Healthy oral hygiene practices were infrequently applied by Burkinabè adults, and education was the key determinant for good oral hygiene practices.
Oral hygiene practices
The majority of Burkinabè cleaned the teeth at least once a day (82.8%), while the recommended number was at least twice a day . Knowledge about oral hygiene was insufficient among Burkinabè  and can affect the level of consistent practices. Thus, less than one-third cleaned the teeth at least twice a day, as found in Indian adults (29%) . The use of fluoridated paste was reported by 25.6%, whereas it was reported by 18% in 35-44y old Burkinabè a decade earlier . Even if it appears to be an improvement, personal oral hygiene in the absence of fluorides does not have a benefit in terms of reducing oral diseases such as dental caries . The lower prevalence of those who visited a dentist (2.1%) reflects the difficult access to oral care in low purchasing power areas and the insufficient human resources to face the need in terms of oral health [7, 16, 19]. Tele-dentistry is helpful to facilitate access to oral health care [20, 21] and should be implemented in Burkina Faso.
Sociodemographic factor correlates with oral hygiene practices
High education level
The correlates of high education level with each hygiene practice that we found were close to results reported among Nepalese adults , and among students, higher oral health literacy was associated with better oral health practices . This may support why lower education was considered a risk factor for dental plaque or gingivitis . Those with higher education levels usually become more concerned about their own physical or body appearance, including tooth whiteness, and then assume behaviours to this goal. Exposure to oral health education programs during primary school years was found to have positive effects on oral health knowledge and practice , and we reported that attending primary school was associated with favourable oral hygiene practices (Table 2). The country would benefit from increasing primary school enrolment and completion rates (respectively at about 89% and 62% in 2019) , while integrating simple oral hygiene education modules into the national curriculum as it has been experienced in Bangladesh, Indonesia, Nepal and Tanzania . Since the health literacy is a strong predictor of an individuals' health, health behaviour and health outcomes , integrating oral and general health through health literacy practices which would be adapted for the general population, should be implemented .
Urban residency and young adults
Except for the practice of the dentist visit, other kinds of oral hygiene practices had an urban residency or were younger adults (25–30 y or 30–44 y) as favourable factors, in line with the results of the Nepalese study . In contrast to our study, it also reported that urban residency was a favourable factor for dentist visits (aOR = 1.9, p < 0.05) and suggested a higher number of oral health professionals in this country (1400 dentists, one per 20,000 inhabitants), with the highest density of workers in an urban area . Moreover, the specific source of motivations for cleaning teeth or toothpaste selection among young adults was the fear of losing teeth and the whitening feature of teeth .
Concerning associations of the female gender with the good practices of cleaning teeth twice a day [aOR = 1.4 (95% CI 1.2–1.6)], as with visiting dentist [aOR = 1.6 (95% CI 1.1–2.5)], our report was similar to that among Nepalese people with the respective aOR of 1.7 (95% CI 1.1–2.4) and 2.2 (95% CI 1.2–3.8) . In Burkina Faso, women represented approximately 52.0% (as in our representative sample), and married/cohabiting Burkinabè represented 86.3% (Table 1). A simple educational intervention has a positive impact on oral health behaviours in groups , and in the framework of family oral hygiene education for Burkinabè societies, women should be placed in a key role. This is quite fitting, especially since being in a group, e.g., married/cohabiting, was also associated with cleaning teeth at least twice a day [aOR = 1.4 (95% CI 1.2–1.7), Table 2].
Occupation with regular income
Professions with regular income were a favourable factor for cleaning teeth at least twice a day [aOR = 1.6 (95% CI 1.4–1.9), Table 2]. Professions may determine the income level, and high income among Korean adults was favourable for daily repetitive tooth brushing . A high number of tooth cleanings may imply more financial investments to provide toothpaste, while the share of Burkinabè people living on less than $1.90 a day was 43.7% in 2014 . In contrast to the Australian study reporting that an increased household income improved dental visits , we noticed that even Burkinabè with regular income did not have a favourable habit of dentist visits [aOR = 0.8 (95% CI 0.5–1.3) Table 2]. This suggests generalized low purchasing power to face dental care costs in Burkina Faso.
Income variables were not collected, and geographic data were not included in the analyses; thus, we missed specific information on their impact in our multivariable models. While these first nationally representative data from 2013 may no longer reflect the current situation, they provide a relevant baseline that can be compared with future WHO STEPS survey data.