Oral Health Habits, Dietary Practices, and Knowledge of University Dental Students in Banja Luka, Bosnia and Herzegovina: A Cross-Sectional Study

Highlights

What are the main findings?

• Positive trend in oral hygiene practices: Senior dental students demonstrate a high level of adherence to preventive measures, with the utilization of fluoride-containing toothpaste reaching between 75.0% and 100.0%.
• Significant knowledge gaps: Critical deficiencies in oral health knowledge persist across all study years (1st to 6th) regarding non-cariogenic sugar substitutes, caries-protective foods, and the identification of saccharides with the highest cariogenic potential.

What are the implications of the main findings?

• Need for curriculum optimization: The discrepancy between high hygiene adherence and low specific nutritional knowledge suggests that the dental curriculum should more effectively integrate functional cariology and dietary counseling.
• Enhancing long-term knowledge retention: The findings highlight the necessity for teaching methodologies that promote the long-term retention of preventive concepts, ensuring that students can transition theoretical knowledge into effective clinical practice and patient education.

Abstract

The primary objective of this research was to evaluate the oral health habits, dietary practices, and knowledge regarding cariogenic diet among University Dental students. Materials and methods: A cross-sectional, questionnaire-based study was conducted among students attending the integrated undergraduate and graduate Dental Medicine (DM) program. Data analysis was performed by stratifying students according to the year of study. In total, 114 questionnaires were collected. Three questionnaires were subsequently excluded, resulting in a final sample size of 111 students for analysis. Results: Over 75% of students from the 2nd (83.3%) to 6th (91.3%) year used a combination of a toothbrush and fluoride toothpaste, whereas 50% of 1st-year students reported using fluoride-free toothpaste (p < 0.05). The majority of senior students (34.8–100%) correctly identified xylitol and sorbitol as non-cariogenic (p < 0.05). However, a notable knowledge gap persisted in the final year, with over 30% of sixth-year students failing to identify them. Furthermore, over 60.0% of third-year and 90.0% of fifth-year students recognized the protective dental effects of hard cheese, cranberry, and green tea (p < 0.05). Regarding cariogenic potential, 45.8% of first-year and 57.1% of second-year students were unable to identify the most cariogenic saccharide (p < 0.05). Conclusions: The study reveals an improvement in oral health habits and knowledge, particularly regarding the use of fluoride toothpaste and the identification of cariogenic saccharides. However, significant knowledge gaps persist across all years, most notably the high prevalence of fluoride-free toothpaste use among first-year students and the inability of a substantial portion of senior students to identify non-cariogenic sugar substitutes and protective foods.

1. Introduction

The fundamental task of dentistry as a scientific discipline is the prevention and control of the initiation and progression of the stomatognathic diseases [1]. According to the current World Health Organization (WHO) Global Strategy and Action Plan on Oral Health 2023–2030, a strategic priority is the promotion of oral health and the prevention of oral pathologies [2]. Furthermore, the 2021 World Health Assembly “Resolution on Oral Health” advocates for a paradigm shift, prioritizing a preventive approach over traditional restorative models [3]. This resolution emphasizes the integration of oral health promotion within families, schools, and workplaces while ensuring timely, comprehensive, and inclusive care within primary healthcare systems [3]. Oral health promotion is defined as a systematic and multifaceted approach aimed at enhancing oral health and preventing disease through structured education, the establishment of hygienic-dietary habits, and the implementation of prophylactic measures [4].

While global dental curricula should ideally cultivate this preventive ethos, the dental profession remains significantly overburdened with restorative treatment provision, which fails to effectively mitigate the overall global burden of dental diseases [1]. At the University of Banja Luka, Bosnia and Herzegovina, the current curriculum of Dental Medicine addresses these needs through the subject Oral Prevention and Public Oral Health, taught in the third semester (second year), and Prophylaxis of Oral Diseases, taught in the seventh semester (fourth year). Through both theoretical lectures and clinical rotations, students are introduced to primary prevention strategies and contemporary prophylactic methodologies. As both subjects are mandatory components of the degree, it is expected that senior students, in particular, possess comprehensive knowledge regarding the preservation and enhancement of oral health. This encompasses the efficacy and frequency of oral hygiene practices, the selection of appropriate oral hygiene aids, regular dental attendance, and the impact of dietary patterns, specifically distinguishing between cariogenic and caries-protective nutrition.

