Cultural Themes Related to Oral Health Practices, Beliefs, and Experiences in Nigeria: A Scoping Review

Abstract

The objective of this scoping review was to map out the cultural themes related to oral health practices, beliefs, and experiences in Nigeria; explore mythologies about oral health in Nigeria; identify the perceived cultural significance of oral health within the Nigerian communities; and determine the implications of study findings for oral health promotion and intervention strategies. This was a scoping review. A systematic literature search was conducted in PubMed, Cochrane Library, Web of Science, Google Scholar, and CINAHL. Published studies in peer-reviewed journals written in English that investigated culture and oral health were included. All forms of literature reviews, editorials, or opinion pieces were excluded. Information on the study characteristics and population characteristics, cultural determinants of oral health, oral health outcomes, and the methods used to assess cultural factors and oral health outcomes was extracted. A narrative synthesis of the findings was conducted to identify key themes in the literature. The 37 articles, published between 1998 and 2024, that met the eligibility criteria wrote on the prevalence of a culture of self-medication and self-care, myths that affect utilization of oral health services, cultures that expose people to increased risk of poor oral health, and cultural norms, beliefs, and practices that facilitate oral health. The findings emphasize the need for culturally tailored strategies to improve oral health literacy and reduce disparities. This review underscores the potential to foster community engagement, trust, and sustainable improvements in oral health outcomes by aligning oral health promotion efforts with Nigeria’s culture. In conclusion, cultural norms, beliefs, and practices can be barriers and facilitate oral health in Nigeria. Identifying and understanding the norms, beliefs, and practices that affect oral health can help improve oral health education and promotion so that they are culturally relevant and effective.

1. Introduction

Poor oral health is a public health crisis affecting over 3.5 billion people worldwide [1]. Yet, oral health is a critical component of overall well-being due to its link with systemic health [2]. Poor oral health is associated with increased risk for systemic conditions such as cardiovascular disease, diabetes, respiratory infections, adverse pregnancy outcomes (e.g., preterm birth and low birth weight), and other chronic diseases [3]. In addition, it can contribute to social and psychological challenges, including reduced self-esteem, difficulties with communication, and diminished quality of life [4].

Most oral health problems are preventable because their causative factors—such as poor hygiene, unhealthy dietary habits, limited access to dental care, and lifestyle choices—are modifiable [5,6,7]. However, addressing these individual behaviours without considering the broader context in which they occur can limit the effectiveness of prevention strategies. The interplay between individual habits and structural factors, such as cultural values, beliefs, and systemic barriers, highlights the complexity of achieving optimal oral health [8].

The study of culture and health is an emerging field driven by the increasing interest in reducing disparities in health, including improving oral healthcare delivery, designing effective public health interventions, and achieving better health outcomes for all populations. It underscores the importance of a holistic view of health that respects cultural diversity and integrates it into global health strategies [9]. Cultural beliefs significantly influence how individuals perceive oral health and illness and determine the causes of oral diseases, including dietary and hygiene practices, perceptions of illness severity, and decisions on treatment options [10]. In addition, communication styles, gender roles, and respect for authority vary across cultures and impact healthcare delivery, as mismatched cultural understanding between providers and patients can lead to mistrust, non-compliance, and poor health outcomes [9,11]. Understanding cultural diversity is crucial for designing effective interventions. Universal solutions often fail without adaptation to local cultural contexts.

Despite the growing recognition of cultural determinants in health research, including their possible effect on the oral health of different communities in Nigeria [12,13], there is a limited synthesis of evidence specifically exploring how culture influences oral health in these communities and for these different populations. The need for this is high given the growing oral health problems in the region: 1 in about every two persons living in the World Health Organization Africa region had an oral health problem in 2019 [14]. Nigeria has over 250 diverse ethnic groups, each with distinct languages, cultures, and traditions influencing food and health behaviours [15]. Little is known about the disparities in oral health outcomes across different cultural groups and the role of culture in shaping these outcomes. Understanding the link between culture and oral health is crucial for developing culturally sensitive oral health interventions and policies and improving oral health outcomes globally [16].

This scoping review mapped the existing literature, identified knowledge gaps, and informed future research directions on the intersection between culture and oral health in Nigeria. The objective of this scoping review was to map out the cultural themes related to oral health practices, beliefs, and experiences in Nigeria; identify the perceived cultural significance of oral health within communities in Nigeria; determine the implications of study findings for oral health promotion and intervention strategies; and develop culturally appropriate recommendations for oral health promotion interventions in Nigeria.

2. Materials and Methods

This scoping review was registered with the Open science Foundation (DOI: https://doi.org/10.17605/OSF.IO/VQRUK) on the 4 March 2025, and the study was conducted in strict adherence to the Joanna Briggs Institute (JBI) guidelines for scoping reviews [17] and reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) statement [18]. It followed a five-stage framework, adapted to comprehensively explore the intersection of cultural factors and oral health in Nigerian communities. Each stage was conducted systematically to ensure rigour and transparency.

