, presents distinct challenges in oral healthcare delivery. Difficult terrain, scattered populations, limited availability of dental services in remote areas, and reliance on traditional beliefs may adversely influence oral health awareness and behaviors. Moreover, dietary patterns, water fluoride levels, and access to oral health education vary considerably across the state, potentially affecting caries prevalence and prevention practices.9-11 While several studies in India have focused on the prevalence of dental caries, data assessing public awareness and preventive practices—especially among the general population of Himachal Pradesh—remain scarce. Awareness regarding the causes of dental caries, the role of oral hygiene, fluoride use, dietary control, and regular dental check-ups is crucial for effective prevention. However, awareness alone may not necessarily translate into appropriate preventive behaviors, highlighting the importance of evaluating both knowledge and practices concurrently. Understanding the level of awareness and the extent to which preventive measures are adopted can provide valuable insights into existing gaps and barriers to optimal oral health. Such information is essential for designing targeted oral health promotion strategies, community-based preventive programs, and policy interventions tailored to regional needs. Therefore, the present study aims to assess the awareness of dental caries and associated preventive practices among the general population of Himachal Pradesh, and to examine the influence of socio-demographic factors on these parameters. By identifying knowledge deficits and behavioral gaps, this study seeks to contribute evidence that can guide effective oral health education, preventive strategies, and public health planning to reduce the burden of dental caries in this region.

Study Design and Setting A community-based, descriptive cross-sectional study was conducted to assess the awareness of dental caries and preventive practices among the general population of Himachal Pradesh, India. The study was carried out over a period of four months, from January to April 2025, and included participants from both urban and semi-urban areas across different districts of the state. The study design was chosen to obtain a comprehensive snapshot of existing knowledge, attitudes, and preventive behaviors related to dental caries in the community. Study Population The study population comprised adult residents aged 18 years and above who had been residing in Himachal Pradesh for at least one year. Individuals willing to participate voluntarily and capable of understanding and responding to the questionnaire were included in the study. Exclusion criteria included: • Individuals with professional dental or medical training (dentists, dental students, medical professionals), to avoid knowledge bias • Participants undergoing active orthodontic or extensive dental treatment • Individuals with systemic conditions affecting oral health (such as severe xerostomia, head and neck radiotherapy) • Incomplete or duplicate questionnaire responses Sample Size Determination The sample size was calculated using the single population proportion formula, assuming a 50% prevalence of adequate awareness of dental caries due to limited region-specific data, with a 95% confidence level and a 5% margin of error. The minimum sample size obtained was 384. To compensate for possible non-response and incomplete entries, the sample size was increased to 420 participants. Sampling Technique and Data Collection A non-probability convenience sampling method was employed. Data were collected using a self-administered, structured questionnaire developed in Google Forms. The survey link was disseminated through social media platforms (WhatsApp, email, and community groups), local resident welfare associations, and educational institutions to ensure wide coverage. Before participation, all respondents were provided with a brief explanation of the study objectives, and informed consent was obtained electronically. Participation was voluntary, and confidentiality was ensured by not collecting any personally identifiable information. Each participant required approximately 10–15 