However, empirical evidence from prior studies suggests a discrepancy between expected and actual knowledge levels [5,6,7,8]. Despite their specialized education, dental students often demonstrate insufficient proficiency in preventive and prophylactic measures. These studies show that dental students’ knowledge is often unsatisfactory and that it is necessary to improve it, as well as improve their behavior and oral health status [5,6,7,8].

High awareness regarding oral health improvement is essential for the students themselves, as well as for their ability to transfer knowledge and educate patients. It is well-documented that deficiencies in subject matter acquisition during undergraduate studies can substantially compromise the quality of clinical care in subsequent postgraduate practice [9,10,11]. Furthermore, through years of working with students, one gains the impression that certain subjects in the curriculum are not of particular interest, especially in the era of expensive aesthetic interventions such as prosthetics and implantology [12]. In such contexts, acquired knowledge often remains superficial and lacks functional application in clinical practice [13].

Consequently, the intention of this extra-curricular research was to evaluate the level of awareness among dental students regarding the lifestyle habits and practices essential for the maintenance and preservation of oral health.

Therefore, the primary objective of this research was to evaluate the oral health habits, dietary practices, and knowledge regarding cariogenic diet of University Dental students in Banja Luka, Bosnia and Herzegovina.

2. Materials and Methods

This cross-sectional study was conducted among students attending the integrated undergraduate and graduate Dental Medicine (DM) program at the University of Banja Luka, Bosnia and Herzegovina. The six-year curriculum complies with the Bologna system, comprising 360 ECTS credits. The research utilized a self-administered questionnaire covering dental visit habits, oral hygiene, dietary habits, and knowledge regarding cariogenic diets.

Ethical considerations were managed in two stages. Initially, the study was conducted as an institutional educational evaluation with administrative authorization from the Head of the Dental Medicine Study Program (University of Banja Luka) prior to the distribution of the anonymous questionnaire, ensuring compliance with the Law on Protection of Personal Data of BiH (Official Gazette Nos. 49/06, 76/11, 89/11, 12/25). To meet international publication standards, the protocol was subsequently submitted for formal verification to Ethics Committee of the Faculty of Medicine, University of Banja Luka, which confirmed the study’s compliance with all ethical standards (Decision No. 18/4. 72/26).

2.1. Study Participants

Students from the first to the sixth year (19–28 years old) of the DM program were recruited based on their attendance at lectures (convenience sampling) on the day of the survey. Participation was voluntary, and questionnaires were distributed at the end of lectures without prior notice. To ensure privacy while confirming participation, students provided informed consent by circling ‘Yes’ on the survey form. Data collection took place between December 2024 and January 2025 on the faculty premises. A total of 214 students regularly attended classes during the 2024–2025 academic year. The distribution by year of study was as follows: 1st year (55), 2nd year (57), 3rd year (34), 4th year (20), 5th year (16), and 6th year (32).

All students present at the lectures agreed to participate in the study. In total, 114 questionnaires were collected. Three questionnaires were incomplete and subsequently excluded, resulting in a final sample size of 111 students for analysis. This sample represents 51.9% of the total student population, providing a margin of error of ±6.45% at a 95% confidence level.

2.1.1. Inclusion Criteria

The inclusion criteria for study participation were defined as being a currently enrolled Dental Medicine student and providing informed consent.

2.1.2. Exclusion Criteria

The exclusion criteria included not being a student of Dental Medicine, refusal to participate, or the submission of an incomplete questionnaire.

2.2. Questionnaire

A structured questionnaire was modeled after similar prior studies and adapted to align with the specific objectives and participants of the current research [14,15]. The demographic section included information on the year of study, gender, and age of the participants.

The questionnaire comprised a total of 17 items divided into three domains: four questions regarding dental visit patterns and oral hygiene habits, nine questions concerning dietary habits, and four questions assessing knowledge of cariogenic diets. Following data collection, the questionnaires were screened for completeness; incomplete forms were excluded, and the valid data were entered into a Microsoft Excel (version 2013, Microsoft Corp., Redmond, WA, USA) database.