To structure the review, we utilized the population, concept, context framework. The population focused on individuals in Africa. The concept centred on cultural norms, beliefs, and practices that can be barriers and facilitate oral health in Nigeria. The context was confined to studies conducted within any of the 54 African countries recognized by the United Nations [19]. This approach ensured a comprehensive and systematic exploration of the literature while maintaining clarity and relevance to the African context.

• Stage 1: Identifying the Research Questions

The following research questions guided this review: (1) What themes related to oral health practices, beliefs, and experiences can be identified within Nigerian communities’ traditional songs and contemporary music? (2) What cultural significance is attributed to oral health? (3) What implications do these perceptions have for oral health promotion and intervention strategies? (4) What culturally appropriate recommendations can be developed for oral health promotion interventions to improve health outcomes in Nigeria?

• Stage 2: Identifying Relevant Literature

A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane Library, Web of Science, Google Scholar, and CINAHL. The search strategy involved MeSH terms and keywords such as “culture”, “cultural competency”, “cultural diversity”, “ethnic group”, “oral health”, “oral hygiene”, “dental health”, “oral diseases”, “Nigeria”, and “Federal Republic of Nigeria.” Boolean operators (AND, OR) and truncation were applied to refine the search results. The search strategies are outlined in Appendix A. In addition, the title “The use of cultural tools for oral health in Nigeria” was used as a search phrase in Google Scholar to capture broader sources. Supplementary sources included grey literature (e.g., conference proceedings, reports) and the reference lists of included studies.

• Stage 3: Study Selection

Empirical studies published in peer-reviewed journals, written in English, and investigating culture and oral health, examined outcomes such as oral health behaviours (e.g., brushing frequency, dietary practices), oral health outcomes (e.g., dental caries, periodontal disease), and cultural practices (e.g., traditional oral health remedies) were included. All forms of literature reviews, editorials, and opinion pieces not explicitly addressing culture and oral health were excluded.

• Stage 4: Data Extraction

Two reviewers (AOE and LA) independently extracted data using a standardized data extraction form. Discrepancies were resolved through discussion or consultation with a third reviewer (MOF). Data extraction forms were designed to capture the study characteristics (author(s), year of publication, study location, design), population characteristics (cultural group, sample size, demographics), cultural determinants (specific cultural factors investigated), oral health outcomes (measures and findings related to oral health), and the methodology (methods used to assess cultural factors and oral health outcomes). Inter-rater reliability was conducted. The inter-rater reliability score was 0.85.

• Stage 5: Data Analysis and Synthesis

A narrative synthesis approach was employed to analyze and present the findings. The extracted data were qualitatively analyzed to identify key themes, patterns, and gaps in the literature. Cultural determinants, oral health outcomes, and study methodologies organized findings. Patterns and trends within different cultural groups were identified, and variations in cultural influences on oral health outcomes were examined. ChatGPT (Version 3.5) was partially used for the qualitative analysis.

3. Results

The search yielded 437 records, downloaded into Endnote and imported into Rayyan. After removing duplicates, 265 records remained. After reviewing the titles and abstracts, 233 articles were eligible for full-text screening. One hundred and fourteen articles were excluded due to insufficient extractable data (especially on the effect of culture on oral health), 15 articles were excluded because the data were not specific to Nigeria, 17 articles were excluded for the publication type, and 37 articles were included in the scoping review [12,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. Figure 1 is the flow diagram of the publication screening process.

3.1. Characteristics of Studies on Culture and Oral Health in Nigeria

Table 1. Extracted information from the scoping review of Nigerian studies on culture and oral health.