minutes to complete the questionnaire. Study Instrument The questionnaire was developed after an extensive review of existing literature and guidelines related to dental caries prevention and oral health promotion. It consisted of four sections: 1. Socio-demographic characteristics – age, gender, education level, occupation, monthly household income, and area of residence 2. Awareness of dental caries – causes, risk factors, early signs and symptoms, role of sugars, oral microorganisms, and consequences of untreated caries 3. Preventive practices – frequency and method of tooth brushing, use of fluoridated toothpaste, flossing and mouthwash use, dietary habits, and frequency of dental visits 4. Perception and attitudes – importance of oral hygiene, preventive dental care, regular dental check-ups, and willingness to participate in oral health education programs Each correct awareness response was awarded one point, while incorrect or “don’t know” responses were scored zero. Scoring and Categorization Based on cumulative awareness scores, participants were categorized into four levels: • Excellent awareness: ≥75% • Good awareness: 50–74% • Fair awareness: 25–49% • Poor awareness: <25% Preventive practice responses were assessed separately, and cumulative practice scores were classified as positive, neutral, or poor based on predefined cut-off values. Validity and Reliability The questionnaire underwent content and face validation by a panel of experts consisting of public health dentists, epidemiologists, and community medicine specialists. A pilot study was conducted among 40 individuals (excluded from final analysis) to test clarity, relevance, and feasibility. Internal consistency of the questionnaire was assessed using Cronbach’s alpha, which yielded a value of ≥0.80, indicating good reliability. Data Management and Statistical Analysis Data collected through Google Forms were exported to Microsoft Excel and subsequently analyzed using IBM SPSS Statistics version 26.0. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to summarize socio-demographic variables, awareness levels, and preventive practices. Inferential analysis was performed using the Chi-square test to assess associations between awareness and preventive practice levels with socio-demographic variables. A p-value < 0.05 was considered statistically significant. Ethical Considerations Ethical principles outlined in the Declaration of Helsinki were strictly followed. Participation was voluntary, informed consent was obtained electronically, and anonymity and confidentiality of all participants were maintained throughout the study.

Table 1 presents the socio-demographic profile of the 420 study participants. The majority of participants belonged to the 26–35-year age group (29.5%), followed by 36–45 years (23.3%) and 18–25 years (22.9%), indicating a predominantly young to middle-aged population. Females (51.9%) slightly outnumbered males (48.1%). A relatively high educational status was observed, with 77.6% of participants being graduates or postgraduates. Service/professional workers constituted the largest occupational group (35.2%), followed by homemakers (24.3%). Most participants belonged to the middle-income group (25,001–75,000 INR). Urban residents accounted for 56.7% of the sample. Notably, 48.6% of participants reported visiting a dentist only when pain occurred, reflecting limited utilization of preventive dental services. Table 1: Socio-Demographic Characteristics of the Study Participants (n = 420) Variable Category Frequency (n) Percentage (%) Age Group (years) 18–25 96 22.9 26–35 124 29.5 36–45 98 23.3 46–60 72 17.1 >60 30 7.2 Gender Male 202 48.1 Female 218 51.9 Educational Level Up to Secondary (≤10+2) 94 22.4 Graduate 176 41.9 Postgraduate and above 150 35.7 Occupation Student 62 14.8 Service/Professional 148 35.2 Homemaker 102 24.3 Self-employed/Business 74 17.6 Retired/Unemployed 34 8.1 Monthly Household Income (INR) <25,000 78 18.6 25,001–50,000 136 32.4 50,001–75,000 118 28.1 >75,000 88 21.0 Area of Residence Urban 238 56.7 Semi-urban 182 43.3 Frequency of Dental Visits Only when pain occurs 204 48.6 Once a year 116 27.6 Every 6 months 74 17.6 Never visited a dentist 26 6.2 Table 2 illustrates