Factors Associated with Self-Reported Gingival Bleeding and Dental Anxiety among Male Dental Students in Herat, Afghanistan: A Cross-Sectional Study

Abstract

Background and Objective: Periodontal diseases and dental anxiety represent significant global public health challenges, and the personal oral health behaviors of dental students serve as important indicators of the effectiveness of their dental education. This study aimed to evaluate the prevalence of and identify factors associated with self-reported gingival bleeding and dental anxiety among male dental students in the educational environment of Herat. Method: An institution-based analytical cross-sectional study was conducted among 408 male dental students from three existing dental faculties in Herat city. Participants were selected using a proportionate stratified random sampling approach based on faculty and academic level. Data regarding demographics, oral hygiene behaviors, tobacco use, self-reported gingival bleeding, and dental anxiety (assessed via a single self-reported yes/no question rather than a validated psychometric instrument) were analyzed using descriptive statistics, chi-square tests, and multivariable binary logistic regression models. Findings/ Result: The overall prevalence of self-reported gingival bleeding during brushing was 21.8%, while dental anxiety was highly prevalent, reported by 38.2% of the students. In the adjusted multivariable analysis, being in the clinical academic stage (aOR = 0.42, 95% CI: 0.24–0.74) and older age (≥25 years; aOR = 0.33, 95% CI: 0.12–0.92) were significantly associated with lower odds of self-reported gingival bleeding. Conversely, smokeless tobacco (Naswar or Siti) use was strongly associated with higher odds of gingival bleeding (aOR = 5.51, 95% CI: 2.20–13.81), with users exhibiting more than five times the odds compared to non-users. Not using dental floss (interdental cleaning) was also significantly associated with higher odds of gingival bleeding (aOR = 2.15, 95% CI: 1.18–3.92). For dental anxiety, none of the demographic, behavioral, or tobacco-related variables showed significant associations in the adjusted multivariable model. Conclusion: The study reveals a concerningly high prevalence of both gingival bleeding and dental anxiety among future dental practitioners in Herat. While older age and clinical academic stage were associated with lower odds of gingival bleeding, poor interdental cleaning habits and smokeless tobacco use were associated with higher odds of gingival bleeding. To address these challenges, dental institutions should integrate formal tobacco cessation counseling and strengthen curriculum-based training in interdental oral hygiene.