Keywords personalized nutritional counseling - oral health - dental practitioners - cross-sectional
survey - Saudi Arabia
Introduction
Oral health is fundamental to an individual's well-being and quality of life.[1 ] It is a significant indicator of physical well-being and overall life quality. Attaining
optimal oral health is crucial for realizing the World Health Organization's definition
of health as “a state of complete physical, mental, and social well-being, and not
merely the absence of disease or infirmity.”[2 ] Diet and nutrition have gained significant prominence among the many factors influencing
oral health.[3 ]
[4 ]
[5 ] While the significant influence of nutrition on systemic and oral health is well-established,
its incorporation into routine dental practice remains insufficient.[6 ]
Numerous chronic conditions, including diabetes mellitus, heart disease, pneumonia,
and gastrointestinal disorders, are linked to poor dental health. Additionally, poor
oral health has been associated with preterm delivery and low birth weight.[7 ]
[8 ]
[9 ]
[10 ] Conversely, a healthy diet lowers the risk of certain oral diseases and promotes
the growth of healthy gingiva and teeth.[11 ]
[12 ]
[13 ] Periodontal diseases profoundly affect oral health-related quality of life, highlighting
the importance of integrated strategies like personalized nutritional counseling (PNC)
to enhance clinical outcomes and overall patient well-being.[14 ]
[15 ] PNC offers targeted support for managing caries, periodontal disease, and enamel
erosion.[16 ]
While tobacco and alcohol are the primary etiological factors for oral cancer, diet
has become a significant determinant in its development. Specific dietary nutrients
play crucial roles in either mitigating or elevating cancer risk. Foods rich in fruits,
vegetables, curcumin, and green tea may reduce risk, while a pro-inflammatory diet
characterized by high consumption of red meat and fried foods can increase it. Dietary
protective factors demonstrate various mechanisms, including antioxidant, anti-inflammatory,
antiangiogenic, and antiproliferative effects.[17 ] This connection extends to systemic health, reinforcing the need for comprehensive
dental care and highlighting the importance of a holistic approach to oral health
care.[18 ]
The necessity for such integration is particularly pertinent in the Middle East, where
dietary patterns and oral health concerns intersect uniquely.[19 ]
[20 ] In Saudi Arabia, despite rapid socioeconomic growth and modernization, the prevalence
of oral and dental diseases remains alarmingly high compared to both developed and
developing nations. This situation calls for enhanced focus on oral health within
the country's health care framework to address these persistent challenges.[21 ]
Although many dental practitioners recognize the significance of nutrition, they often
need more training or confidence to offer personalized guidance.[22 ]
[23 ]
[24 ] Furthermore, current research frequently emphasizes general knowledge instead of
examining the specific practices and obstacles dental practitioners face in incorporating
nutritional counseling into patient care. This creates a gap in understanding the
practical application of personalized advice in everyday practice.
This study evaluates Saudi Arabian dental practitioners' current practices, knowledge,
and attitudes regarding PNC. Specifically, it seeks to determine how frequently nutritional
counseling is provided, identify the key factors considered during counseling, and
assess the formal training and resources available to dental practitioners. Additionally,
the study explores the challenges and barriers that limit the integration of nutritional
counseling into dental practice, including time constraints, lack of resources, insufficient
training, and patient interest. The findings aim to provide insights that can guide
future educational interventions and policy formulation to enhance the integration
of nutritional counseling in oral health care in Saudi Arabia.
Materials and Methods
This cross-sectional study sought to examine the impact of PNC on improving oral health
management among Saudi dental practitioners. The Jazan University Standing Committee
on the Ethics of Scientific Research (REC-45/05/895, HAPO-10-Z-001) approved the study,
affirming compliance with ethical standards. Dental practitioners from various regions
of Saudi Arabia, affiliated with governmental bodies, private practices, and educational
institutions, were invited to participate in the study, ensuring a diverse representation
of the dental sector.
Content and Development of the Questionnaire
Content and Development of the Questionnaire
The methodology of this study involved a carefully structured approach to developing
a questionnaire to assess the role of personalized nutritional counseling in enhancing
oral health management among Saudi Arabian dental practitioners. The questionnaire's
development followed several critical steps to ensure its relevance, validity, and
reliability.
