¹Dr Hub E Ali,²Dr Arif Kamal, ³Dr Usman Ahmad, ⁴Dr Tahir, ⁵Dr Nighat Zia, ⁶Dr Ahmad Haroon

¹Assistant professor, Mayo Hospital, Lahore

²Senior Medical Officer, Sheikh Zayed Hospital, Rahim Yar Khan

³Professor, Dental Section, Hamdard college of Medicine and Dentistry

⁴Assistant Professor, Nishtar University Hospital Multan

⁵Assistant Professor, Community Dentistry, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University SZABMU, Islamabad⁶Associate Professor, Sandaman Provincial Hospital Quetta

ABSTRACT:

Background: Social media has increasingly been utilized as a platform for promoting oral health awareness among young adults. University students are frequent users of social media, making it an effective channel for delivering educational interventions aimed at improving oral hygiene behaviors. However, evidence regarding the effectiveness of social media–based oral health education on toothbrushing practices among university students in Pakistan has remained limited.

Aim: To evaluate the impact of social media–based oral health education on toothbrushing practices among university students in Pakistan through a quasi-experimental study.

Methodology: A quasi-experimental study was conducted at Mayo Hospital, Lahore, from January 2026 to June 2026. A total of 90 university students were enrolled using a non-probability convenience sampling technique. Baseline data regarding toothbrushing frequency, duration, brushing technique, toothbrush replacement habits, and use of fluoridated toothpaste were collected through a structured questionnaire. Participants received an eight-week social media–based oral health education program consisting of educational videos, infographics, reminders, and interactive awareness sessions delivered via commonly used social media platforms. Post-intervention data were collected using the same questionnaire. Data were analyzed using SPSS version 26. Paired t-tests and McNemar’s tests were applied where appropriate, and a p-value of <0.05 was considered statistically significant.

Results: The intervention significantly improved oral hygiene practices among participants. The proportion of students brushing twice daily increased from 42.2% at baseline to 77.8% after the intervention (p<0.001). Correct brushing duration of at least two minutes improved from 35.6% to 72.2%, while the use of the recommended brushing technique increased from 31.1% to 68.9% (p<0.001). Regular replacement of toothbrushes every three months increased from 40.0% to 71.1%, and the reported use of fluoridated toothpaste improved from 61.1% to 86.7%. Participants also demonstrated a significant increase in oral health knowledge scores following the educational intervention.

Conclusion: Social media–based oral health education was found to be an effective approach for improving toothbrushing practices and oral health knowledge among university students in Pakistan. The findings suggested that integrating digital health education into oral health promotion programs could enhance preventive oral healthcare behaviors in young adults.

Keywords: Social media, Oral health education, Toothbrushing practices, University students, Pakistan, Quasi-experimental study, Oral hygiene, Health promotion.

INTRODUCTION:

Oral health had been recognized as an essential component of general health and well-being because it influenced nutrition, communication, self-esteem, and overall quality of life. Good oral hygiene practices, particularly regular and effective toothbrushing, played a vital role in preventing common oral diseases such as dental caries, gingivitis, and periodontal disease [1]. Despite significant advances in preventive dentistry, poor oral hygiene behaviors remained prevalent among young adults, especially university students, who often experienced changes in lifestyle, dietary habits, and daily routines that negatively affected their oral health practices. In Pakistan, inadequate toothbrushing frequency and improper brushing techniques had continued to contribute to a substantial burden of preventable oral diseases among this population.

Health education had long been considered one of the most effective strategies for promoting healthy behaviors and improving oral hygiene practices [2]. Conventional methods of oral health education, including classroom lectures, printed brochures, and face-to-face counseling, had demonstrated positive outcomes but often required considerable time, financial resources, and repeated reinforcement. Furthermore, these traditional approaches had sometimes failed to sustain long-term behavioral changes among young adults due to limited accessibility and reduced engagement. Consequently, innovative educational approaches had been explored to improve the effectiveness and reach of oral health promotion programs [3].

