In this cross-sectional study, we aimed to explore the dental care-seeking behavior of prison inmates at Central Prison, Peshawar, Pakistan, utilizing the WHO Basic Oral Health Survey 2013 tool. A total of 225 adult prisoners, comprising both convicted and under-trial individuals, were enrolled. Notably, participants residing in urban areas exhibited a higher frequency of dental visits, whereas more than half of those with partial dentures reported never visiting a dentist. The most prevalent motivation for dental visits was pain or discomfort in teeth, gums, or mouth. Participants with a tooth count between 10 and 19 were less inclined to seek dental care. Moreover, our study uncovered an intriguing trend: among participants who reported rare or no consumption of sweets, there was a notable preference for frequent dental visits (once or more than once). Additionally, inmates who employed a toothbrush for oral hygiene maintenance were the most regular visitors to the dentist, while those using toothpicks were also prominently represented among dental care seekers. Notably, individuals reporting no speech difficulties over the past 12 months exhibited a higher frequency of dental check-ups. Conversely, participants experiencing tooth pain or discomfort were less likely to seek dental care compared to their counterparts without such discomfort. Similarly, those who did not use dentures demonstrated a higher likelihood of visiting the dentist compared to denture users.

In our study, prisoners who used to live in urban areas visits dentists more frequently than those who lived in rural areas although the result were statistically non-significant. A study conducted in the US by Huabin Luo to assess rural-urban differences in dental service demonstrated that adults from rural areas were less likely to receive oral procedures [20]. These findings demonstrate that individuals living in urban areas have greater access to dental care and may be more aware of the importance of oral health. These findings highlight the need to improve access to dental care in rural areas where jails are located so to reduce oral health disparities.

Another important finding of this study was that more than half of the participants who had partial dentures never visited the dentist. A study in the UK with a multi-center approach showed that those with partial dentures feel embracement and stigma and avoid visiting the hospital or cleaning their denture [21]. Another study conducted in India aimed to assess the oral health status and treatment needs of jail prisoners. The results revealed that 8.8% of the study population had oral dentures.These results suggest that there may be a lack of education and awareness among the prisoner population about the importance of regular dental checkups, particularly for those with partial dentures who require specialized care.

Pain or discomfort in teeth, gums, or mouth was the most common reason cited by participants for visiting the dentist. A similar trend was also observed by Muhanad Alhareky in Saudi Arabia, where pain was the most common reason to visit the dentist [22]. Similarly, another study conducted in Saudi Arabia reported that 95.1% of Janil prisoners sought dental care due to tooth pain [23]. This research emphasizes the need to inform prisoner about the value of preventive care and routine dental examination, as delaying the treatment until the symptoms appear can result in expensive procedures.

Our study revealed that among participants who reported consuming sweets seldom or never, more than half (58.8%, n = 47) demonstrated a significant inclination towards frequent dental visits. This finding suggests that individuals who consume sweets less frequently are more likely to prioritize their dental health by seeking regular dental care [24].

A study conducted in Thailand among prisoners revealed that the majority of participants believed that increasing the frequency of tooth brushing and reducing their consumption of sugary beverages could help alleviate dental discomfort and ultimately lead to fewer dental visits [25]. Those with 10 to 19 teeth were less likely to visit the dentists once or more. These findings may relate to the fact that participants with fewer teeth may have less concern about maintaining their oral health or may have difficulty accessing dental care due to physical or financial barriers [26].

Finally, those who had no speech issues in the previous 12 months were more likely to go to the dentist. This research shows that those who have trouble speaking may find it difficult to get dental treatment or may not realize how important regular dental examinations are. A study conducted by Appukuttan D [27] stated that dental anxiety, phobia, and speech issues create huddles in the avoidance of dental care and suggested cognitive and psychotherapeutic interventions.

Finally, in our study, inmates who utilized a toothbrush for oral hygiene were the most consistent attendees of dental check-ups, and toothpick users were also notably represented among those seeking dental care. In contrast, a study conducted in Nigeria revealed that approximately 89.3% of prisoner participants had never heard of dental floss, and only a mere 1.8% had ever used it [28]. This discrepancy suggests a potential variation in oral hygiene practices and awareness between the two populations of jail prisoners.

While this study offers valuable insights into dental care-seeking behavior among prison inmates, it has certain limitations. Its cross-sectional design prevents causal conclusions, providing only a snapshot. Conducted in a single center, generalizability to broader inmate populations may be limited. Future research with a longitudinal, multi-center approach could provide a more comprehensive understanding.