Adolescent oral health has been recognised as a crucial factor in achieving overall well-being, impacting both physical, social, and psychological aspects of life (1, 2). The Global Oral Health Action Plan 2023–2030 seeks to address this issue by promoting early prevention, disseminating crucial information on combating health disparities, and developing innovative strategies to enhance oral health outcomes (3).

According to data from 2022 published by the World Health Organisation (WHO), untreated dental decay in children’s deciduous teeth affects nearly half of the population in Slovakia and Poland (4, 5). Untreated caries not only cause pain and infection but also strain families’ finances and healthcare systems worldwide. Furthermore, the aesthetic value of teeth can significantly impact individuals’ confidence and overall quality of life (6, 7).

Whilst individual behaviour, such as toothbrushing, was a primary focus of discussions encircling policy-making and prevention, a broader perspective now acknowledges the influence of social determinants. These, along with Common Risk Factor Approach (unhealthy diet, tobacco and alcohol consumption, physical inactivity and environmental pollution), significantly contribute to the development of non-communicable chronic diseases (NCDs) (8).

Self-care, the autonomous practise of maintaining health, is essential for well-being and oral disease prevention. Since most oral diseases are preventable, sustained self-care and informed choices by individuals and communities are key to improving oral health across the life course (9). Zaborskis et al. utilising data from 20 countries participating in the Health Behaviour in School-aged Children (HBSC) study between 1994 and 2018 examined cross-national trends in toothbrushing behaviour over time and its association with sociodemographic factors. The findings confirmed that gender and family affluence are the primary determinants influencing toothbrushing practises (10).

Health literacy (HL) significantly influences oral health by shaping individuals’ understanding of preventive care practises, improving their ability to make informed health decisions and encouraging behaviours that reduce the risk of dental issues (11, 12). Research indicates that the role of HL in achieving overall oral health is paramount, particularly given the limited oral health literacy amongst adolescent caregivers, which significantly impacts children’s oral health outcomes (13–16). In Central Europe disparities in oral health are often linked to socioeconomic factors, health literacy and access to preventive services. The number of dentist per capita differed significantly at 4.9 per 10,000 inhabitants in Slovakia and 3.5 per 10,000 inhabitants in Poland (4, 5).

Recent surge in focus on research of HL in Central Europe might be linked to Health Literacy Survey conducted in 2015 which shown poor level of health literacy in this region (17, 18). Although attempts have been made, the term of health literacy appears to not be the unified umbrella term the WHO presented in 1998, which states: “The cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways which promote and maintain good health” (13, 18, 19).

Therefore, the aim of the present study was first to assess the association between oral health and health literacy, gender, age, family affluence and country of origin amongst adolescents from two countries from the World Health Organization European region. In addition, this study sought to compare the associations between oral health and health literacy, gender, age and family affluence amongst adolescents from Slovakia and Poland separately. This analysis will provide insights into the effectiveness of current oral health strategies in both countries and potentially guide future public health initiatives. Our research study has been followed in accordance with the STROBE checklist and recommended guidelines for cross-sectional studies.

The frequencies and missing data of the whole sample are presented in Table 1.

The frequencies and missing data of the Polish and Slovak data are presented in Table 2.

Table 3 presents the results of the binary logistic regression for regular toothbrushing (brushing the teeth more than once a day) in the combined sample of Slovak and Polish adolescents, adjusted for age, gender, family affluence, health literacy, and country of origin. Overall, significant associations were observed for gender, family affluence, and health literacy. Boys reported substantially lower odds of brushing their teeth more than once a day compared with girls. Similarly, adolescents from families with lower or medium affluence, as well as those with lower or medium health literacy, also showed significantly lower odds of regular toothbrushing compared with their peers from high-affluence families or with high health literacy.

Table 4 presents the binary logistic regression results comparing Polish and Slovak adolescents with regard to toothbrush usage (brushing the teeth more than once a day), adjusted for age, gender, family affluence, and health literacy. In both countries, boys reported significantly lower odds of brushing their teeth more than once a day compared with girls. Lower and medium family affluence were also consistently associated with less frequent toothbrushing in both samples. Similarly, adolescents with lower or medium health literacy had significantly lower odds of brushing their teeth regularly compared with those with high health literacy. Overall, the direction and strength of associations were comparable between the Polish and Slovak samples.

The area under the ROC curve (AUC) indicated modest discriminatory performance of the models, with values of 0.648 for the total sample, 0.649 for the Polish subsample, and 0.652 for the Slovak subsample.

The aim of this study was to examine how gender, age, family affluence, and health literacy are associated with toothbrushing frequency amongst adolescents in Poland and Slovakia. Using data from the 2022 Health Behaviour in School-aged Children (HBSC) survey, collected via anonymous self-administered questionnaires in school settings, we explored the complex interplay of sociodemographic and cognitive factors in two Central European countries. Although differing in population size and certain structural aspects, Poland and Slovakia share a comparable post-socialist historical background, which provides a meaningful context for cross-national comparison. In addition to individual-level determinants, the findings invite further reflection on how national health governance structures and policy approaches may contribute to variations in oral health behaviours amongst adolescents.

