Background: This study aimed to investigate the complex relationships between smokeless tobacco (SLT) consumption behaviors, socio-demographic factors, and oral health status among patients in Bangladesh, using Structural Equation Modeling (SEM).

Methods: A cross-sectional study was conducted from December 2021 to June 2022 with 156 participants included via purposive sampling from a dental outpatient department. Data were collected using a semi-structured questionnaire, translated and piloted for validity, covering socio-demographics, detailed SLT behaviors, and oral health status assessed by clinical dentists using the WHO Oral Health Assessment Form for Adults. Data analysis was performed employing descriptive statistics, Spearman correlations, and SEM to evaluate associations.

Results: SEM analysis revealed a strong positive relationship between SLT using behavior and oral health status (path coefficient = 0.99), while the path from socio-demographic factors to oral health was moderately positive (path coefficient = 0.59). Key specific associations included a significant relationship between the duration of SLT use and the need for more urgent treatment interventions (P < .001), with over 70% of participants having used SLT for more than a decade. Furthermore, earlier age of initiation (P = .016), higher frequency of daily use (P = .015), and specific SLT types (P = .022) were significantly associated with treatment urgency. The SEM model demonstrated an acceptable overall fit based on ULS-appropriate indices, including the Root Mean Square Residual (RMR = 0.079), Goodness of Fit Index (GFI = 0.986), Adjusted Goodness of Fit Index (AGFI = 0.981), and Normed Fit Index (NFI = 0.916), indicating a reasonable representation of the observed data.

Conclusions: The use of SLT is a major and direct factor associated with poor oral health outcomes, and the length of usage is a crucial risk factor. Although less important, sociodemographic traits are also important.