Initially, a comprehensive examination of the current literature on PNC, oral health
management, and related dental practices was conducted. This literature review provided
the theoretical framework for identifying key themes and topics pertinent to the study
objectives. Based on these findings, an initial draft of the questionnaire was constructed
to cover various aspects, including the frequency of counseling, factors considered
during counseling, challenges faced, and the perceived impact on oral health.
Subsequently, the draft questionnaire was reviewed by a panel of experts in nutrition,
oral health, and clinical practice. These experts provided feedback to assess the
questionnaire's face and content validity, ensuring it captured the essential dimensions
of PNC in oral health. Their insights were crucial in refining the questionnaire to
ensure it met the study's goals.
The questionnaire was then pilot-tested with 18 dental practitioners from Jazan University's
College of Dentistry. The pilot test aimed to evaluate the internal reliability of
the questionnaire, with Cronbach's alpha coefficient calculated at 0.81, indicating
strong reliability. Feedback from the pilot participants further contributed to fine-tuning
the questionnaire, ensuring clarity and ease of understanding for the final version
used in the more extensive survey.
Process of Data Acquisition
Process of Data Acquisition
The revised questionnaire, consisting of 10 items, functioned as the tool for data
collection in this nationwide study. To foster inclusivity within diverse sectors
of the dental profession in the Kingdom of Saudi Arabia, the questionnaire was disseminated
via popular social media platforms, including Facebook, Twitter, and WhatsApp. This
strategic distribution aimed to engage general dentists, specialists from private
and public hospitals, and professionals associated with academic institutions across
the kingdom. Participants could access the questionnaire by clicking on a Google Form
link. The questionnaire was constructed in a closed-ended format to enhance the efficiency
of data collection. The questionnaire comprehensively assessed the role of PNC in
enhancing oral health management.
Criteria of Inclusion and Exclusion
Criteria of Inclusion and Exclusion
The study's inclusion and exclusion criteria encompassed all dentists currently in
active dental practice in Saudi Arabia, including those connected to government agencies,
private clinics, and educational institutions—the exclusion criteria comprised professionals
not based in Saudi Arabia and unlicensed nonpractitioners. Our primary goal was to
recruit 384 participants for the sample size calculation, calculated using the formula
for estimating proportions in a finite population. A margin of error of 5% and a confidence
interval of 95% were employed in this calculation. We restricted the study to 207
participants for practical reasons. Despite the reduction, the sample size is still
adequate to achieve the objectives of the study.
Statistical Analysis
The response data were obtained as an MS Excel spreadsheet and later imported into
a statistical software program. The data were analyzed utilizing the Statistical Package
for Social Sciences (SPSS) software, specifically version 23.0, created by IBM Corp.
in Armonk, New York, United States. Descriptive statistics were used to analyze the
frequency of responses, and chi-square tests were performed to assess associations
between demographic variables (e.g., gender, experience) and critical outcomes. A
significance level of p <0.05 was considered statistically significant.
Results
Analytical Examination of Socio-demographic Variables
The study included 207 dental practitioners, with the majority aged between 20 and
30 (31.4%), followed by those aged 41 to 50 (30.0%). A nearly equal gender distribution
was observed, with males representing 50.2% of the participants and females 49.8%.
Regarding professional experience, the largest group of participants (31.4%) had 5
to 10 years of experience, while 26.6% had less than 5 years of experience. Only 20.3%
had more than 20 years of experience. Regarding specialization, 56.5% of the participants
were general dentists, while 43.5% were specialists. Workplace settings varied, with
42.5% of the respondents working in private clinics or hospitals, 31.9% employed at
teaching institutes, and 25.6% in government hospitals.
[Table 1 ] provides insights into the frequency of responses offering nutritional counseling
and factors considered, which are central to the current study. It reveals that most
participants (39.1%) offered nutritional counseling “sometimes,” with 26.1% doing
so “often” or “always.” Key factors in personalized counseling included “dietary habits”
(70.0%), “patient age” (66.2%), “oral health status” (62.8%), and “medical history”
(65.7%). Training levels were low, with 68.1% reporting minimal training and only
2.4% receiving extensive training. Confidence was moderate: 43.5% felt neutral and
29.5% were confident in their counseling abilities.