s/n	Author(s), Date	Objective of Study	Study Population	Study Location	Study Design	Sample Size
1	Lawal and Ifesanya, 2016 [20]	To assess the impact of unmet dental treatment needs on the quality of life of adolescents in a rural community in Nigeria	Adolescents	Oyo State, Southwest, Nigeria	Cross-sectional study	395 Male: 222 Female: 173
2	Taiwo and Panas, 2018 [21]	To evaluate the types of oral health conditions and treatment needs encountered by CPs in Plateau State, Nigeria	Community pharmacists	Plateau State, North Central, Nigeria	Cross-sectional study	113 Male: 71 Female: 42
3	Oziegbe and Schepartz, 2021 [22]	To determine the relationship between parity and tooth loss in a population with many high-parity women.	Hausa women	Kano State, Northwest, Nigeria	Cross-sectional study	612 Male: 0 Female: 612
4	Oziegbe and Schepartz, 2019 [23]	To explore the views of Hausa women regarding the link between parity and tooth loss	Hausa women	Kano State, Northwest, Nigeria	Cross-sectional study (focused group discussion)	33 Male: 0 Female: 33
5	Otuyemi et al., 1998 [24]	To determine whether perceptions of dental aesthetics as rated by urban and rural Nigerian students are similar to those of the US	Nigerian students	Osun State, Southwest, Nigeria	Cross-sectional study (comparative study)	200 Male: NS Female: NS
6	Osuh et al., 2023 [12]	To explore oral health perceptions, practices, and care-seeking experiences of slum residents in Ibadan, Nigeria	Adult household representatives	Oyo State, Southwest, Nigeria	Cross-sectional study (focused group discussion)	58 Male: 29 Female: 29
7	Osadolor and Osadolor, 2019 [25]	To evaluate the oral hygiene aids used in a rural community in Nigeria	Adult patients	Enugu State, Southeast, Nigeria	Cross-sectional study	268 Male: 126 Female: 142
8	Okundigie and Ogbebor, 2018 [26]	To examine concerns and care-seeking behaviour for dental caries among dental outpatients	Adult patients	Edo State, South-south, Nigeria	Cross-sectional study	194 Male: 98 Female: 96
9	Okolo et al., 2020 [27]	To determine the prevalence of dental caries, dental trauma, gingivitis, and oral hygiene scores in street children	Qur’anic schools’ pupils	Kano State, Northwest, Nigeria	Cross-sectional study	366 Male: 366 Female: 0
10	Okoli et al., 2024 [28]	To determine factors that contribute to oral healthcare services challenges among oral health care professionals	Oral health professionals	Anambra State, Southeast, Nigeria	Cross-sectional study	70 Male: 33 Female: 37
11	Lawal et al., 2013 [29]	To describe the oral health practices of adult inhabitants of a traditional community in Nigeria	Adult household representatives	Oyo State, Southwest Nigeria	Cross-sectional study	390 Male: 219 Female: 171
12	Ohamaeme et al., 2018 [30]	To assess the risk factors leading to periodontal diseases and suggest how to ease the condition in the populace	Primary and secondary school students	Imo State, Southeast Nigeria	Cross-sectional study	500 Male: 288 Female: 212
13	Ogunrinde et al., 2015 [31]	To assess the dental care knowledge and practice of private and public secondary school adolescents	Secondary school students	Oyo State, Southwest, Nigeria	Cross-sectional study	412 Male: 163 Female: 249
14	Oginni et al., 2010 [32]	To determine the knowledge and cultural beliefs about the etiology and management of orofacial clefts in Nigeria’s major ethnic groups	Individuals in communities	34 of 36 states of Nigeria	Cross-sectional study	650 Male: 300 Female: 350
15	Nwoga et al., 2012 [33]	To examine the reasons for voluntary jaw wiring and the outcome of a shorter period of treatment with fewer wires	Adult female patients	Enugu State, Southeast, Nigeria	Cross-sectional study	34 Male: 0 Female: 34
16	Kanmodi et al., 2017 [34]	To explore the beliefs and attitudes of trainees in primary healthcare-related programmes in Ibadan, Nigeria, towards natal tooth	Diploma students of PHC programmes	Oyo State, Southwest Nigeria	Cross-sectional study	83 Male: 23 Female: 60
17	Jauro et al., 2024 [35]	To assess the knowledge, myths, and practices concerning teething in a group of mothers in Ogun State	Mothers	Ogun State, Southwest, Nigeria	Cross-sectional study	100 Male: 0 Female: 100
18	Inegbenosun and Azodo, 2020 [36]	To find the relationship between oral health literacy levels on oral hygiene and gingival health status	Adult patients	Edo State, South-south, Nigeria	Cross-sectional study	208 Male: 130 Female: 78
19	Ibiyemi et al., 2022 [37]	To report how a local traditional song on oral hygiene education amongst children and teenagers in southwestern Nigeria was developed	Parents, guardians, and schoolteachers	Oyo State, Southwest Nigeria	Tool development	Not applicable
20	Folayan et al., 2020 [38]	To determine if there is an association between oral hygiene practices and water and sanitation hygiene (WASH) practices among street-involved young people (SIYP)	Street-involved young people	Osun and Lagos States, Southwest Nigeria	Cross-sectional study	845 Male: 452 Female: 393
21	Folayan et al., 2004 [39]	To identify the interrelating roles of culture, age, and gender and how these relationships may affect variability in the expression and measurement of dental anxiety in children	Children	Osun State, Southwest Nigeria	Literature review of studies on the effect of culture on dental anxiety	Not applicable
22	Fagbule et al., 2023 [40]	This study aims to determine the effect of traditional rhyme (folk song) as a tool for oral hygiene education among children in rural communities in Nigeria	Primary 4 pupils	Oyo State, Southwest Nigeria	Proposal for a cluster-randomized, assessor-blinded, controlled trial	Not applicable
23	Bukar et al., 2004 [41]	To determine the traditional oral health practices among Kanuri women of Borno State, Nigeria	Kanuri Women	Borno State, Northeast, Nigeria	Cross-sectional study	495 Male: 0 Female: 495
24	Bankole et al., 2018 [42]	To explain the rationale behind the choice of a culturally appropriate health educational video and the process of developing the video	Not applicable	Oyo State, Southwest Nigeria	Tool development	Not applicable
25	Bankole et al., 2017 [43]	To investigate the perception and practices of nomadic Fulani women toward their children’s oral health	Nomadic Fulani Women	Oyo State, Southwest Nigeria	Cross-sectional study	197 Male: 0 Female: 197
26	Bankole and Lawal, 2017 [44]	To assess the beliefs and practices of residents in Igbo Ora, a rural township in Nigeria, regarding the teething process	Parents of children attending child welfare clinics	Oyo State, Southwest Nigeria	Cross-sectional study	393 Male: 58 Female: 335
27	Bankole et al., 2012 [45]	To assess the attitudes and beliefs of traditional birth attendants to prematurely erupted teeth in children	Traditional Birth Attendants	Oyo State, Southwest Nigeria	Cross-sectional study	163 Male: 7 Female: 156
28	Bankole et al., 2017 [46]	To develop a culturally appropriate health education video on natal teeth in the Yoruba language targeted at the low social class to appropriately inform the public that eruption of natal/neonatal teeth is not a curse	Not applicable	Oyo State, Southwest Nigeria	Tool development	Not applicable
29	Bankole et al., 2019 [47]	To develop a culturally appropriate video in the Yoruba language as a health education tool to change their wrong beliefs regarding reversing the eruption sequence of teeth	Not applicable	Oyo State, Southwest Nigeria	Tool development	Not applicable
30	Bankole et al., 2003 [48]	To describe the rationale behind the choice of the photo posters and the process of developing them	Not applicable	Oyo State, Southwest Nigeria	Tool development	Not applicable
31	Bankole et al., 2005 [49]	To assess whether using a photo poster enhanced the outcome of traditional health education methods on teething problems	Nurses	Oyo State, Southwest Nigeria	Cross-sectional study	542 Male: 23 Female: 519
32	Azodo et al., 2013 [50]	To assess Nigerian dental therapy students’ knowledge, attitudes, and willingness to care for patients with HIV	Dental therapy students	Enugu State, Southeast, Nigeria	Cross-sectional study	210 Male: 67 Female: 143
33	Ani et al., 2024 [51]	To assess the prevalence and use of unorthodox medications among patients in Enugu, Nigeria	Adult patients	Enugu State, Southeast, Nigeria	Cross-sectional study	409 Male: NS Female: NS
34	Alabi, 2024 [52]	To uncover the sociocultural influences on oral health practices	Adults	Osun State, Southwest, Nigeria	Tool development	Not applicable
35	Ajayi et al., 2023 [53]	To describe how a local traditional folktale for oral health education among primary school pupils was developed	Not applicable	Oyo State, Southwest Nigeria	Tool development	Not applicable
36	Ada, 2018 [54]	To examine the cultural and environmental determinants of dental fluorosis in children in a rural community in Nigeria	School children	Taraba State, Northeast, Nigeria	Cross-sectional study	269 Male: 136 Female: 133
37	Ehizele et al., 2012 [55]	To identify the various misconceptions that still exist among teachers about oral health practices and their incorrect ideas about dental conditions	Primary school teachers	Edo State, South-south, Nigeria	Cross-sectional study	603 Male: 73 Female: 530

