This study explored self-medication for oral health problems in a community setting in eastern Nepal. The prevalence of self-medication for oral health problems in this community was 43.3%, which is lower than that reported in India [15] (72%), and Cameroon [16] (67.8%). A higher prevalence has been reported in a developed country such as Saudi Arabia with a very high Human Development Index (HDI) [17]. A study carried out on dental patients visiting a hospital in Nepal [7] has shown a higher prevalence (62.6%) than that seen in our study. The study reports a prevalence comparable to that reported in Nigeria [18](42.5%). Burkina Faso [19], a landlocked country in western Africa, also has a similar prevalence of self-medication for oral health problems (48%). Our study suggests that family income is significantly related to the practice of self-medication. Differences in the prevalence of self-medication for oral health problems are also perhaps due to a myriad of factors such as sampling variability, differences in the availability of health services or the belief in traditional treatments [7].

Housemakers and students made up almost half of the study participants, as they were available at home during the house-to-house survey. There are considerably more women than men in Wards 1 and 2 of Baraha Municipality [20]. This is reflected in our study, as they make up more than 57% of the study population.

In the current study, the most common trigger factor that led to self-medication was toothache. Community-based surveys have shown that toothache is one of the common dental problems faced by people. A population-based survey in Iran [21] found that 55.1% of the participants have had toothache in the last 6 months. Similarly, a high prevalence of toothache has been reported in Brazil [22]. The use of analgesics to treat toothaches was found to be a common feature in our survey. Similar findings have been reported in Cameroon [16] and India [15]. On the surface, it looks like a benign phenomenon with occasional gastritis as a side effect but the use of analgesics to treat dental pain can lead to a rapid increase in dental problems. Simple reversible pulpitis can progress to periapical abscess or more severe clinical conditions before reaching a dentist. Surgical visits can save patients a lot of pain and suffering.

Saltwater was a common remedy reported in our study to alleviate their oral health problems. There is no scientific evidence to prove the efficiency of this method; clinicians often advise lukewarm saltwater rinse to their patients [23]. There is no prescribed dose of concentration or frequency of use, but it has not produced any side effects. Altman and Bland [24] have rightly said ‘The absence of evidence is not evidence of absence’.

In addition to toothache, other trigger factors leading to self-medication were bleeding gums, swelling, and halitosis. These are among the main complaints that patients present in dental outpatient departments. The duration of self-medication was a few days for most of the participants. It was intriguing to find that around a quarter of those using self-medication reported using it until the problem was over. Dental problems are seldom treated successfully with self-medication alone. E.g.; pain caused due to the progression of dental caries cannot be relieved with medication alone. A visit to a dentist for root canal treatment (or extraction, if the patient so desires) is mandatory. While self-medication may be acceptable as a temporary measure to manage pain in emergency situations, relying on it as a solution to address the underlying issue is inadvisable. Although symptoms may temporarily subside, the underlying condition is likely to recur with increased severity over time.

Apart from a few participants (around 10%), all others agreed that they had to see a dental practitioner to take care of their oral health problems. The reason they could not visit was lack of time and money, previous experience of treating similar diseases, traditional beliefs, and the inaccessibility of doctors. This reflects that self-medication is not only related to the inaccessibility of health services, but also has traditional and cultural determinants. Similar reasons have been cited in previous studies [15]. Regardless of the reasons they practised self-medication, the feeling they achieved was temporary relief.

The use of antibiotics as self-medication was only reported by a small proportion of people. However, in Nepal, the regulation of prescription drug sales is poor [25]. Therefore, the abuse of antibiotics may be more prevalent than that found in this study. Illiterate individuals may have failed to differentiate between analgesics and antibiotics while answering. The source of self-medication acquisition is pharmacy for more than half of users. This phenomenon of acquiring drugs from pharmacists without consulting a doctor is relatively common in Nepal [26]. In addition to side effects such as improper medication and incorrect treatment, it is contributing to increasing drug resistance. The medicines were also acquired from traditional homes. The herbs prescribed by people running traditional homes are based on no solid source of knowledge and cannot be trusted.

No differences were observed between male and female participants in their use of self-medication. Similar findings have been reported in a study in Cameroon [16]. Similarly, other sociodemographic variables such as marital status, occupation, education, and participation in social health insurance schemes did not show a significant association with self-medication. However, the practice of self-medication was found to have a strong association with family income. Interestingly, analgesics that have commonly been consumed without a prescription from a doctor are comparatively cheaper drugs. Both direct and indirect costs to obtain dental services may be a barrier for people visiting a dental hospital, especially in people with low family incomes [27].

There have been some studies in medical, dental and nursing students’ utilization of self-medication in Nepal [28,29,30]. Some studies also explore self-medication in community settings of Nepal as well [31,32,33]. But, to the best of the authors’ knowledge, this is the first house-to-house survey to explore self-medication for oral health problems in Nepal. It provides evidence of how people take care of their oral treatment needs. It also sheds light on the prominent issue of the unavailability of dental services, even to people living in municipalities of the country. If a patient receives antibiotics for the treatment of a periapical abscess from a health center, it is rational to think that they will take those drugs by themselves the next time a similar problem arises. Hospitals should provide their own specialist dental services. In the current scenario, only a handful of government hospitals in the country provide dental services in Nepal.

This study was not without limitations. The community-based survey was conducted during the day. The offices and transport services were open during this survey period, meaning that people who had certain jobs were not available at home for an interview. This may have compromised the representativeness of the sample as the wards were conveniently selected. Participants who could not read and write may not have been able to correctly report the medication they used. The difference between an analgesic and an antibiotic can sometimes be overwhelming, especially for those who have little education. This survey was conducted immediately after the COVID-19 lockdown was over. Hospital services were limited to the treatment of emergency services. People may have been using self-medication practices in the absence of accessible health services. At the same time, because of the COVID-19 pandemic, they might have considered oral health issues as minor problems and not reported them at all. Social desirability bias can be present while reporting about self-medication. In light of these limitations, our findings should be interpreted with caution. However, this study provides evidence of self-medication for oral health problems, most of which require a mandatory visit to dentists for surgical intervention.