Table 1
Frequency of response of each question
Question
1. Knowledge and practices of personalized nutritional counseling
Number
Percentage
Q1
Never
18
8.7
Sometimes
81
39.1
Often
54
26.1
Always
54
26.1
Q2
Oral health status
130
62.8
Dietary habits
145
70.0
Medical history
136
65.7
Patient Age
137
66.2
Q3
2. Training and resources
Yes, extensive training
5
2.4
Yes, some training
61
29.5
Yes, minimal training
141
68.1
No training
–
–
Q4
Very confident
5
2.4
Confident
61
29.5
Neutral
90
43.5
Not confident
51
24.6
Q5
Prof. journals
134
64.7
Education courses
149
72.0
Online databases
149
72.0
Peer consultations
142
68.6
Q6
3. Challenges and barriers
Lack of time during patient appointments
136
65.7
Insufficient training or knowledge
116
56.0
Lack of patient interest
129
62.3
Lack of resources
117
56.5
Q7
More training and education on the subject
166
80.2
Access to better assessment tools
145
70.0
Increased patient awareness and education
125
60.4
Collaboration with nutritionists
125
60.4
Q8
4. Oral health management (perception)
No impact
4
1.9
Minimal impact
9
4.3
Moderate impact
89
43.0
Significant impact
105
50.7
Q9
Reduction in dental caries
142
68.6
Improved gum health
144
69.6
Better management of oral infections
109
52.7
Enhanced overall oral hygiene
162
78.3
Q10
Definitely increase
50
24.2
Likely increase
96
46.4
Maintain current level
52
25.1
Likely decrease
9
4.3
Note: This table summarizes the frequency of responses to various aspects of personalized
nutritional counseling. Most participants provide counseling "sometimes" and consider
dietary habits and patient age in their practices. Most received minimal training
and had moderate confidence. Key resources include educational courses and online
databases. Common challenges include lack of time and patient interest, while improvements
are seen in oral health outcomes, with plans to increase the use of counseling in
the future.
Educational courses (72.0%) and online databases (72.0%) were the resources relied
upon, alongside peer consultations (68.6%) and professional journals (64.7%). Challenges
cited were time constraints (65.7%), patient interest (62.3%), insufficient training
(56.0%), and resource limitations (56.5%). In total, 80.2% favored more training and
70.0% better assessment tools to enhance integration.
Regarding impact, 50.7% believed PNC significantly affected oral health management,
with 78.3% noting improved overall hygiene and 68.6% reporting reduced dental caries.
For future plans, 46.4% indicated they would likely increase their counseling use,
and 24.2% expressed a definite intention.
[Table 2 ] highlights the associations between age and responses regarding PNC. Younger practitioners
(20–30 years) were more likely to report providing counseling “never” (21.5%), while
older practitioners (41–50 years) reported “always” providing counseling (50.0%),
with a significant association (p < 0.001). Additionally, practitioners over 50 were more likely to consider “oral
health status” (77.3%) and “medical history” (86.4%) compared to younger colleagues
(p = 0.006 and p = 0.002, respectively). In terms of training, only 7.7% of younger practitioners
reported extensive training, whereas 93.1% of those aged 31 to 40 had minimal training,
showing a highly significant association (p < 0.001). Confidence levels were higher among practitioners aged 31 to 40, with 36.2%
feeling “confident” (p = 0.006). Younger practitioners utilized professional journals less frequently (47.7%),
with significant associations found for journals (p = 0.001), educational courses (p < 0.001), and online databases (p = 0.013). Challenges included a higher incidence of resource issues for older practitioners
(27.3%) and notable insufficient training among those aged 41 to 50 (79.0%; p = 0.012 and p < 0.001). The need for more training was emphasized by 90.8% of younger and 70.7%
of middle-aged practitioners, with significant associations (p = 0.034 and p < 0.001). While most practitioners observed a significant impact of counseling on
oral health management, this was not statistically significant (p = 0.094). Significant improvements in “reduction in dental caries” and “improved
gum health” were more frequently reported by older practitioners (p < 0.001). Lastly, practitioners aged 31 to 40 were more likely to intend to “definitely
increase” their use of PNC in the future (41.4%; p < 0.001). These results indicate significant variations in practices, training, and
perceptions of nutritional counseling based on age among dental practitioners.