shows the characteristics of the 37 studies on culture and oral health between 1998 and 2024. Five (13.5%) studies were conducted between 1998 and 2007, 12 (32.4%) studies were conducted between 2008 and 2017, and 20 (54.1%) studies were conducted between 2018 and 2024. The total number of participants included in the study was 9236: 5319 (57.6%) females and 3917 (42.4%) males. The sample size ranged from 33 [23] to 845 [38].

Twenty-one (56.8%) studies were conducted in the Southwest [12,20,24,29,31,34,35,37,38,39,40,42,43,44,45,46,47,48,49,52,53], three in the South-south [26,36,55], six in the Southeast [25,28,30,33,50,51], three in the Northwest [22,23,27], one in the Northcentral [21], and two in the Northeast [41,54] geopolitical zones. A study was conducted in 34 out of the 36 states of Nigeria [32]. In Southwest Nigeria, the studies were conducted in the Oyo [12,20,29,31,34,37,40,42,43,44,45,46,47,48,49,53], Osun [24,39,52], Ogun [35], and Lagos and Osun [38] states. No studies were conducted in the Ekiti and Ondo states in the Southwest geopolitical zone.

The included studies were cross-sectional studies [12,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,38,41,43,44,45,50,51,54,55], a literature review [39], protocols for oral health education tool development [37,42,46,47,48,49,52,53], and a protocol for a cluster-randomised, assessor-blinded, controlled trial [40]. One of the cross-sectional studies was comparative [24], and two made use of focus group discussion [12,23] and case–control studies [42,45], respectively.

The cross-sectional studies collected data that reflected the effect of culture on oral health practices, beliefs, or statuses from various groups such as school children in primary and/or secondary schools [30,31,39,40,54], pupils in Qur’anic schools [27], adolescents [20], street-involved young people [38], adult patients [25,26,33,36], mothers [23,25,35,41,43], students in Nigeria [24,34,50], adult household representatives [12,29], oral health professionals [28], community pharmacists [21], nurses [49], traditional birth attendants [45], primary school teachers [55], parents of children attending child welfare clinics [44], and randomly selected individuals in communities of northern and southern Nigeria [32]. Some of the women studied were Hausa women [22,23], Kanuri women [41], and nomadic Fulani women [43].