2.3. Data Analysis

Data analysis was performed by stratifying students according to the year of study, which served as the independent variable (first through sixth year). The outcome variables were categorized as follows:

-

Dental visit and oral hygiene habits: Assessed through regularity of dental visits, timing of the last visit, brushing frequency, and the use of oral hygiene aids.

-

Dietary habits: Assessed through the consumption frequency of fruits, vegetables, salty snacks, sweets, sweetened beverages, meat, fish, milk and dairy products, and cereals.

-

Cariogenic diet knowledge: Assessed through the students’ ability to identify non-cariogenic sugars and sugar substitutes, hidden sugars in processed foods, caries-protective foods, and the saccharide with the highest cariogenic potential.

Items regarding oral hygiene aids and cariogenic diet knowledge were designed as multiple-response questions (allowing multiple answers). The section on dietary habits consisted of quantitative questions assessing the frequency of intake for specific food groups.

2.4. Statistical Tests

Statistical analysis was performed using the Chi-square test (X²) to evaluate differences between groups. The results are presented as absolute frequencies (n) and percentages (%) in cross-tabulation tables. The level of statistical significance was set at p < 0.05. Data processing and calculations were conducted using an available online statistical calculator (Social Science Statistics, https://www.socscistatistics.com, accessed on 7 April 2026).

3. Results

In total, 114 questionnaires were collected. Three questionnaires were incomplete and subsequently excluded, resulting in a final sample size of 111 students for analysis. The distribution of respondents by year of study was as follows: 1st year (28), 2nd year (24), 3rd year (10), 4th year (16), 5th year (10), and 6th year (23) (

Table 1. Distribution of respondents.

Year of Study	n (%)	Gender
		M	F
		n (%)
1st year	28 (25.2)	3 (10.7)	25 (89.3)
2nd year	24 (21.6)	8 (33.3)	16 (66.7)
3rd year	10 (9.0)	3 (30.0)	7 (70.0)
4th year	16 (14.4)	7 (43.8)	9 (56.3)
5th year	10 (9.0)	3 (27.3)	7 (63.6)
6th year	23 (20.7)	7 (30.4)	16 (69.6)
Total	111 (100.0)	31 (28.6)	80 (71.4)

).

A high percentage of respondents of all years of study (67.9% to 90.0%) reported visiting the dentist “regularly, every 6–12 months”. While no statistically significant difference was observed between the years of study, a small proportion of respondents (6.3% to 14.3%) reported visiting the dentists only “when in need, e.g., due to toothache, cavities, gingivitis or trauma”. This percentage decreased as the year of study progressed. The majority of respondents (60.9% to 87.5%) had visited a dentist within “the last six months”. Regarding daily habits, over 98.1% of participants reported brushing their teeth at least twice a day. The only statistically significant finding was related to “the use of oral hygiene aids”. While over 75% of students from the 2nd to 6th year use a combination of a toothbrush and fluoride toothpaste, approximately 50% of 1st year students reported using toothpaste without fluoride. Over 50% of respondents across all years use dental floss, and between 35.7% and 70% utilize inter-dental brushes (

Table 2. Dental visit and oral hygiene habits in respondents according to the year of study.