Table 2
Association of responses with age
Question
Response
Age (years)
x
2 -Value
p- Value
20–30
(n = 65)
31–40
(n = 58)
41–50
(n = 62)
Above 50
(n = 22)
Q1
Never
N
14
0
4
0
62.183
<0.001**
%
21.5%
0%
6.5%
0%
Sometimes
N
17
38
15
11
%
26.2%
65.5%
24.2%
50.0%
Often
N
18
16
12
8
%
27.7%
27.6%
19.4%
36.4%
Always
N
16
4
31
3
%
24.6%
6.9%
50.0%
13.6%
Q2
Oral health status
N
42
26
45
17
12.623
0.006*
%
64.6%
44.8%
72.6%
77.3%
Dietary habits
N
41
34
54
16
13.780
0.003*
%
63.1%
58.6%
87.1%
72.7%
Medical history
N
45
27
45
19
15.268
0.002*
%
69.2%
46.6%
72.6%
86.4%
Patient age
N
48
50
22
17
39.413
<0.001**
%
73.8%
86.2%
35.5%
77.3%
Q3
Yes, extensive training
N
5
0
0
0
33.218
<0.001**
%
7.7%
0%
0%
0%
Yes, some training
N
26
4
22
9
%
40.0%
6.9%
35.5%
40.9%
Yes, minimal training
N
34
54
40
13
%
52.3%
93.1%
64.5%
59.1%
No training
N
–
–
–
–
%
–
–
–
–
Q4
Very confident
N
4
0
0
1
23.262
0.006*
%
6.2%
0%
0%
4.5%
Confident
N
14
21
24
2
%
21.5%
36.2%
38.7%
9.1%
Neutral
N
29
28
25
8
%
44.6%
48.3%
40.3%
36.4%
Not confident
N
18
9
13
11
%
27.7%
15.5%
21.0%
50.0%
Q5
Prof. journals
N
31
48
41
14
16.588
0.001*
%
47.7%
82.8%
66.1%
63.6%
Education courses
N
49
23
62
15
54.715
<0.001**
%
75.4%
39.7%
100.0%
68.2%
Online databases
N
56
41
38
14
10.795
0.013*
%
86.2%
70.7%
61.3%
63.6%
Peer consultations
N
47
33
44
18
6.049
0.109; NS
%
72.3%
56.9%
71.0%
81.8%
Q6
Lack of time during patient appointments
N
40
42
36
18
5.800
0.122; NS
%
61.5%
72.4%
58.1%
81.8%
Insufficient training or knowledge
N
30
27
49
10
19.003
<0.001**
%
46.2%
46.6%
79.0%
45.5%
Lack of patient interest
N
43
34
38
14
0.789
0.852; NS
%
66.2%
58.6%
61.3%
63.6%
Lack of resources
N
44
33
34
6
11.034
0.012*
%
67.7%
56.9%
54.8%
27.3%
Q7
More training and education on the subject
N
59
41
50
16
8.655
0.034*
%
90.8%
70.7%
80.6%
72.7%
Access to better assessment tools
N
51
33
46
15
7.519
0.057; NS
%
78.5%
56.9%
74.2%
68.2%
Increased patient awareness and education
N
42
37
33
13
2.112
0.550; NS
%
64.6%
63.8%
53.2%
59.1%
Collaboration with nutritionists
N
25
43
50
7
35.790
<0.001**
%
38.5%
74.1%
80.6%
31.8%
Q8
No impact
N
4
0
0
0
14.886
0.094; NS
%
6.2%
0%
0%
0%
Minimal impact
N
2
5
2
0
%
3.1%
8.6%
3.2%
.0%
Moderate impact
N
31
21
28
9
%
47.7%
36.2%
45.2%
40.9%
Significant impact
N
28
32
32
13
%
43.1%
55.2%
51.6%
59.1%
Q9
Reduction in dental caries
N
29
50
57
6
58.823
<0.001**
%
44.6%
86.2%
91.9%
27.3%
Improved gum health
N
54
44
26
20
33.780
<0.001**
%
83.1%
75.9%
41.9%
90.9%
Better management of oral infections
N
44
21
30
14
13.707
0.003*
%
67.7%
36.2%
48.4%
63.6%
Enhanced overall oral hygiene
N
48
51
45
18
5.272
0.153; NS
%
73.8%
87.9%
72.6%
81.8%
Q10
Definitely increase
N
14
24
5
7
40.903
<0.001**
%
21.5%
41.4%
8.1%
31.8%
Likely increase
N
23
23
44
6
%
35.4%
39.7%
71.0%
27.3%
Maintain current level
N
23
11
9
9
%
35.4%
19.0%
14.5%
40.9%
Likely decrease
N
5
0
4
0
%
7.7%
0%
6.5%
0%
Note: This table presents the association of responses with age groups, analyzed using
the chi-square test. Significant associations (p < 0.05) were observed for several questions, including Q1, Q2, Q3, Q4, Q5, Q6, Q7,
Q9, and Q10, indicating age-related differences in responses. Highly significant associations
(p < 0.001) were found in Q1, Q2, Q3, Q5, Q9, and Q10, reflecting notable variations
across age groups. Nonsignificant (NS) results were noted for other questions, suggesting
no substantial differences in responses across age groups. Chi-square test: NS: p > 0.05; not significant.
*
p < 0.05; significant
**
p < 0.001; highly significant.
Regarding gender, significant differences were observed in how male and female practitioners