the awareness of dental caries among the study participants. Overall, awareness was found to be satisfactory, with a majority correctly identifying key etiological and preventive factors. Bacteria acting on sugars as the primary cause of dental caries was correctly identified by 75.7%, while 81.4% recognized the role of frequent sugar consumption. Awareness regarding preventive aspects was high, with 85.2% acknowledging the importance of twice-daily brushing and 86.2% recognizing the role of regular dental check-ups in early detection. However, comparatively lower awareness was observed for early signs of caries (59.0%) and the broader systemic impact of dental caries (63.8%), indicating gaps in clinical and holistic understanding of the disease. Table 2: Awareness Regarding Dental Caries Among the Study Participants (n = 420) Q. No. Question Options Correct n (%) 1 Dental caries is mainly caused by a) Trauma to teeth b) Vitamin deficiency c) Bacteria acting on sugars d) Tooth eruption 318 (75.7) 2 Frequent consumption of sugary foods leads to a) Gum bleeding b) Increased risk of dental caries c) Tooth sensitivity only d) No effect on teeth 342 (81.4) 3 Dental plaque is best described as a) Food debris b) Sticky bacterial film on teeth c) Hard calculus d) Tooth stain 296 (70.5) 4 Poor oral hygiene can result in a) Tooth discoloration only b) Bad breath only c) Dental caries and gum disease d) Tooth alignment problems 364 (86.7) 5 An early sign of dental caries is a) Severe pain b) White or brown spots on teeth c) Tooth mobility d) Gum swelling 248 (59.0) 6 Untreated dental caries may lead to a) Tooth whitening b) Jaw fracture c) Pain, infection, and tooth loss d) Tooth alignment correction 332 (79.0) 7 Fluoride helps in preventing dental caries by a) Whitening teeth b) Killing all bacteria c) Strengthening tooth enamel d) Reducing gum bleeding 284 (67.6) 8 Brushing teeth twice daily helps in a) Removing stains only b) Preventing dental caries c) Increasing tooth sensitivity d) Weakening enamel 358 (85.2) 9 Use of fluoridated toothpaste a) Has no role in caries prevention b) Reduces the risk of dental caries c) Causes tooth decay d) Is harmful to enamel 276 (65.7) 10 Dental caries can occur in a) Children only b) Adults only c) Both children and adults d) Elderly only 386 (91.9) 11 Irregular dental visits a) Improve oral health b) Increase the risk of dental caries c) Have no effect on teeth d) Strengthen enamel 312 (74.3) 12 Dental caries is a) Always painful b) Non-preventable c) A preventable disease d) Only genetic 352 (83.8) 13 Frequent snacking between meals a) Improves digestion b) Increases caries risk c) Strengthens teeth d) Has no effect on oral health 306 (72.9) 14 Dental caries can affect overall health by causing a) Improved immunity b) Infection and systemic complications c) Better nutrition d) No general health impact 268 (63.8) 15 Acid produced by oral bacteria causes a) Tooth whitening b) Demineralization of tooth enamel c) Tooth eruption d) Gum thickening 292 (69.5) 16 Rinsing the mouth after meals a) Has no benefit b) Helps reduce food debris and caries risk c) Causes tooth erosion d) Weakens enamel 260 (61.9) 17 A decayed tooth should be treated a) Only if painful b) Only in children c) Even if there is no pain d) Only if swelling occurs 334 (79.5) 18 Regular dental check-ups help in a) Tooth whitening b) Reducing brushing frequency c) Early detection and prevention of caries d) Avoiding fluoride use 362 (86.2) 19 Dental caries in primary (milk) teeth a) Do not require treatment b) Heal on their own c) Should be treated d) Are unimportant 346 (82.4) 20 Dental caries can be prevented by a) Avoiding brushing b) Using mouthwash only c) Good oral hygiene and dietary control d) Taking antibiotics 374 (89.0) Table 3 depicts the preventive practices adopted by the participants. While 56.2% reported brushing twice daily, only 51.0% used fluoridated toothpaste and 47.1% replaced their toothbrush every three months. Preventive behaviors such as flossing were poorly practiced, with only 38.6% using dental floss occasionally or regularly. Nearly half of the participants (48.6%) visited dental clinics only when pain occurred, and 44.8% consumed sugary snacks daily. Although 