Question	Answer	Year of Study						p **	X2
		1st Year	2nd Year	3rd Year	4th Year	5th Year	6th Year
		n (%)
Regularity of dental visits	Regularly, every 6–12 months	19 (67.9)	17 (70.8)	8 (80.0)	13 (81.3)	9 (90.0)	17 (73.9)	0.974	3.28
	Irregularly-occasionally	5 (17.9)	4 (16.7)	1 (10.0)	2 (12.5)	1 (10.0)	4 (17.4)
	When in need *	4 (14.3)	3 (12.5)	1 (10.0)	1 (6.3)	0	2 (8.7)
	I usually don’t go to the dentist	0	0	0	0	0	0	0.658	12.27
Timing of the last dental visit	In the last 6 months	20 (71.4)	18 (75.0)	7 (70.0)	14 (87.5)	8 (80.0)	14 (60.9)
	About 6–12 months ago	5 (17.8)	3 (12.5)	3 (30.0)	1 (6.3)	2 (20.0)	6 (26.1)
	About 1–2 years ago	3 (10.7)	3 (12.5)	0	0	0	2 (8.7)
	About 2–5 years ago	0	0	0	1 (6.3)	0	1 (4.4)
	Five or more years ago	0	0	0	0	0	0
Brushing frequency	Less than one time a day	0	0	0	0	0	0	0.838	5.72
	One time a day	0	1 (4.2)	0	0	0	1 (4.4)
	Two times a day	18 (64.3)	12 (66.7)	7 (70.0)	7 (43.8)	5 (50.0)	13 (56.5)
	More than two times a day	10 (35.7)	11(45.8)	3 (30.0)	9 (56.3)	5 (50.0)	9 (39.1)
The use of oral hygiene aids ***	Toothbrush + non-fluoride toothpaste	14 (50.0)	4 (16.7)	2 (20.0)	4 (25.0)	0	2 (8.7)	0.041 **	44.61
	Toothbrush + fluoride toothpaste	14 (50.0)	20 (83.3)	8 (80.0)	12 (75.0)	10 (100.0)	21 (91.3)
	Dental floss	14 (50.0)	12 (50.0)	8 (80.0)	9 (56.3)	9 (90.0)	14 (60.9)
	Interdental brushes	10 (35.7)	12 (50.0)	4 (40.0)	7 (43.8)	7 (70.0)	14 (60.9)
	Mouth washes	11 (39.3)	7 (29.2)	1 (10.0)	0	2 (20.0)	2 (8.7)
	Water flossers (Waterpik)	0	0	2 (20.0)	0	1 (10.0)	1 (4.4)
	Dental picks	2 (7.1)	1 (4.2)	1 (10.0)	0	0	1 (4.4)

* toothache, cavities, gingivitis, trauma, tooth fracture, etc.; ** p < 0.05; *** multiple-answer question.

).

No statistically significant differences were observed across the years of study regarding dietary habits. Most participants consumed fruit, vegetables, meat, and milk 2–6 times per week. High-frequency consumption (2–6 times weekly) was also noted for sweets (over 40.7%) and salty snacks (30.0–44.4%) (

Table 3. Dietary habits of respondents according to the year of study.