approached PNC, illustrated in [Fig. 1(A, B) ]. Females were more likely to consider dietary habits (p = 0.003) and medical history (p = 0.005). At the same time, males placed greater emphasis on patient age (p < 0.001) and reported higher confidence levels (p = 0.011) in providing counseling. This suggests that gender may influence practitioners'
perspectives and approaches in nutritional counseling.
Fig. 1 (A and B ) Association of responses with gender among dental practitioners regarding personalized
nutritional counseling. Significant associations were observed in multiple responses,
including Q2 (factors considered in counseling), Q4 (confidence in providing nutritional
counseling), Q5 (resources used to stay updated), Q6 (challenges in providing counseling),
and Q10 (future use of personalized nutritional counseling). Notable gender differences
were identified, with females more likely to consider dietary habits and medical history,
while males reported higher confidence and a greater tendency to use peer consultations.
Nonsignificant differences were observed in other areas.
[Table 3 ] summarizes the association between years of experience and various responses, highlighting
several key findings. In Question 1, the frequency of providing nutritional counseling
was significantly influenced by years of experience (p < 0.001), with more experienced professionals offering counseling more often. Question
2 showed that the consideration of factors such as oral health status and medical
history significantly correlated with years of experience (p < 0.001 for both), while dietary habits were also significant (p = 0.007); however, patient age did not show a significant association (p = 0.184). Regarding training received (Question 3), extensive training was uncommon
among less experienced practitioners (p = 0.024), with minimal training reported across all levels. Confidence in providing
counseling (Question 4) varied significantly with experience (p = 0.001), as more experienced professionals generally felt more confident. Question
5 revealed that resources like professional journals and online databases were significantly
associated with years of experience (p = 0.001 and p < 0.001, respectively), while peer consultations were also significant (p = 0.003); educational courses did not show a significant association (p = 0.099). In Question 6, challenges such as insufficient training and lack of resources
were significantly related to years of experience (p < 0.001 and p = 0.006, respectively). In contrast, lack of time and patient interest were not significant
(p = 0.062 and p = 0.214). For improvements needed for integration (Question 7), the demand for more
training and patient awareness was significant (p = 0.012 and p = 0.005), along with access to better assessment tools and collaboration with nutritionists
(p = 0.070 and p = 0.028, respectively). The perceived impact of nutritional counseling on oral health
(Question 8) did not significantly relate to years of experience (p = 0.455). However, improvements in dental caries and gum health (Question 9) were
significantly associated with experience (p < 0.001 for both). At the same time, better management of oral infections and enhanced
hygiene did not reach significance (p = 0.094 and p = 0.269). Finally, the future use of PNC (Question 10) was significantly associated
with years of experience (p < 0.001), with professionals having 5 to 10 years of experience more likely to indicate
plans for increased use.