74.3% expressed willingness to attend oral health awareness programs, the overall pattern indicates suboptimal preventive practices despite moderate awareness levels. Table 3: Preventive Practices Related to Dental Caries Among the Study Participants (n = 420) Q. No. Practice Statement Options Responses n (%) 1 Frequency of tooth brushing per day a) Never b) Once daily c) Twice daily d) More than twice 236 (56.2) 2 Type of toothpaste commonly used a) Non-fluoridated b) Herbal only c) Fluoridated toothpaste d) Do not know 214 (51.0) 3 Replacement of toothbrush is done every a) >6 months b) 3 months c) 1 year d) Never replaced 198 (47.1) 4 Use of dental floss a) Never b) Occasionally c) Daily d) Do not know about floss 162 (38.6) 5 Rinsing mouth after meals a) Never b) Sometimes c) Always d) Rarely 248 (59.0) 6 Consumption of sugary foods/snacks a) Daily b) Weekly c) Occasionally d) Rarely 188 (44.8) 7 Consumption of carbonated/soft drinks a) Frequently b) Occasionally c) Rarely d) Never 174 (41.4) 8 Dental visit pattern a) Never b) Only when pain occurs c) Once a year d) Every 6 months 204 (48.6) 9 Use of mouthwash a) Never b) Occasionally c) Daily d) Under dentist advice only 176 (41.9) 10 Reason for dental visit a) Routine check-up b) Pain or problem c) Tooth cleaning only d) Cosmetic reasons 212 (50.5) 11 Habit of night-time brushing a) Never b) Sometimes c) Always d) Rarely 226 (53.8) 12 Use of fluoride supplements a) Yes regularly b) Occasionally c) Only if advised by dentist d) Never 264 (62.9) 13 Supervision of children’s brushing (if applicable) a) Never b) Sometimes c) Always d) Not applicable 188 (44.8) 14 Awareness of sugar-free chewing gum after meals a) No b) Yes but not practiced c) Yes and practiced d) Not sure 172 (41.0) 15 Action taken for painless cavity a) Ignore it b) Home remedies c) Visit dentist d) Wait for pain 234 (55.7) 16 Frequency of dental check-ups a) Never b) Irregular c) Once a year d) Every 6 months 198 (47.1) 17 Preference for professional tooth cleaning a) Unnecessary b) Harmful c) Necessary periodically d) Only cosmetic 258 (61.4) 18 Tobacco use (smoking/chewing) a) Yes b) Occasionally c) Past user d) Never 146 (34.8) 19 Effort to limit sugary snacks in children a) No effort b) Sometimes c) Yes regularly d) Not applicable 202 (48.1) 20 Willingness to attend oral health awareness programs a) Not interested b) Maybe c) Yes d) Only if free 312 (74.3) Table 4 summarizes the overall awareness levels of dental caries among the participants. Good awareness was observed in 40.0% of respondents, while 24.8% demonstrated excellent awareness. However, 24.3% exhibited fair awareness and 11.0% had poor awareness. The mean awareness score was 13.7 ± 3.3 (out of 20), indicating an overall moderate to good level of knowledge. These findings suggest that although a majority possess basic awareness, a substantial proportion still lacks comprehensive understanding of dental caries. Table 4: Overall Awareness Level Regarding Dental Caries Among the Study Participants (n = 420) Awareness Level Score Range Participants (n) Percentage (%) Excellent ≥75% (15–20) 104 24.8 Good 50–74% (10–14) 168 40.0 Fair 25–49% (5–9) 102 24.3 Poor <25% (0–4) 46 11.0 Total — 420 100.0 Mean ± SD awareness score (out of 20): 13.7 ± 3.3 Table 5 shows the association between socio-demographic variables and awareness levels. Awareness was significantly associated with age (p = 0.010), education (p < 0.001), occupation (p = 0.004), monthly income (p = 0.012), and area of residence (p = 0.025). Higher awareness levels were observed among postgraduates (36.0% excellent awareness) and higher-income groups (>75,000 INR). Urban residents exhibited better awareness compared to semi-urban participants. Gender did not show a statistically significant association with awareness (p = 0.564), indicating that awareness was influenced more by socio-economic and educational factors than by gender. Table 5: Association Between Socio-Demographic Variables and Awareness Level Regarding Dental Caries Among the Study Participants (n = 420) Variable Category Excellent n (%) Good n (%) Fair n (%) Poor n (%) χ² value p-value Significance Age Group (years) 18–25 (n=96) 16 (16.7) 34 (35.4) 30 (31.3) 16 (16.6) 