Question	Answer	Year of Study						p	X2
		1st Year	2nd Year	3rd Year	4th Year	5th Year	6th Year
		n (%)
Fruit consumption frequency	≤one time a week	5 (18.5)	2 (8.3)	3 (30.0)	0	2 (20.0)	4 (17.4)	0.445	9.95
	2–6 times a week	14 (51.9)	12 (50.0)	3 (30.0)	11(68.8)	3 (30.0)	13 (56.5)
	One or more times a day	8 (29.6)	10 (41.7)	4 (40.0)	5 (31.3)	5 (50.0)	6 (26.1)
Vegetable consumption frequency	≤one time a week	2 (7.4)	3 (12.5)	2 (20.0)	2 (12.5)	0	1 (4.35)	0.693	7.34
	2–6 times a week	15 (55.6)	11 (45.8)	4 (40.0)	8 (50.0)	4 (40.0)	15 (65.2)
	One or more times a day	10 (37.0)	10 (41.7)	4 (40.0)	5 (31.3)	6 (60.0)	6 (26.1)
Salty snack consumption frequency	≤one time a week	15 (55.6)	14 (58.3)	6 (60.0)	10 (62.5)	5 (50.0)	12 (52.2)	0.916	4.60
	2–6 times a week	12 (44.4)	8 (33.3)	4 (40.0)	5 (31.3)	3 (30.0)	9 (39.1)
	One or more times a day	0	2 (8.3)	0	1 (6.3)	0	2 (8.7)
Sweets consumption frequency	≤one time a week	10 (37.0)	9 (37.5)	1 (10.0)	4 (25.0)	2 (20.0)	9 (39.1)	0.452	9.86
	2–6 times a week	11 (40.7)	11 (45.8)	9 (90.0)	8 (50.0)	6 (60.0)	11 (47.8)
	One or more times a day	6 (22.2)	4 (16.7)	0	4 (25.0)	2 (20.0)	3 (13.0)
Sweetened beverage consumption frequency	≤one time a week	16 (59.3)	14 (58.3)	7 (70.0)	7 (43.8)	8 (80.0)	15 (65.2)	0.836	5.74
	2–6 times a week	9 (33.3)	9 (37.5)	3 (30.0)	6 (37.5)	1 (10.0)	7 (30.4)
	One or more times a day	2 (7.4)	1 (4.2)	0	2 (12.5)	1 (10.0)	1 (4.3)
Meat consumption frequency	≤one time a week	10 (37.0)	9 (37.5)	1 (10.0)	4 (25.0)	2 (20.0)	9 (39.1)	0.452	9.86
	2–6 times a week	11 (40.7)	11 (45.8)	9 (90.0)	8 (50.0)	6 (60.0)	11 (47.8)
	One or more times a day	6 (22.2)	4 (16.7)	0	4 (25.0)	2 (20.0)	3 (13.0)
Fish consumption frequency	≤one time a week	24 (88.9)	14 (58.3)	10 (100.0)	13(81.3)	7 (70.0)	19 (82.6)	0.099	15.99
	2–6 times a week	3 (11.1)	8 (33.3)	0	2 (12.5)	3 (30.0)	4 (17.4)
	One or more times a day	0	2 (8.3)	0	0	0	0
Milk and dairy product consumption frequency	≤one time a week	5 (18.5)	3 (12.5)	1 (10.0)	2 (12.5)	4 (40.0)	3 (13.0)	0.564	8.66
	2–6 times a week	13 (48.1)	8 (33.3)	5 (50.0)	8 (50.0)	3 (30.0)	13 (56.5)
	One or more times a day	9 (33.3)	13 (54.2)	4 (40.0)	6 (37.5)	3 (30.0)	7 (30.4)
Cereal consumption frequency	≤one time a week	15 (55.6)	14 (58.3)	8 (80.0)	9 (56.3)	4 (40.0)	12 (52.2)	0.678	7.49
	2–6 times a week	4 (14.8)	8 (33.3)	2 (20.0)	2 (12.5)	4 (40.0)	6 (26.1)
	One or more times a day	5 (18.5)	2 (8.3)	0	2 (12.5)	2 (20.0)	3 (13.0)

). A certain percentage (13.0–25.0%) consume sweets and 4.2–12.5% consume sweetened beverages “one or more times a day”. A notable prevalence (8.0–20.0%) was also observed among those who consume cereals once or more times daily (Table 3).

Statistically significant differences were observed across the groups regarding the ability to identify non-cariogenic sugars/substitutes, foods with protective effects, and the disaccharide with the highest cariogenic potential. The majority of respondents in the senior years (34.8% to 100%) identified xylitol and sorbitol as non-cariogenic. While approximately 75.0% of first-year students were unable to identify a non-cariogenic sugar, a notable knowledge gap persisted in the final year, with over 30% of sixth-year students also not able to identify them. Over 60.0% of third-year students and over 90.0% of fifth-year students identified hard cheese, cranberry, and green tea as foods with protective dental effects. However, a significant portion of respondents across the 1st, 2nd, 4th, and 6th years (30.4–75.0%) remained unaware of which foods offered these benefits. Regarding cariogenic potential, 45.8–57.1% of first- and second-year students could not identify the most cariogenic saccharide, while the majority of students in the senior years (30.4–60%) noted that glucose and sucrose had the highest cariogenic potential (

Table 4. Cariogenic diet knowledge of respondents according to the year of study.

