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12 rev port estomatol med dent cir maxilofac . 2026;67(1):11-20

Introduction Material and methods
Oral health is an essential part of overall health, acting as a This cross-sectional study was reviewed and approved by the
significant determinant of an individual’s quality of life and Portuguese Air Force’s Ethics Committee for Health and Direc-
sharing several risk factors with other aspects of general torate of Health (ref no. 01/2020).
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health. Several oral pathologies are associated with chronic The study population consisted of Portuguese Air Force
diseases, with examples including poor oral health and diabe- military personnel on active duty in 2021. All individuals who
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tes mellitus or chronic obstructive pulmonary disease. voluntarily completed the questionnaire and attended an oral
Therefore, oral disease prevention is important not only for health appointment that year were included in the study. The
maintaining good oral health but also for supporting overall questionnaire was created on an online platform and made
well-being. accessible to potential participants via an email link. The email
The Armed Forces require individuals who are mili- message and the first page of the questionnaire included a
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tary-ready, fit, healthy, and mobile. Good oral health is partic- brief explanation of the study’s objectives and procedures,
ularly important, as the opposite can lead to emergencies concluding with a mandatory question regarding informed
during service or missions. Dental emergencies can disrupt and voluntary participation.
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operations and may even require medical evacuation , ulti- Air Force services (Directorate of Communications and In-
mately undermining the unit’s overall effectiveness and the formation Systems and Public Relations) distributed the ques-
success of the mission. 7 tionnaire electronically to potential participants in February
Within the Armed Forces, aviation plays a key role by in- 2021, and sent two subsequent follow-up emails between
creasing the mobility of ground forces. Due to variations in March and May of the same year to optimize response rates.
temperature, pressure, and ergonomic factors, aviation activ- The questionnaire was also made available on the Portuguese
ities consistently expose personnel to the physiological effects Air Force Internal Portal.
of physical and mechanical hazards, which can negatively The questionnaire was specifically designed for this study,
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impact the stomatognathic system. Furthermore, mission based on a literature review. 14,15,19,20 Before its final implemen-
deployment represents a stressful period with challenging liv- tation, it was reviewed by two experts experienced in ques-
ing conditions, requiring a high-calorie diet because of the tionnaire research and pre-tested with three individuals to
physical exertion involved and the mission’s intensity. During assess the clarity of the questions.
missions, unhealthy behaviors such as smoking and oral hy- After explaining the objectives and procedures of the
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giene negligence may become more common. All these fac- study, the questionnaire included an initial section to verify
tors can cause underlying asymptomatic oral conditions to inclusion criteria and obtain informed consent. Participants
manifest symptoms, leading to emergencies that could be who met the criteria then proceeded to the main question-
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avoided. Therefore, studying the factors that influence the oral naire, which gathered information on demographic details,
health of Armed Forces personnel is essential for preventing oral health-related attitudes and behaviors, and self-reported
oral diseases and their various consequences. oral health status. The section on behaviors and attitudes in-
A recent study on Air Force cadets revealed that, despite corporated the Portuguese version of the HUDBI. 15
their young age and military fitness, nearly half showed clin- The HUDBI comprises 21 dichotomous response items for
ical signs of periodontal disease. Another study conducted participants to indicate whether they agree or disagree with
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in 2018 with data from an army regiment in Viseu reported each item. Its total score is calculated by summing the scores
high dental caries prevalence (51.6%) and high plaque index of 12 of the 21 items, with a maximum of 12 points. Lower
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values in 58.2% of military personnel. These previous studies scores reflect less positive oral health-related attitudes and
reveal indicators of poor oral health, highlighting the need for behaviors. The total HUDBI score for each individual was cal-
intervention and preventive measures. Research on oral health culated by adding 1 point for each correct response to one of
among the Portuguese military population remains limited, the 12 items included in this total: items 2, 4, 6, 8, 9, 10, 11, 12,
and collecting current data, particularly across all ages and 14, 15, 16, 19. 14
military ranks, is necessary to develop more effective preven- Statistical analysis was conducted using SPSS, including
tion strategies and promote oral health. descriptive analyses of all variables. For numerical variables,
Attitudes and behaviors play a decisive role in oral health, the mean, median, and standard deviation were also calculat-
as they directly influence preventive practices and adherence ed. The relationships between variables were examined using
to oral hygiene and dental care. The Hiroshima University the Mann-Whitney U and Kruskal-Wallis tests at the 0.05 sig-
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Dental Behavioral Inventory (HUDBI), developed by Kawamu- nificance level.
ra, 14 is one of the instruments available in the literature for
assessing the attitudes and oral health behaviors of adults. This
instrument has already been validated for the Portuguese pop- Results
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ulation and has been used in several Portuguese studies. 16-20

This study aims to explore oral health-related attitudes Out of a total of 3217 military personnel, 437 responses were
and behaviors among active-duty personnel of the Portuguese collected. After applying the inclusion and exclusion criteria,
Air Force, identify their self-reported oral health problems, and the final sample comprised 360 individuals, representing 11.2%
analyze the relationship between self-reported oral health of the entire target population. Participants from all deploy-
problems and oral health attitudes and behaviors. ment units were included in the study, with the largest groups