13.26 0.010 Significant 26–35 (n=124) 30 (24.2) 54 (43.5) 26 (21.0) 14 (11.3) 36–45 (n=98) 32 (32.7) 42 (42.9) 16 (16.3) 8 (8.1) 46–60 (n=72) 20 (27.8) 28 (38.9) 16 (22.2) 8 (11.1) >60 (n=30) 6 (20.0) 10 (33.3) 14 (46.7) 0 (0.0) Gender Male (n=202) 48 (23.8) 78 (38.6) 48 (23.8) 28 (13.8) 2.04 0.564 NS Female (n=218) 56 (25.7) 90 (41.3) 54 (24.8) 18 (8.2) Education Level Up to Secondary (n=94) 10 (10.6) 26 (27.7) 34 (36.2) 24 (25.5) 28.74 <0.001 Highly Significant Graduate (n=176) 40 (22.7) 76 (43.2) 42 (23.9) 18 (10.2) Postgraduate & above (n=150) 54 (36.0) 66 (44.0) 26 (17.3) 4 (2.7) Occupation Student (n=62) 8 (12.9) 20 (32.3) 22 (35.5) 12 (19.3) 18.62 0.004 Significant Service/Professional (n=148) 44 (29.7) 62 (41.9) 28 (18.9) 14 (9.5) Homemaker (n=102) 24 (23.5) 38 (37.3) 26 (25.5) 14 (13.7) Self-employed (n=74) 20 (27.0) 30 (40.5) 18 (24.3) 6 (8.2) Retired/Unemployed (n=34) 8 (23.5) 18 (52.9) 8 (23.6) 0 (0.0) Monthly Income (INR) <25,000 (n=78) 12 (15.4) 22 (28.2) 26 (33.3) 18 (23.1) 14.91 0.012 Significant 25,001–50,000 (n=136) 28 (20.6) 54 (39.7) 36 (26.5) 18 (13.2) 50,001–75,000 (n=118) 32 (27.1) 52 (44.1) 26 (22.0) 8 (6.8) >75,000 (n=88) 32 (36.4) 40 (45.4) 14 (15.9) 2 (2.3) Area of Residence Urban (n=238) 68 (28.6) 102 (42.9) 48 (20.2) 20 (8.3) 9.36 0.025 Significant Semi-urban (n=182) 36 (19.8) 66 (36.3) 54 (29.7) 26 (14.2) NS = Not Significant Table 6 presents the overall preventive practice scores related to dental caries. Positive preventive practices were observed in 62.4% of participants, while 26.2% demonstrated neutral practices and 11.4% exhibited poor practices. The mean preventive practice score was 14.0 ± 3.5 (out of 20). Although a majority showed favorable practices, the presence of neutral and poor practice categories indicates incomplete adoption of recommended oral health behaviors. Table 6: Overall Preventive Practice Scores Related to Dental Caries Among the Study Participants (n = 420) Practice Category Score Range Participants (n) Percentage (%) Positive Practice ≥70% (14–20) 262 62.4 Neutral Practice 40–69% (8–13) 110 26.2 Poor Practice <40% (0–7) 48 11.4 Total — 420 100.0 Mean ± SD preventive practice score (out of 20): 14.0 ± 3.5 Table 7 highlights the association between socio-demographic variables and preventive practice scores. Preventive practices showed statistically significant associations with age (p = 0.036), education (p < 0.001), occupation (p = 0.006), monthly income (p = 0.010), and area of residence (p = 0.034). Participants with higher education, professional occupations, higher income, and urban residence demonstrated better preventive practices. Gender was not significantly associated with preventive behavior (p = 0.419). These findings indicate that socio-economic status and accessibility strongly influence the adoption of preventive oral health practices. Table 7: Association Between Socio-Demographic Variables and Preventive Practice Scores Related to Dental Caries Among the Study Participants (n = 420) Variable Category Positive n (%) Neutral n (%) Poor n (%) χ² value p-value Significance Age Group (years) 18–25 (n=96) 48 (50.0) 30 (31.3) 18 (18.7) 11.92 0.036 Significant 26–35 (n=124) 78 (62.9) 34 (27.4) 12 (9.7) 36–45 (n=98) 70 (71.4) 20 (20.4) 8 (8.2) 46–60 (n=72) 48 (66.7) 18 (25.0) 6 (8.3) >60 (n=30) 18 (60.0) 8 (26.7) 4 (13.3) Gender Male (n=202) 120 (59.4) 54 (26.7) 28 (13.9) 1.74 0.419 NS Female (n=218) 142 (65.1) 56 (25.7) 20 (9.2) Education Level Up to Secondary (n=94) 40 (42.6) 30 (31.9) 24 (25.5) 26.48 <0.001 Highly Significant Graduate (n=176) 110 (62.5) 46 (26.1) 20 (11.4) Postgraduate & above (n=150) 112 (74.7) 34 (22.7) 4 (2.6) Occupation Student (n=62) 26 (41.9) 22 (35.5) 14 (22.6) 17.36 0.006 Significant Service/Professional (n=148) 108 (73.0) 28 (18.9) 12 (8.1) Homemaker (n=102) 62 (60.8) 28 (27.5) 12 (11.7) Self-employed (n=74) 48 (64.9) 20 (27.0) 6 (8.1) Retired/Unemployed (n=34) 18 (52.9) 12 (35.3) 4 (11.8) Monthly Income (INR) <25,000 (n=78) 32 (41.0) 28 (35.9) 18 (23.1) 15.02 0.010 Significant 25,001–50,000 (n=136) 82 (60.3) 36 (26.5) 18 (13.2) 50,001–75,000 (n=118) 82 (69.5) 26 (22.0) 10 (8.5) >75,000 (n=88) 66 (75.0) 20 (22.7) 2 (2.3) Area of Residence Urban (n=238) 162 (68.1) 54 (22.7) 22 (9.2) 8.64 0.034 Significant Semi-urban (n=182) 100 (54.9) 56 (30.8) 26 (14.3) NS = Not Significant