Table 3
Association of responses with years of experience
Question
Response
Years of experience
x
2 -Value
p- Value
<5
(n = 55)
5–10
(n = 65)
11–20
(n = 45)
>20
(n = 42)
Q1
Never
N
14
0
0
4
54.207
<0.001**
%
25.5%
0%
0%
9.5%
Sometimes
N
21
30
19
11
%
38.2%
46.2%
42.2%
26.2%
Often
N
12
7
17
18
%
21.8%
10.8%
37.8%
42.9%
Always
N
8
28
9
9
%
14.5%
43.1%
20.0%
21.4%
Q2
Oral health status
N
33
29
34
34
18.444
<0.001**
%
60.0%
44.6%
75.6%
81.0%
Dietary habits
N
40
40
40
25
12.263
0.007*
%
72.7%
61.5%
88.9%
59.5%
Medical history
N
40
35
22
39
24.647
<0.001**
%
72.7%
53.8%
48.9%
92.9%
Patient age
N
32
44
28
33
4.835
0.184; NS
%
58.2%
67.7%
62.2%
78.6%
Q3
Yes, extensive training
N
5
0
0
0
14.523
0.024*
%
9.1%
0%
0%
0%
Yes, some training
N
14
19
15
13
%
25.5%
29.2%
33.3%
31.0%
Yes, minimal training
N
36
46
30
29
%
65.5%
70.8%
66.7%
69.0%
No training
N
–
–
–
–
%
–
–
–
–
Q4
Very confident
N
0
0
0
5
28.647
0.001*
%
0%
0%
0%
11.9%
Confident
N
14
19
15
13
%
25.5%
29.2%
33.3%
31.0%
Neutral
N
30
26
15
19
%
54.5%
40.0%
33.3%
45.2%
Not confident
N
11
20
15
5
%
20.0%
30.8%
33.3%
11.9%
Q5
Prof. journals
N
24
46
31
33
15.624
0.001*
%
43.6%
70.8%
68.9%
78.6%
Education courses
N
45
40
33
31
6.264
0.099; NS
%
81.8%
61.5%
73.3%
73.8%
Online databases
N
50
43
36
20
24.659
<0.001**
%
90.9%
66.2%
80.0%
47.6%
Peer consultations
N
29
46
30
37
14.063
0.003*
%
52.7%
70.8%
66.7%
88.1%
Q6
Lack of time during patient appointments
N
36
49
30
21
7.319
0.062; NS
%
65.5%
75.4%
66.7%
50.0%
Insufficient training or knowledge
N
22
50
23
21
18.316
<0.001**
%
40.0%
76.9%
51.1%
50.0%
Lack of patient interest
N
31
39
34
25
4.477
0.214; NS
%
56.4%
60.0%
75.6%
59.5%
Lack of resources
N
37
26
25
29
12.505
0.006*
%
67.3%
40.0%
55.6%
69.0%
Q7
More training and education on the subject
N
52
50
35
29
11.020
0.012*
%
94.5%
76.9%
77.8%
69.0%
Access to better assessment tools
N
44
43
34
24
7.051
0.070; NS
%
80.0%
66.2%
75.6%
57.1%
Increased patient awareness and education
N
42
32
22
29
13.055
0.005*
%
76.4%
49.2%
48.9%
69.0%
Collaboration with nutritionists
N
27
45
32
21
9.117
0.028*
%
49.1%
69.2%
71.1%
50.0%
Q8
No impact
N
1
1
0
2
8.811
0.455; NS
%
1.8%
1.5%
0%
4.8%
Minimal impact
N
4
2
3
0
%
7.3%
3.1%
6.7%
0%
Moderate impact
N
25
24
22
18
%
45.5%
36.9%
48.9%
42.9%
Significant impact
N
25
38
20
22
%
45.5%
58.5%
44.4%
52.4%
Q9
Reduction in dental caries
N
41
30
41
30
26.848
<0.001**
%
74.5%
46.2%
91.1%
71.4%
Improved gum health
N
35
60
24
25
24.392
<0.001**
%
63.6%
92.3%
53.3%
59.5%
Better management of oral infections
N
26
40
18
25
6.382
0.094; NS
%
47.3%
61.5%
40.0%
59.5%
Enhanced overall oral hygiene
N
44
55
34
29
3.930
0.269; NS
%
80.0%
84.6%
75.6%
69.0%
Q10
Definitely increase
N
10
25
10
5
47.330
<0.001**
%
18.2%
38.5%
22.2%
11.9%
Likely increase
N
23
26
31
16
%
41.8%
40.0%
68.9%
38.1%
Maintain current level
N
15
14
2
21
%
27.3%
21.5%
4.4%
50.0%
Likely decrease
N
7
0
2
0
%
12.7%
0%
4.4%
0%
Note: This table presents the association of responses with years of experience. Significant
associations include the frequency of providing nutritional counseling and considerations
of dietary habits (p = 0.010*), medical history (p = 0.020*), and patient age (p = 0.007*). Confidence in providing personalized nutritional counseling significantly
