Background: Oral diseases had remained a major public health concern in Sub-Saharan Africa, where limited oral health knowledge, inappropriate hygiene practices, sociocultural misconceptions and inadequate access to professional dental services had contributed to preventable oral morbidity. This study assessed and compared oral health information, practices and dental service utilization among adults in rural and urban communities in Bayelsa State, Nigeria.

Method: A community-based comparative cross-sectional study was conducted among 355 adults aged 18–65 years, comprising 177 urban and 178 rural respondents selected through a multistage sampling technique. Data were collected using a structured interviewer-administered questionnaire, while respondents demonstrated their toothbrushing techniques using a dental model. No clinical oral examination was conducted. The questionnaire demonstrated acceptable internal consistency, with a Cronbach’s alpha coefficient of 0.70. Data were managed using Microsoft Excel and analysed using IBM SPSS Statistics version 23 and STATA. Frequencies and percentages were calculated, while Pearson’s chi-square test, Yates’ continuity correction and Fisher’s exact test were applied as appropriate. Statistical significance was determined at p < 0.05

Results: Radio and television were the leading sources of oral health information in both settings. Only 38.6% of respondents identified bacteria as a cause of tooth decay, while 34.4% attributed it to worms and 7.3% attributed it to deities, witches or wizards. Knowledge of bacterial causation was significantly higher among urban respondents (53.7%) than rural respondents (23.6%; p < 0.001). Only 13.8% correctly stated that fluoride prevented tooth decay, while 76.6% did not know what dental plaque was. Toothbrush use was significantly higher among urban respondents than rural respondents (59.3% versus 14.0%; p < 0.001), whereas chewing-stick use was substantially higher among rural respondents (53.9% versus 6.8%; p < 0.001). Rural respondents more frequently brushed only in the morning and demonstrated the horizontal brushing technique. Among respondents who had experienced toothache, drug use was more common among rural respondents, whereas visiting a dentist was more common among urban respondents (p < 0.001). Only 13.0% of all respondents had ever visited a dentist, and attendance was significantly higher among urban respondents (19.8%) than rural respondents (6.2%; p < 0.001). Pain accounted for 63.0% of dental visits, while only 19.6% were for routine check-ups. Lack of nearby dental clinics and absence of pain were prominent barriers among rural respondents, whereas lack of time predominated among urban respondents.

Conclusion: The study concluded that considerable rural–urban inequalities had existed in oral health knowledge, hygiene practices, toothache management and dental service utilization. Dental attendance had remained low and predominantly symptom-driven. Culturally appropriate oral health education, practical toothbrushing instruction, correction of misconceptions, integration of basic oral healthcare into primary healthcare and expanded rural dental outreach had been required.