The present study provides a comprehensive assessment of awareness regarding dental caries and the associated preventive practices among the general population of Himachal Pradesh. The findings reveal that although overall awareness of dental caries was moderate to good, significant gaps persist in the translation of knowledge into consistent preventive behavior. This knowledge–practice discordance underscores the continuing public health challenge posed by dental caries, a largely preventable disease that remains highly prevalent in India. In the current study, nearly two-thirds of the participants demonstrated good to excellent awareness regarding dental caries. Most respondents correctly identified the role of bacteria, frequent sugar consumption, and poor oral hygiene in the development of caries, and recognized that dental caries is a preventable condition affecting individuals across all age groups. These findings suggest that basic oral health information has reached a substantial proportion of the population, likely through mass media, educational institutions, and interactions with healthcare providers. Similar levels of awareness have been reported in studies conducted in other parts of India, indicating a gradual improvement in oral health literacy at the community level.15-19 Despite satisfactory awareness, the study revealed notable deficiencies in preventive practices. Although over half of the participants reported brushing twice daily and using fluoridated toothpaste, a large proportion visited dental clinics only when pain or discomfort occurred. Regular preventive dental check-ups, flossing, and professional tooth cleaning were practiced by a relatively small segment of the population. Frequent consumption of sugary snacks and carbonated beverages was also commonly reported. These findings clearly demonstrate a gap between awareness and actual preventive behavior, a phenomenon consistently observed in oral health behavior research. Awareness alone appears insufficient to motivate sustained behavioral change without reinforcement, accessibility, and perceived urgency.15,17,20 Socio-demographic factors played a significant role in determining both awareness and preventive practices. Higher levels of awareness and better preventive behavior were observed among individuals with higher educational attainment, professional occupations, and higher income levels. Education emerged as the strongest predictor, with postgraduates showing significantly better awareness and practices compared to participants with secondary-level education. Education likely enhances understanding of disease processes, improves access to health information, and fosters positive health-seeking behavior. These findings are consistent with previous studies that have demonstrated a strong association between educational status and oral health outcomes.21-24 Age also showed a significant association with awareness and preventive practices, with middle-aged adults exhibiting better oral health behaviors compared to younger participants. Younger individuals, despite having reasonable knowledge, demonstrated poorer preventive practices, possibly due to lifestyle factors, time constraints, and a lower perceived susceptibility to dental disease. This highlights the need for targeted oral health promotion strategies aimed at younger populations to encourage early adoption of preventive habits.4,16,19 Gender was not significantly associated with either awareness or preventive practices in the present study. This suggests that oral health knowledge and behaviors are influenced more by socio-economic and educational factors than by gender alone. Similar observations have been reported in other community-based studies, indicating that gender differences in oral health behavior may be narrowing in contemporary populations.7,15,18,22 Area of residence also influenced oral health practices, with urban residents exhibiting better preventive behavior than those residing in semi-urban areas. Improved access to dental services, greater exposure to health information, and higher availability of preventive care facilities in