Question	Answer	Year of Study						p *	X2
		1st Year	2nd Year	3rd Year	4th Year	5th Year	6th Year
		n (%)
Identify non-cariogenic sugars/ sugar substitutes **	Coconut sugar	4 (14.3)	4 (16.7)	1 (10.0)	4 (25.0)	0	4 (17.4)	0.001 *	71.65
	Honey	5 (17.9)	5 (20.8)	4 (40.0)	4 (25.0)	0	4 (17.4)
	Brown sugar	2 (7.1)	1 (4.2)	2 (20.0)	0	0	1 (4.4)
	White sugar—sucrose	0	1 (4.2)	0	0	0	0
	Corn syrup	1 (3.6)	3 (12.5)	1 (10.0)	1 (6.2)	0	0
	Xylitol	2 (7.1)	11 (45.8)	10 (100.0)	6 (37.5)	9 (90.0)	9 (39.1)
	Sorbitol	2 (7.1)	6 (25.0)	4 (40.0)	7 (43.8)	6 (60.0)	8 (34.8)
	Erythrol	1 (3.6)	8 (33.3)	6 (60.0)	3 (18.8)	1 (10.0)	4 (17.4)
	I don’t know	21 (75.0)	9 (37.5)	0	4 (25.0)	2 (20.0)	7 (30.4)
Identify foods to which sugars are added during processing and production **	Pickles	4 (14.3)	5 (20.8)	0	6 (37.5)	4 (40.0)	6 (26.1)	0.973	40.75
	Biscuits	19 (67.9)	19 (79.2)	8 (80.0)	9 (56.2)	10 (100.0)	18 (78.3)
	Bakery products ***	18 (64.3)	17 (70.8)	5 (50.0)	12 (75.0)	10 (100.0)	20 (87.0)
	Tortillas	6 (21.4)	7 (29.2)	1 (10.0)	6 (37.5)	9 (90.0)	15 (65.2)
	Ketchup	17 (60.7)	17 (70.8)	8 (80.0)	9 (56.2)	8 (80.0)	19 (82.6)
	Sauces	14 (50.0)	18 (75.0)	5 (50.0)	7 (43.8)	9 (90.0)	17 (73.9)
	Peanut butter	10 (35.7)	4 (16.7)	3 (30.0)	7 (43.8)	6 (60.0)	10 (43.5)
	Chips	6 (21.4)	9 (37.5)	3 (30.0)	5 (31.3)	8 (80.0)	8 (34.8)
	Solty sticks (sticks, pretzels, etc.)	7 (25.0)	8 (33.3)	2 (20.0)	5 (31.2)	6 (60.0)	9 (39.1)
	Jams and marmalade	19 (67.9)	17 (70.8)	9 (90.0)	11 (68.8)	9 (90.0)	21 (91.3)
	Dried fruit	1 (3.6)	5 (20.8)	2 (20.0)	4 (25.0)	4 (40.0)	10 (43.5)
	I don’t know	4 (14.3)	2 (8.3)	0	0	1 (10.0)	1 (4.4)
Identify foods that have a caries protective effect **	Hard cheese	3 (10.7)	6 (25.0)	6 (60.0)	6 (37.5)	9 (90.0)	12 (52.2)	0.000 *	86.99
	Cereals	1 (3.6)	5 (20.8)	0	0	3 (30.0)	3 (13.0)
	Peanuts	1 (3.6)	1 (4.2)	1 (10.0)	1 (6.2)	0	1 (4.4)
	Cranberry	2 (7.1)	3 (12.5)	8 (80.0)	8 (50.0)	10 (100.0)	7 (30.4)
	Wholemeal pastry	1 (3.6)	3 (12.5)	1 (10.0)	1 (6.2)	0	2 (8.7)
	Green tea	3 (10.7)	7 (29.2)	6 (60.0)	6 (37.5)	4 (90.0)	4 (17.4)
	Corn flour tortilla chips	0	4 (16.7)	0	0	0	0
	I don’t know	21 (75.0)	11 (45.8)	0	0	5 (50.0)	7 (30.4)
Identify the saccharide with the highest cariogenic potential **	Lactose	2 (7.1)	0	0	0	0	0	0.000 *	67.90
	Glucose	6 (21.4)	8 (33.3)	6 (60.0)	3 (18.8)	3 (30.0)	7 (30.4)
	Fructose	2 (7.1)	3 (12.5)	2 (20.0)	1 (6.2)	1 (10.0)	8 (34.8)
	Sucrose	3 (10.7)	3 (12.5)	4 (40.0)	7 (43.8)	6 (60.0)	11 (47.8)
	Maltose	0	3 (12.5)	0	0	0	0
	I don’t know	16 (57.1)	11 (45.8)	0	3 (18.8)	1 (10.0)	1 (4.4)

* p < 0.05; ** multiple-answer question; *** bread rolls, croissants, bread.

).