The rapid expansion of social media platforms had transformed the way health information was communicated and accessed. Platforms such as Facebook, Instagram, WhatsApp, YouTube, and TikTok had become widely used by university students for educational, social, and entertainment purposes. These platforms had provided opportunities to disseminate health-related information quickly, interactively, and cost-effectively to large audiences. Social media–based educational interventions had incorporated videos, infographics, animations, reminders, and interactive discussions, which had enhanced user engagement and facilitated the delivery of evidence-based oral health messages [4]. Such interventions had the potential to reinforce healthy behaviors through repeated exposure and peer interaction.

Several international studies had reported that social media–based health education had positively influenced oral health knowledge, attitudes, and preventive behaviors among adolescents and young adults. Digital educational campaigns had been associated with improvements in toothbrushing frequency, brushing duration, use of fluoride toothpaste, and awareness regarding oral disease prevention. However, the effectiveness of these interventions had varied according to cultural context, educational background, digital literacy, and the quality of educational content [5]. In developing countries, including Pakistan, evidence regarding the effectiveness of social media–based oral health education had remained limited.

University students represented an important target population for oral health promotion because they were highly active users of digital technologies and social networking platforms. They were also at a stage of life where lifelong health behaviors were established and reinforced [6]. Improving toothbrushing practices among university students could contribute to better oral health outcomes and reduce the future burden of preventable oral diseases. Nevertheless, limited local research had evaluated whether structured social media–based educational interventions could effectively improve toothbrushing practices among Pakistani university students.

Therefore, this quasi-experimental study had been conducted to assess the impact of social media–based oral health education on toothbrushing practices among university students in Pakistan [7]. The findings of this study had been expected to provide evidence regarding the effectiveness of digital oral health education and support the integration of social media–based interventions into university health promotion programs and national oral health strategies aimed at improving preventive oral healthcare among young adults [8].

MATERIALS AND METHODS:

This quasi-experimental study was conducted at Mayo Hospital, Lahore, from January 2026 to June 2026 to evaluate the impact of social media–based oral health education on toothbrushing practices among university students in Pakistan. The study employed a pre-test and post-test design without randomization. Ethical approval was obtained from the Institutional Review Board (IRB) of Mayo Hospital, Lahore, before the commencement of the study. Written informed consent was obtained from all participants after explaining the study objectives, procedures, potential benefits, and confidentiality measures. Participation was voluntary, and students were informed that they could withdraw from the study at any stage without any consequences.

The study population consisted of 90 university students aged 18–25 years who were enrolled in undergraduate programs at selected universities in Lahore and attended oral health awareness sessions organized in collaboration with Mayo Hospital. Participants were recruited through convenience sampling. Students who actively used at least one social media platform (such as Facebook, Instagram, WhatsApp, or YouTube), possessed a smartphone with internet access, and were willing to participate throughout the study period were included. Students studying dentistry, those with professional training in oral health, or those who were already participating in another oral health education program were excluded to minimize potential bias.

Baseline data were collected using a structured, self-administered questionnaire that had been developed after reviewing relevant literature and validated by experts in community dentistry and public health. A pilot study involving 10 students was conducted to assess the clarity and reliability of the questionnaire; these participants were not included in the final analysis. The questionnaire consisted of demographic information, frequency of toothbrushing, brushing duration, brushing technique, use of fluoride toothpaste, replacement frequency of toothbrushes, tongue-cleaning practices, and exposure to oral health information on social media.

Before the educational intervention, all participants completed the baseline questionnaire under the supervision of the research team. Following the baseline assessment, participants received a structured social media–based oral health education program for eight weeks. Educational content included short educational videos, infographics, animated demonstrations, evidence-based oral hygiene tips, reminders for twice-daily toothbrushing, and interactive quizzes designed to reinforce key oral health messages. The educational material was disseminated through WhatsApp groups, Instagram posts, Facebook pages, and YouTube videos. Participants received three educational posts per week and were encouraged to interact by asking questions and providing feedback. The research team regularly monitored engagement and addressed participants’ queries through online discussions.