urban settings may explain this disparity. In contrast, semi-urban and hilly regions of Himachal Pradesh may face challenges such as limited dental infrastructure, difficult terrain, and reduced frequency of dental outreach programs, which can hinder regular preventive care. The findings of this study highlight an important public health concern: while knowledge about dental caries is improving, preventive practices remain inadequate, particularly routine dental visits and dietary modifications. This emphasizes the need to move beyond information-based interventions toward behavior-focused oral health promotion. Community-based programs, school and workplace oral health education, and regular dental screening camps could play a pivotal role in reinforcing preventive behaviors. Additionally, integrating oral health education into primary healthcare services may help bridge the gap between awareness and action.11,15,19,22 From a policy perspective, the results underscore the importance of strengthening preventive dental services, especially in semi-urban and underserved areas of Himachal Pradesh. Public health strategies should focus on increasing accessibility to affordable dental care, promoting the use of fluoridated toothpaste, discouraging excessive sugar consumption, and normalizing routine dental check-ups as part of general health maintenance. Strengths and Limitations The strengths of the present study include its community-based design, adequate sample size, use of a validated and reliable questionnaire, and comprehensive assessment of both awareness and preventive practices. The inclusion of multiple socio-demographic variables allowed for a nuanced understanding of factors influencing oral health behavior. However, certain limitations must be acknowledged. As a cross-sectional, self-reported survey, the study is subject to recall bias and social desirability bias. The online mode of data collection may have excluded individuals with limited digital access, potentially affecting generalizability. Additionally, the absence of clinical oral examinations precludes correlation of awareness and practices with actual caries prevalence. Implications for Practice and Research The findings suggest that oral health promotion programs in Himachal Pradesh should prioritize behavioral change communication, rather than solely focusing on awareness generation. Future research should incorporate clinical assessments to evaluate the relationship between knowledge, practices, and actual oral health status. Longitudinal studies could further help in understanding how awareness translates into sustained preventive behavior over time.

The present study highlights that awareness regarding dental caries among the general population of Himachal Pradesh is moderate to good, with a majority of participants demonstrating adequate knowledge about the causes, consequences, and preventive measures of dental caries. However, despite satisfactory awareness levels, preventive practices remain suboptimal, particularly with respect to routine dental visits, use of interdental cleaning aids, dietary control, and early dental consultation for painless carious lesions. This reflects a clear and persistent gap between knowledge and practice, which continues to contribute to the burden of preventable oral diseases. Educational level, occupation, income, age, and area of residence were found to significantly influence both awareness and preventive behavior, whereas gender showed no significant association. Individuals with higher education and socio-economic status exhibited better oral health practices, emphasizing the role of socio-economic empowerment in promoting preventive health behavior. The findings underscore that dental caries remains a public health concern even in relatively educated populations, particularly in regions with geographic and healthcare access challenges such as Himachal Pradesh. Overall, the study reinforces the need to shift oral health strategies from mere dissemination of information to behavior-oriented, accessible, and community-specific preventive interventions to effectively reduce the prevalence and impact of dental caries.

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