4. Discussion

The examination of “Dental visit and oral hygiene habits” in our respondents showed a statistically significant difference (p = 0.041; X² = 44.61) regarding the utilization of oral hygiene aids. Among first-year students, 50.0% reported using a toothbrush and non-fluoride toothpaste for their oral hygiene routine. According to Expert Market Research (EMR), fluoride toothpastes hold a market share of approximately 85–90%, whereas non-fluoride alternatives represent only 10–15% of the global market [16]. Therefore, it is likely that first-year students, due to limited professional knowledge, remain unaware that they are actually using a fluoride toothpaste. Among senior students, the prevalence of fluoride-containing toothpaste utilization reached between 75.0% and 100.0%. A gradual upward trend was also observed among those students regarding the use of supplementary oral hygiene aids, such as dental floss (50.0–90.0%) and interdental brushes (40.0–70.0%). Similar findings have been reported in a study conducted among dental students at Kirikkale University, Turkey [7]. The authors found that fluoride toothpaste is preferred by 71.91% of preclinical and 93.28% of clinical students. A much lower percentage of their respondents used dental floss, reported as 17.80% for preclinical and 17.16% for clinical students, respectively [7]. Conversely, a study by Reddy et al. on oral hygiene practices among 425 dental students and faculty members in India revealed that only 34.9% strictly adhered to oral self-care habits, comprising measures such as the regular use of fluoride toothpaste [17].

Other questions in the “Dental visit and oral hygiene habits” category did not show statistically significant differences. However, it is noteworthy that a certain number of dental students (6.3–14.3%) visit their dentist only “when in need” (i.e., in cases of toothache, cavities, gingivitis, trauma, tooth fracture, etc.). Regarding the frequency of dental visits, available literature highlights a study conducted by colleagues in Split, Croatia, which investigated medical and non-medical university students aged 19–39 [18]. This study found a high percentage (43.2%) of students who visit the dentist only when necessary or, as stated in their manuscript, “if necessary” [18].

With respect to respondents’ dietary habits, no significant differences were observed among our participants in relation to the year of study; these habits remain constant over time. These results are concerning, especially considering that consumption frequency—a critical factor in cariogenesis—was being evaluated. Among our respondents, a certain percentage (13.0–25.0%) consume sweets “one or more times a day,” and 4.2–12.5% consume sweetened beverages. A notable prevalence (8.0–20.0%) was also observed among those who consume cereals once or more daily. It is well-established that carious lesions result from the interaction of three primary factors over time: cariogenic microorganisms, fermentable carbohydrates, and the host (tooth). Almost all foods can be more or less cariogenic, particularly when they are part of a frequent daily or nocturnal consumption pattern (as seen, for instance, in children with Early Childhood Caries) [19]. Dietary habits involving processed foods rich in refined starch and free sugars are classified as highly cariogenic, often falling outside the WHO’s guidelines, which limit sugar consumption to below 10% of total energy intake [20]. In this context, whole grains represent a crucial energy source due to their high content of carbohydrates, fiber, vitamins, minerals, amino acids, and phytochemicals [21]. However, cereal consumption in the human diet is largely restricted to refined grains, such as breakfast cereals [22]. This category of food exhibits a higher sugar content and low levels of other micronutrients. This is further substantiated by a study by Khehra et al., which investigated the sugar content of the 13 most prominent children’s cereals on the United Kingdom market [23]. Their research revealed that only one product had a low sugar content (5 g/100 g); four contained medium sugar levels (5–22.5 g/100 g), while eight were classified as having a high sugar content (exceeding 22.5 g/100 g) [23].

Regarding “Cariogenic diet knowledge,” significant differences were observed across the groups of our respondents. Respondents showed significant differences in their ability to identify non-cariogenic sugars/sugar substitutes. A low percentage (7.1%) of first-year students are familiar with the non-cariogenic effect of xylitol, as well as two other sugar alcohols (sorbitol (7.1%) and erythritol (3.6%)). A greater number identified coconut sugar (14.3%) and honey (17.9%) as non-cariogenic, and as many as 75.0% chose the “I don’t know” option for this question. In senior years, these percentages change. All of the third-year students (100%) demonstrated knowledge regarding the anticariogenic effects of xylitol. Such a high percentage may reflect recent completion of an exam in Oral Prevention and Public Oral Health. Unfortunately, this knowledge was retained to a lesser extent by sixth-year students, as 30.4% answered “I don’t know,” and only 39.1% possessed knowledge about xylitol. This finding substantiates the argument presented in the Introduction: the knowledge students acquire for examinations is often not functionally integrated into practical application.