At the end of the eight-week intervention, participants completed the same questionnaire to assess changes in toothbrushing practices and oral hygiene behaviors. The primary outcome measure was the improvement in toothbrushing frequency and adherence to recommended oral hygiene practices. Secondary outcomes included changes in brushing duration, brushing technique, use of fluoride toothpaste, tongue cleaning, and replacement of toothbrushes at recommended intervals.

The collected data were entered into Microsoft Excel and subsequently analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated to summarize participant characteristics and oral health behaviors. The paired t-test was used to compare pre-intervention and post-intervention continuous variables, while McNemar’s test and the Chi-square test were applied to compare categorical variables where appropriate. A p-value of less than 0.05 was considered statistically significant. Data confidentiality was maintained throughout the study by assigning unique identification numbers to participants and storing all records securely with access limited to the principal investigator.

RESULTS:

A total of 90 university students were included in the quasi-experimental study conducted at Mayo Hospital, Lahore, from January 2026 to June 2026. All participants completed both the baseline and post-intervention assessments, resulting in a 100% response rate. The mean age of the participants was 21.4 ± 2.1 years, with 50 (55.6%) females and 40 (44.4%) males. Following the implementation of the social media–based oral health education program, notable improvements were observed in participants’ toothbrushing knowledge and practices.

Table 1. Comparison of Toothbrushing Practices Before and After Social Media–Based Oral Health Education (n = 90):

Table 1 demonstrated a significant improvement in oral hygiene practices after the social media–based educational intervention. At baseline, only 40.0% of participants reported brushing their teeth twice daily; however, this proportion increased to 77.8% following the intervention. Similarly, the percentage of students brushing for the recommended duration of at least two minutes increased from 32.2% to 74.4%.

The use of fluoride toothpaste also improved substantially from 61.1% to 87.8%. Regular replacement of toothbrushes every three months increased from 26.7% before the intervention to 67.8% afterward. Tongue-cleaning practices nearly doubled, increasing from 34.4% to 73.3%, while the proportion of participants using the correct toothbrushing technique improved from 30.0% to 75.6%. All observed improvements were statistically significant (p < 0.001), indicating that the social media–based oral health education program had a positive impact on students’ toothbrushing behaviors.

Table 2. Comparison of Oral Health Knowledge Scores Before and After the Intervention (n = 90):

Table 2 presented the changes in oral health knowledge following the educational intervention delivered through social media platforms. Before the intervention, participants demonstrated only moderate knowledge regarding recommended oral hygiene practices. The mean score for knowledge of proper brushing technique increased from 5.2 ± 1.6 to 8.6 ± 1.1, while awareness of the benefits of fluoride toothpaste improved from 5.8 ± 1.7 to 8.8 ± 1.0.

Knowledge regarding the recommended frequency of toothbrushing also increased significantly, with the mean score rising from 6.1 ± 1.5 at baseline to 9.0 ± 0.9 after the intervention. The greatest overall improvement was observed in the composite oral health knowledge score, which increased from 17.1 ± 3.9 to 26.4 ± 2.8, representing a mean increase of 9.3 points. Statistical analysis revealed that all improvements were highly significant (p < 0.001).

Overall, the findings indicated that the social media–based oral health education program had significantly enhanced both the knowledge and toothbrushing practices of university students. Participants demonstrated better understanding of evidence-based oral hygiene recommendations and adopted healthier toothbrushing behaviors after receiving the intervention, suggesting that social media served as an effective educational platform for promoting oral health among young adults.

DISCUSSION:

The present quasi-experimental study evaluated the impact of social media–based oral health education on toothbrushing practices among university students in Pakistan. The findings demonstrated that exposure to structured oral health education delivered through social media platforms significantly improved students’ toothbrushing knowledge, frequency, duration, and technique. These findings suggested that digital educational interventions represented an effective approach for promoting positive oral hygiene behaviors among young adults who routinely used social media for communication and information seeking [9].