Some of the included studies documented protocols for developing culturally appropriate tools for oral health education. The tools were in the form of oral hygiene education songs developed in English and translated into Yorùbá [37,40], oral health educational videos acted in Yorùbá [42,46,47], photo-posters with educative captions translated into Yorùbá, Igbo, and Hausa [48], Yorùbá proverbs and wise sayings [52], and traditional folktales graphically presented with comic strips [53].

3.2. Cultural Implications for Oral Health

Table 2. Cultural implications for oral health.

s/n	Author, Date	Cultural Concept Associated with Oral Health
Potential oral health facilitator
1	Lawal and Ifesanya, 2016 [20]	Indigenous language can improve oral health literacy.
2	Inegbenosun and Azodo, 2020 [36]	Improving oral health literacy can improve poor oral health.
3	Ibiyemi et al., 2022 [37]	Oral hygiene beliefs and practices can be effectively communicated through songs in the traditional African setting.
4	Folayan et al., 2020 [38]	Good water and sanitation hygiene (WASH) practices (water collection and storage) are associated with good oral hygiene.
5	Folayan et al., 2004 [39]	Cultural beliefs and values directly affect the cognitive schemas that interpret events as threatening and specify appropriate coping or avoidance responses. African cultures may stress obedience, self-control, and emotional restraint.
6	Fagbule et al., 2023 [40]	Folk songs can be a useful tool to deliver oral health education to children.
7	Bankole et al., 2018 [41]	Nigerians prefer Nigerian films in the indigenous languages and spend long hours watching these films. Using culturally appropriate and sensitive videotapes as health education tools has been found effective among Nigerians.
8	Bankole et al., 2003 [48]	It is believed that using pictures of real babies who are seen to be healthy when their teeth first emerge should go a long way to reducing some of the misconceived ideas.
9	Bankole et al., 2005 [49]	This study reported that displaying photo posters in the workplace did little to change nurses’ perceptions of teething problems. The posters had more influence when they were used in an instructional, interactive atmosphere.
10	Alabi, 2024 [52]	The Yorubas’ oral hygiene practices involve using stems, roots, and leaves, aligning with the broader cultural emphasis on cleanliness and neatness. The Yoruba culture stresses the importance of the mouth’s cleanliness and the whiteness of the teeth irrespective of the number of teeth lost.
11	Ajayi et al., 2023 [53]	Traditional Oral Health Education Folktale is a culturally sensitive method of educating the young.
	Potential oral health barrier
1	Taiwo and Panas, 2018 [21]	The pharmacy is the first resource for people with varied health conditions because the culture of self-medication and self-care may make patients patronize unauthorized pharmacists’ assistants with inadequate knowledge.
2	Oziegbe and Schepartz, 2021 [22]	Hausa culture allows early marriage, high parity, and longer reproductive years, which are related to more significant tooth loss.
3	Oziegbe and Schepartz, 2019 [23]	Hausa women associate tooth loss with vomiting during labour (payar baka)’, tooth worm, cancer, and ageing.
4	Otuyemi et al., 1998 [24]	Africans’ perception of dental aesthetics is generally based on stereotypes, e.g., Africans usually regard midline diastema as a sign of beauty.
5	Osuh et al., 2023 [12]	Poverty facilitates the culture of self-medication and self-care. Unorthodox cleaning materials reported were ground glass, wood ash, charcoal, “epa Ijebu” (a dentifrice), and “orin ata” (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/concoctions.
6	Osadolor and Osadolor, 2019 [25]	Cultural and religious factors influence the choice of oral hygiene aids. The use of dental floss is still not optimal despite its potential benefit.
7	Okundigie and Ogbebor, 2018 [26]	Cultural beliefs affect oral health-seeking patterns in patients with dental caries, and cultural and religious factors influence health-seeking behaviour.
8	Okolo et al., 2020 [27]	The culture of ‘Almajiris’ increases the oral disease prevalence.
9	Okoli et al., 2024 [28]	Cultural beliefs and myths affect oral healthcare services.
10	Lawal et al., 2013 [29]	Study participants used additional cleaning agents to “whiten” their teeth, such as ashes, charcoal, and grounded ceramics.
11	Ohamaeme et al., 2018 [30]	The study population resorted to herbal medication in the management of their oral health conditions.
12	Ogunrinde et al., 2015 [31]	The study population cracks bones or opens caps of bottled drinks with their teeth.
13	Oginni et al., 2010 [32]	The cultural belief about what causes orofacial cleft includes God and the Devil, evil spirits, witchcraft, retribution, mother’s sins, reincarnation, curses, ancestral origin, and the evil child.
14	Nwoga et al., 2012 [33]	There is a cultural/social belief that slimness is more beautiful. Therefore, single women wire their jaws for the desire to attract a marriage mate, prepare for an engagement, and fit into a wedding gown. Married women, on the other hand, do it to please a husband or achieve postpartum weight loss.
15	Kanmodi et al., 2017 [34]	There is a cultural belief that natal teeth are caused by witchcraft, curses, the will of God, evil spirits, and bad luck.
16	Jauro et al., 2024 [35]	Mothers associate teething with several systemic symptoms and tend to result in self-medication or the use of some non-medication remedies.
17	Bukar et al., 2004 [41]	Oral hygiene tools used by the respondents included charcoal and ordinary water, and some did not clean their teeth. They perform tattooing of lips or gingivae, mainly before marriage, with thorns of plants and a mixture of charcoal and seeds as pigments.
18	Bankole et al., 2017 [46]	The nomadic Fulani women studied resorted to herbs and traditional concoctions for their children’s teething.
19	Bankole and Lawal, 2017 [44]	Diarrhea, fever, and boils were believed to be synonymous with teething. Remedies for teething in children included traditional concoctions.
20	Bankole et al., 2012 [45]	Some traditional birth attendants believe that premature eruption of teeth in children is caused by evil spirits, contravening cultural taboos and prolonged gestation, and that the effect on the child includes strange behaviour, the child developing evil spiritual powers, and intellectual disability. Their practice included advising parents to get rid/of or hide the child and immediate extraction of the teeth with or without sacrifices.
21	Bankole et al., 2017 [46]	Children with natal teeth and their families have been stigmatized and are believed to be cursed.
22	Bankole et al., 2019 [47]	Individuals who have a reversal of the eruption sequence of their teeth are believed to be evil carriers of misfortune, and their families are deemed cursed. Such children are stigmatized, abandoned, and may be gotten rid of.
23	Azodo et al., 2013 [50]	Some of the studied Nigerian dental therapy students believed that transmission of HIV can be through blood donation, mosquito bites, and sharing cups and plates with others. Some also believe HIV is a harmless, self-limiting, antibiotic-sensitive contagious infection, while some believe it is a punishment virus meant for only someone who has sinned.
24	Ani et al., 2024 [51]	The studied population used unorthodox medication before presenting to the dental clinic because they felt there was no need for orthodox medication, and “Agnes Nwamma” was the most common unorthodox medication used.
25	Ada, 2018 [54]	Cultural causes of high fluoride levels are linked to food culture and the type of foods consumed by the population, such as brick tea, zanba, roasted corn and chilli, injera, milk, and vegetables.
26	Ehizele et al., 2012 [55]	Some school teachers felt that worms and black magic caused tooth decay. Tooth loss was considered a natural process by some, and many did not feel it was possible to keep all the teeth in the dentition for life. They did not consider tooth loss a severe health problem. Traditional medicine was used for toothache and gingival bleeding, and some reported self-medication.