varied with years of experience (p = 0.004*). Challenges such as lack of time during patient appointments (p = 0.032*) and insufficient training (p = 0.028*) were also significant. The perceived impact of personalized nutritional
counseling on oral health management showed significant variation (p = 0.025*). Nonsignificant results are noted where p >0.05. Chi-square test: NS: p > 0.05; not significant.
*
p < 0.05; significant.
**
p < 0.001; highly significant.
[Fig. 2 (A, B) ] shows the association of responses with specialization. All comparisons between
general dentists and specialists yielded nonsignificant results (p > 0.05). This includes the frequency of nutritional counseling (p = 0.234) and factors considered in counseling, such as oral health status, dietary
habits, medical history, and patient age (p = 0.880, 0.129, 0.529, and 0.897, respectively). Training received, confidence levels,
and resources used also showed no significant differences (p = 0.095, 0.643, 0.507, 0.315, 0.489, and 0.703). Similarly, challenges faced and
improvements needed did not significantly differ between the groups (p = 0.969, 0.902, 0.753, 0.597, 0.178, 0.989, 0.501, and 0.125). The perceived impact
of PNC and future use also showed nonsignificant results (p = 0.824, 0.937, 0.301, 0.130, and 0.883).
Fig. 2 (A and B ) The association between responses and specialization among dental practitioners
regarding personalized nutritional counseling. Key findings include that general dentists
and specialists exhibit similar responses across various questions, with no significant
differences observed (p > 0.05) in their training, confidence, or perceived barriers. Notably, both groups
recognize the importance of increased training and education. Responses indicate that
while a majority believe in the moderate to significant impact of personalized nutritional
counseling on oral health management, no significant variations were found based on
specialization.
The association of responses with workplace settings shows significant differences
across several areas, as shown in [Table 4 ]. Private clinic professionals were more likely to always provide nutritional counseling
(36.4%) compared to those in government (3.8%) and teaching institutes (30.3%; p < 0.001). Oral health status was significantly considered more by government professionals
(86.8%) than private (59.1%) or teaching (48.5%; p < 0.001). Extensive training was notably low across all settings, with only 7.5%
of government reporting it (p < 0.001), while minimal training was most common (p < 0.001). Confidence levels also varied, with private professionals being the most
confident (43.2%) and government professionals being the least confident (0%) (p < 0.001). Significant differences were also seen in the use of professional journals
(p < 0.001), educational courses (p = 0.002), challenges such as lack of time (p < 0.001), and the need for more training (p = 0.047). However, there were no significant differences in perceived impacts on
patient outcomes or the likelihood of maintaining the current service level.