The integration of cariology, dietary habits, and oral health promotion into clinical training is a progressive process at our institution. During the third semester, within the Oral Prevention and Public Oral Health course (2 lectures and 3 clinical rotations per week), students are introduced to the principles of preventive dentistry and the public health aspects of oral diseases. At this stage, clinical training focuses on applying evidence-based preventive measures and mastering the tools for disease prevention. This training further intensifies in the seventh semester through the Prophylaxis of Oral Diseases course (1 lecture and 2 clinical rotations per week). In this advanced phase, students are trained to utilize contemporary scientific data on disease etiology to design, recommend, and implement individualized prophylactic protocols for patients. This clinical work serves as a bridge, where students translate their personal health habits and academic knowledge into professional social practices, actively promoting oral health through patient education and chair-side prevention. In recent decades, university education in Banja Luka has undergone significant shifts; many study programs are transitioning away from traditional didactic methods toward interactive learning. These modern approaches aim to actively engage students through increased clinical practice, research, and presentations. However, reproductive learning largely persists as a dominant pattern. In this regard, Oleksenko demonstrated that students educated via ‘studactive’ methodologies possess superior knowledge—characterized by depth, systematic structure, and operability—compared to those taught traditionally [24]. This trend is clearly mirrored among our respondents.

Over 60.0% of third-year students and over 90.0% of fifth-year students identified hard cheese, cranberry, and green tea as foods with caries-protective effects. However, a significant portion of respondents across the 1st, 2nd, 5th, and 6th years (30.4–75.0%) remained unaware of which foods offered these benefits. Regarding cariogenic potential, 45.8–57.1% of first- and second-year students could not identify the most cariogenic saccharide, while the majority of students in the senior years (30.4–60.0%) noted that glucose and sucrose had the highest cariogenic potential. A similar study was conducted among fifth-year undergraduate students at the Faculty of Dentistry, King Abdulaziz University [25]. Their respondents demonstrated lower levels of knowledge regarding the protective role of hard cheese against caries, with only 40.8% responding affirmatively. Similarly, just over half of the participants (51.3%) identified sucrose as the most cariogenic saccharide. Awareness was significantly higher regarding xylitol, with 92.0% of respondents correctly identifying it as the only bulk sweetener with anticariogenic potential [25].

The limitations of our study primarily stem from its design. As a cross-sectional study, it captures a snapshot of the situation at a specific point in time, without the possibility of examining causal relationships. For instance, while it was observed that students adopted the habit of using fluoride toothpaste after acquiring relevant knowledge, they did not significantly alter the dietary habits that would contribute to better oral health. To understand the underlying reasons for such discrepancies, a longitudinal design would be required. As the questionnaire was distributed immediately after a lecture, this may have introduced a degree of bias in the results. Specifically, students might have provided “socially desirable” or “fake good” responses rather than responses that reflect their actual daily habits. Furthermore, while the study sample is representative of the selected dental student population, its size is insufficient to allow for the generalization of the results to the broader student population.

Despite these limitations, this research represents the first study to examine acquired knowledge in practical, extra-curricular applications among dental students in Bosnia and Herzegovina. The significance of the topic addressed in this manuscript is substantial as it focuses on young people capable of significantly contributing not only to their own well-being but also to broader oral health promotion and public education. Consequently, future research could expand this scope to include other universities offering dental and medical studies, as well as the general student population.

5. Conclusions

The study reveals an improvement in oral health habits and knowledge as students advance through the curriculum, particularly regarding the use of fluoride toothpaste and the identification of cariogenic saccharides. However, significant knowledge gaps persist across all years, most notably the high prevalence of fluoride-free toothpaste use among first-year students and the inability of a substantial portion of senior students to identify non-cariogenic sugar substitutes and protective foods. These inconsistencies, especially among final-year students, highlight the need for a more integrated and continuous approach to teaching preventive dentistry and clinical nutrition to ensure all graduates achieve the necessary competencies for independent practice.