shows the cultural norms, beliefs, and practices identified from the included studies as potential oral health barriers [12,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,41,43,44,45,46,47,50,51,54,55]. Cultural factors influence the choice of oral hygiene aids [12,25]. The culture of self-medication and self-care is prevalent among the Nigerian population studied [27], and they sometimes resort to the use of various agents such as ground glass, wood ash, charcoal [12,29,41] herbs, traditional concoctions, and unorthodox medications [35,43,51] for oral healthcare. Some scientifically explainable patterns seen in Nigerian populations are, in some cases, culturally believed to be caused by evil spirits, curses, and repercussions for contravening cultural taboos [30,31,34,45,47].

Some cultural beliefs and myths affect the utilization of oral health services [28]. Some treatable oral health conditions may be erroneously perceived as inevitable; e.g., tooth loss is believed to be due to vomiting during labour [23], diastema was considered a sign of beauty [24], tooth loss was considered a natural process by some, and many did not feel it is possible to keep all the teeth in the dentition for life [55]. Some cultures also expose the people to increase the risk of oral health conditions, e.g., Hausa culture allows early marriage, high parity, and longer reproductive years, which are related to more significant tooth loss [23]; the culture of ‘Almajiris’ can lead to oral health neglect and increased prevalence of the oral diseases [27]; the culture of cracking bones or open caps of bottled drinks with teeth can lead to tooth fractures [31], and the cultural/social belief that slimness is more beautiful can make women seek voluntary wiring of the jaws, which can potentially prevent their optimal plaque control [33].

Table 2 also shows the cultural norms, beliefs, and practices that can be potential oral health facilitators [20,36,37,38,39,40,42,49,52,53]. Oral health literacy can improve poor oral health [36] and using the indigenous language in oral health education can improve oral health literacy [20]. Culturally sensitive and appropriate tools for oral health education are being developed using indigenous languages and tools. These appear in forms of oral hygiene education songs [37,40], oral health educational stories acted in short videos [40,46,47], photo-posters depicting oral health used to correct myths and misconceptions about oral health [42], proverbs and wise sayings [52], and traditional folktales graphically presented with comic strips used to convey oral health education to children in a form they can easily understand and identify with [53].