The results indicate that boys are substantially less likely to engage in regular toothbrushing compared to girls, highlighting a persistent gender disparity in oral hygiene behaviours. Additionally, lower socioeconomic status, as measured by family affluence, is associated with a decreased likelihood of frequent toothbrushing, suggesting that economic factors play a crucial role in oral health practises. Similarly, health literacy emerges as a key determinant, with adolescents exhibiting lower health literacy levels demonstrating significantly reduced engagement in regular toothbrushing.

In recent years, Slovakia has proposed several initiatives, such as introducing a tax on sugar-containing beverages and mapping vulnerable social groups (25). Additionally, efforts are being made to include health workers in school workflows to educate children on oral hygiene and the importance of a balanced diet (26, 27). Furthermore, the Slovak Dental Association (Slovenská komora zubných lekárov, SKZL) has prioritised the promotion of oral health-related information specifically tailored for practitioners and parents (28). Additionally, insurance companies have introduced subsidised care packages covering dental treatment as well as preventive hygiene procedures (25).

Poland and Slovakia have adopted significantly different approaches to addressing adolescent oral health from both legislative and practical perspectives. In Poland, several local and governmental initiatives have been implemented, including the deployment of mobile dental clinics in underserved areas and the promotion of oral health prevention amongst vulnerable groups such as pregnant women and school-aged children (29–32). Although data on their impact is limited, the available information primarily focuses on general recommendations rather than targeted interventions tailored to community needs (33). In contrast, whilst Slovakia has outlined key goals for improving oral health, most initiatives are driven by private companies promoting health-related projects or by student-led efforts (34, 35). Furthermore, essential tools for assessing inequalities in access to dental care remain insufficient. Although basic oral healthcare for children is fully subsidised in both countries (36, 37), the number of accessible procedures appears to be disproportionately low compared to the actual needs of young patients (33, 38). Both countries have issued recommendations grounded in epidemiological data and supported by available preventive measures; however, to the best of the author’s knowledge, no clear implementation strategy has been established, reflecting a gap between expert guidance and political action (29, 35). Notable setbacks have also been observed in both countries’ oral care frameworks, such as the discontinuation of school-based dental care programmes in Poland and the cessation of supervised tooth-brushing in Slovak kindergartens—changes that are likely to have a significant negative impact on oral health outcomes (27, 39).

Identifying gaps in healthcare programmes in both countries is insufficient unless accompanied by a systematic approach to assessing and addressing the population’s specific needs. A health-literate system extends beyond the mere availability of services; it ensures that healthcare initiatives are accessible, comprehensible and effectively utilised by the target population. To achieve meaningful improvements in public health outcomes, the integration of structured needs assessments, policy-level commitments and continuous evaluation mechanisms that ensure that interventions are evidence-based, responsive and sustainable must be ensured (40).

Health literacy is crucial for individuals to navigate specific needs and follow proposed preventative measures. Future policy should prioritise education and mapping inequalities to meet personal healthcare needs. Simple preventive measures, like reading informative brochures or meeting specialists, are ineffective without proper education (41). In addition to personal health literacy, measures like the family affluence scale can indicate further disparities that need addressing (42). Although access to educational and self-directed resources is becoming increasingly widespread, this accessibility does not necessarily enhance the educational value for individuals seeking to understand these materials. In fact, it has been shown to be inefficient for patients with poorer educational outcomes (43). It is crucial to note that whilst many countries may prioritise the selection of social media or mobile applications in promoting health-oriented behaviours, it is essential to recognise that this approach may not necessarily align with the needs of the addressed population (44). This highlights the need for individualised care and tailored interventions to address the specific health needs of different populations.

Collaborative efforts amongst countries with similar socioeconomic contexts, such as the initiative amongst four Balkan countries (Albania, Bosnia and Herzegovina, Croatia and Serbia), are vital for addressing adolescent oral health disparities. However, the limited information on the implementation and outcomes of these strategies calls for further research into their effectiveness (45). A dialogue amongst oral health professionals could provide valuable insights into effective prevention strategies, drawing on experiences from countries such as Denmark, which has successfully reduced caries rates, and on practical resources like the preventive toolkits developed in the United Kingdom. Comparative research across countries provides valuable insights into weaknesses within health-care systems and highlights opportunities for strengthening NCDs prevention (46). Such exchanges could also inform future collaborative programmes in Poland and Slovakia, supporting the development of more effective, evidence-based approaches to improving oral and general health.

The findings of this study demonstrate that toothbrushing frequency amongst Polish and Slovak adolescents is strongly associated with gender, family affluence, and health literacy. By identifying these key sociodemographic and cognitive determinants, the findings provide evidence for public health practitioners and policymakers to better understand oral hygiene behaviours in adolescents and to develop population-level interventions that target the groups at greatest risk of inadequate oral care.