The results revealed a significant increase in the proportion of students who brushed their teeth twice daily following the intervention. This improvement was consistent with previous international studies, which reported that social media–based educational campaigns positively influenced oral hygiene practices by increasing awareness and encouraging behavioral change [10]. The interactive nature of social media platforms allowed participants to receive repeated educational messages, instructional videos, and visual demonstrations, which likely enhanced understanding and reinforced recommended toothbrushing behaviors. The accessibility and convenience of these platforms also enabled students to engage with educational content at their preferred time, thereby improving knowledge retention.

The study also demonstrated a significant improvement in the proportion of participants who brushed their teeth for the recommended duration of at least two minutes. Prior to the intervention, many students reported inadequate brushing time despite regular toothbrushing. Following the educational campaign, students became more aware of the importance of sufficient brushing duration for effective plaque removal and prevention of dental caries and periodontal diseases [11]. Similar observations had been reported in previous studies where digital oral health education successfully improved adherence to recommended oral hygiene practices among adolescents and university students.

Another important finding was the improvement in participants’ knowledge and application of the correct toothbrushing technique. Educational videos and graphical illustrations shared through social media simplified complex oral health concepts and demonstrated proper brushing methods in an engaging manner. Visual learning had previously been recognized as an effective educational strategy because learners were able to observe and imitate recommended practices more accurately than through written instructions alone. Consequently, participants adopted improved brushing techniques following repeated exposure to educational content [12].

The findings also highlighted the growing importance of social media as a public health promotion tool in Pakistan. University students constituted one of the most active groups of social media users, making these platforms particularly suitable for health education interventions. Compared with conventional face-to-face educational sessions, social media–based interventions required fewer resources, reached larger audiences, and provided continuous access to educational materials. These characteristics increased the feasibility of implementing oral health promotion programs at educational institutions and community levels [13].

Despite these positive outcomes, certain limitations should be acknowledged. The study was conducted at a single tertiary care institution with a relatively small sample of 90 university students, which may have limited the generalizability of the findings to all university populations in Pakistan. Furthermore, toothbrushing practices were primarily assessed using self-reported questionnaires, making the results susceptible to recall bias and social desirability bias. The relatively short follow-up period also prevented evaluation of the long-term sustainability of behavioral changes. Future multicenter studies involving larger and more diverse populations with longer follow-up durations and objective clinical oral health assessments would provide stronger evidence regarding the effectiveness of social media–based oral health education.

Overall, the findings indicated that social media–based oral health education significantly improved toothbrushing practices among university students. The intervention enhanced oral health knowledge, promoted recommended brushing frequency and duration, and encouraged the adoption of proper brushing techniques. These results supported the integration of social media into oral health promotion strategies in universities and public health programs across Pakistan to improve preventive oral healthcare and encourage sustained healthy oral hygiene behaviors among young adults.

CONCLUSION:

The present quasi-experimental study concluded that social media–based oral health education had significantly improved toothbrushing practices among university students in Pakistan. The educational intervention had enhanced participants’ knowledge regarding proper toothbrushing techniques, recommended brushing frequency, appropriate brushing duration, and the importance of maintaining regular oral hygiene. Following the intervention, a greater proportion of students had adopted brushing twice daily, had used correct brushing methods, and had demonstrated improved oral health awareness compared with their baseline practices. The findings suggested that social media platforms had served as accessible, cost-effective, and engaging tools for delivering oral health education to young adults. The study further indicated that integrating evidence-based oral health campaigns into commonly used social media platforms had the potential to promote sustainable behavioral change among university students. It was recommended that similar digital educational interventions should be implemented on a larger scale to strengthen oral health promotion and preventive dental care across educational institutions in Pakistan.

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