Some included studies identified cultural values that can be capitalized on to improve oral health. Yorùbá’s cultural emphasis on mouth cleanliness and teeth whiteness, irrespective of the number lost, can lead to good oral health attitudes and practices [52]. African cultures stress obedience, self-control, and emotional restraint, which can make an African child more cooperative when receiving dental treatment [39]. Good water and sanitation hygiene (WASH) practices (water collection and storage) are associated with good oral hygiene, implying that WASH practices can be improved on to improve oral health [38].

4. Discussion

This scoping review explored the cultural factors influencing oral health practices in Nigerian communities and provided recommendations for culturally appropriate interventions. The study findings indicated that cultural beliefs, self-medication, and traditional remedies often delay proper dental care and perpetuate myths that discourage seeking professional help. Practices such as using their teeth to crack bones or open bottles increase the risk of dental damage and poor hygiene. However, integrating cultural tools like music, storytelling, and proverbs has proven effective in promoting oral health awareness, especially when using indigenous languages and aligning with cultural values like the Yorùbá emphasis on mouth cleanliness.

In addition, the study findings indicated that broader sociocultural factors, such as religious beliefs and social norms, also shape oral health behaviours. For instance, the Almajiri system’s neglect of children’s oral hygiene and cultural practices, like early marriages in Hausa communities, contributes to higher rates of oral health issues. Thus, interventions must address these social determinants, incorporating education on oral hygiene and water, sanitation, and hygiene (WASH) initiatives to improve both oral health and public health outcomes.

Furthermore, the study findings highlighted that cultural myths, sayings, beliefs, and misconceptions such as the supernatural causes of tooth loss, continue to impede access to professional dental care. To combat these, oral health education must challenge harmful beliefs and promote scientifically validated practices through culturally relevant methods like folktales and songs. Collaboration with cultural and religious leaders is essential to debunk these myths and foster a healthier attitude toward dental care. Culturally sensitive oral health campaigns should align with positive cultural values such as cleanliness and respect for children’s behaviour during treatment.

The study findings indicated that addressing oral health in Nigeria cannot only be dependent on addressing cultural barriers and promoting cultural facilitators to oral care. There is also the need to improve access to care, such as expanding affordable dental services, particularly in underserved areas, and integrating oral health into primary healthcare. Focusing on vulnerable populations, such as the Almajiris and nomadic groups, will ensure that preventive and curative services reach those most in need. In addition, educating women about the connection between reproductive health and oral health and integrating oral health programmes into schools will further enhance care accessibility and awareness. Policy efforts must focus on integrating oral health education into school curricula and community health programmes. Ongoing community engagement and a regular evaluation of these strategies will ensure they effectively address local cultural norms and improve oral health outcomes across Nigerian communities.

One of the strengths of the study is that it offers valuable insights into improving oral health in Nigerian communities through culturally appropriate interventions. It highlights the importance of incorporating cultural values and beliefs into oral health interventions, ensuring strategies are grounded in local contexts. This cultural sensitivity enhances the likelihood of community acceptance and engagement. It also thoroughly examines the barriers and facilitators to oral health in Nigerian communities, offers insights into cultural practices, myths, and social norms that influence behaviours, and outlines actionable, culturally appropriate strategies for improving oral health outcomes. Special attention is given to vulnerable populations, such as the Almajiris and nomadic groups, which ensures that the recommendations address health disparities and reach those most in need. Furthermore, the study connects oral health improvement with other public health initiatives—the WASH programme—demonstrating a holistic approach to health promotion.

The study, however, has some limitations. First, the study is a scoping review, relying heavily on secondary sources and theoretical frameworks rather than primary data collection. This limits the ability to make firm conclusions based on real-world evidence from Nigerian communities. In addition, while cultural factors are essential, the study may not fully address the structural barriers to oral healthcare, such as economic constraints, healthcare infrastructure, and policy gaps, which also play a significant role in oral health outcomes. The study’s simplified recommendations may underestimate the complexity of changing deeply ingrained cultural beliefs and practices. They may not fully account for regional variations within Nigeria, potentially oversimplifying the approach needed in certain areas. Finally, while the study advocates for ongoing community engagement and regular evaluation, the practical aspects of monitoring and adapting interventions remain underexplored, which could make it difficult to assess the effectiveness of these strategies over time. Despite the study’s limitations, the findings are strategically important for planning oral health promotion programmes in Nigeria.

The findings of this scoping review highlight the complex relationship between cultural beliefs, practices, and oral health in Nigerian communities. These findings can be connected to several theories guiding culturally competent health interventions, each offering valuable insights for improving oral health outcomes. First, the study underscores the importance of engaging communities and religious leaders in ongoing self-reflection and learning as highlighted in prior studies [56,57]. Health programmes can address cultural myths and misperceptions by collaborating with local leaders, including religious and cultural figures. This aligns with cultural humility, which promotes recognizing power imbalances and learning directly from communities to provide more culturally relevant care [58].

Second, the study found that beliefs, such as supernatural explanations for tooth loss, create barriers to seeking professional care, emphasizing how cultural beliefs shape health perceptions and behaviours, as highlighted by the Health Belief Model [59]. Addressing these myths through culturally appropriate interventions, like using indigenous languages, folk songs, and storytelling, can shift perceptions and encourage timely dental care.

Third, the scoping review revealed that social influences like community norms and family practices shape oral health behaviours. Social Cognitive Theory highlights role models’ role in behaviour change [60]. By using traditional figures as positive role models for oral hygiene and showcasing successful health behaviours, the community can be encouraged to adopt better oral health practices.

Fourth, the Ecological Systems Theory, on the other hand, emphasizes the multiple layers of influence on health, from individual behaviour to broader societal factors [61]. The study found that sociocultural factors, such as the Almajiri system and the early marriage norms in some Nigerian communities, shape oral health outcomes. Interventions must address these broader structural issues, integrating oral health into primary care and WASH programmes, to ensure a holistic approach to improving oral health.

Fifth, the findings underscore the importance of cultural sensitivity in oral health interventions. Culturally rooted practices can either support or hinder oral health. Health professionals should advance along the Cultural Competence Continuum by integrating culturally acceptable methods, such as promoting chewing sticks with scientific validation [62]. Interventions must address cultural norms through local narratives and influencers, reshaping attitudes and encouraging preventive care, as emphasized by the Theory of Planned Behaviour [63]. Social factors like gender, class, ethnicity, religion, and education intersect with cultural practices to influence oral health outcomes, as highlighted in Intersectionality Theory [64]. For instance, early marriages and low oral health literacy among groups like the Almajiri community worsen disparities.

Low oral health literacy refers to an individual’s limited ability to obtain, process, understand, and use basic oral health information and services to make appropriate decisions regarding their oral health [65]. This includes difficulties in comprehending dental care instructions, understanding the importance of preventive measures, navigating the healthcare system to access dental services, and interpreting oral health-related materials [66]. Low oral health literacy can lead to poor oral hygiene practices, delayed or inappropriate care-seeking behaviours, and a higher prevalence of oral diseases, as individuals may not fully grasp the significance of maintaining good oral health or the consequences of neglecting it [67,68]. In the context of this study, low oral health literacy is particularly relevant in Nigerian communities where cultural beliefs, myths, and limited access to education may further exacerbate the challenges individuals face in understanding and managing their oral health effectively. Targeted education and services addressing these intersecting factors of culture and low oral health literacy can promote equitable care. Recognizing individuals’ varying readiness to change, interventions should be tailored to behavioural stages, using storytelling for earlier stages and direct education for those ready to adopt healthier habits, per the Transtheoretical Model [69].

Cultural themes are essential in the study of oral healthcare practices because they can inform policy formulation and the development of practice guidelines [70]. With global migration and regional cultural variations, dental professionals need evidence to be able to adapt to diverse cultural contexts to provide inclusive and equitable care. Cultural themes also include the socioeconomic challenges faced by marginalized groups [71], like the Almajiri children in Nigeria. Addressing these factors through culturally competent interventions can reduce disparities and promote sustainable health improvements. In addition, by integrating traditional cultural values and practices with evidence-based oral healthcare practices, it is possible to bridge the gap between modern dental care and local cultural beliefs [72], and by fostering a more inclusive approach, communities may be more willing to adopt healthy behaviours while preserving cultural identity [73]. Addressing cultural barriers is not just about changing behaviours; it is about respecting and working within existing cultural frameworks to build trust and improve access to care sustainably [74,75]. Monitoring and ensuring intervention effectiveness are equally critical through regular assessments, community feedback mechanisms, and longitudinal studies that can track progress, inform programme adjustments, and strengthen the long-term impact of oral health initiatives.

For Nigeria specifically, the study findings indicate that the use of indigenous languages, folk songs, proverbs, and community gatherings to disseminate oral health messages, correct misconceptions, and promote scientific knowledge to overcome barriers related to myths and supernatural explanations of oral conditions is crucial. Actions such as collaborating with community and religious leaders to challenge harmful myths and engaging these leaders as role models for positive oral health behaviours can effectively influence community norms. A focus on groups like the Almajiri and women in rural communities would help to address specific cultural practices and offer tailored education, such as educating women about the links between pregnancy and oral health, to promote early interventions. Collaborating with the local media to create culturally relevant campaigns can further enhance the reach of oral health messages. Finally, policies that integrate oral health into the broader healthcare system, particularly in schools and community health programmes, can ensure sustainable changes and practices that are culturally sensitive. These findings may be adaptable to other countries and regions with similar cultures to Nigeria.

5. Conclusions

In conclusion, addressing cultural barriers to oral healthcare access and uptake is a crucial step in reducing inequalities in oral health outcomes, especially in communities where traditional beliefs and practices heavily influence health behaviours, such as in Nigeria. By combining traditional cultural values with evidence-based oral healthcare practices, it becomes possible to bridge the gap between modern dental care and local cultural beliefs. Future research is needed to generate evidence on how to sustainably address cultural barriers in African communities through working within existing cultural frameworks to build trust and sustainably improve access to care.