Table 4
Association of responses with workplace
Question
Response
Workplace
x
2 -Value
p- Value
Private clinic/hospitals (n = 88)
Government hospital (n = 53)
Teaching institute (n = 66)
Q1
Never
N
3
7
8
32.068
<0.001**
%
3.4%
13.2%
12.1%
Sometimes
N
24
27
30
%
27.3%
50.9%
45.5%
Often
N
29
17
8
%
33.0%
32.1%
12.1%
Always
N
32
2
20
%
36.4%
3.8%
30.3%
Q2
Oral health status
N
52
46
32
19.367
<0.001**
%
59.1%
86.8%
48.5%
Dietary habits
N
60
37
48
0.373
0.830; NS
%
68.2%
69.8%
72.7%
Medical history
N
60
35
41
0.618
0.734; NS
%
68.2%
66.0%
62.1%
Patient age
N
59
29
49
5.058
0.080; NS
%
67.0%
54.7%
74.2%
Q3
Yes, extensive training
N
1
4
0
20.662
<0.001**
%
1.1%
7.5%
0%
Yes, some training
N
36
15
10
%
40.9%
28.3%
15.2%
Yes, minimal training
N
51
34
56
%
58.0%
64.2%
84.8%
No training
N
–
–
–
%
–
–
–
Q4
Very confident
N
5
0
0
25.720
<0.001**
%
5.7%
0%
0%
Confident
N
38
7
16
%
43.2%
13.2%
24.2%
Neutral
N
26
31
33
%
29.5%
58.5%
50.0%
Not confident
N
19
15
17
%
21.6%
28.3%
25.8%
Q5
Prof. journals
N
55
21
58
30.319
<0.001**
%
62.5%
39.6%
87.9%
Education courses
N
71
41
37
12.357
0.002*
%
80.7%
77.4%
56.1%
Online databases
N
66
39
44
1.389
0.499; NS
%
75.0%
73.6%
66.7%
Peer consultations
N
56
40
46
2.205
0.332; NS
%
63.6%
75.5%
69.7%
Q6
Lack of time during patient appointments
N
42
39
55
23.183
<0.001**
%
47.7%
73.6%
83.3%
Insufficient training or knowledge
N
49
18
49
19.368
<0.001**
%
55.7%
34.0%
74.2%
Lack of patient interest
N
62
28
39
4.805
0.090; NS
%
70.5%
52.8%
59.1%
Lack of resources
N
50
30
37
0.009
0.996; NS
%
56.8%
56.6%
56.1%
Q7
More training and education on the subject
N
69
38
59
6.102
0.047*
%
78.4%
71.7%
89.4%
Access to better assessment tools
N
62
43
40
5.915
0.052; NS
%
70.5%
81.1%
60.6%
Increased patient awareness and education
N
54
34
37
0.865
0.649; NS
%
61.4%
64.2%
56.1%
Collaboration with nutritionists
N
57
32
36
1.649
0.438; NS
%
64.8%
60.4%
54.5%
Q8
No impact
N
2
1
1
1.323
0.970; NS
%
2.3%
1.9%
1.5%
Minimal impact
N
5
1
3
%
5.7%
1.9%
4.5%
Moderate impact
N
37
24
28
%
42.0%
45.3%
42.4%
Significant impact
N
44
27
34
%
50.0%
50.9%
51.5%
Q9
Reduction in dental caries
N
61
41
40
3.866
0.145; NS
%
69.3%
77.4%
60.6%
Improved gum health
N
58
37
49
1.239
0.538; NS
%
65.9%
69.8%
74.2%
Better management of oral infections
N
44
26
39
1.621
0.445; NS
%
50.0%
49.1%
59.1%
Enhanced overall oral hygiene
N
67
44
51
0.977
0.614; NS
%
76.1%
83.0%
77.3%
Q10
Definitely increase
N
24
13
13
9.280
0.158; NS
%
27.3%
24.5%
19.7%
Likely increase
N
44
26
26
%
50.0%
49.1%
39.4%
Maintain current level
N
15
12
25
%
17.0%
22.6%
37.9%
Likely decrease
N
5
2
2
%
5.7%
3.8%
3.0%
Note: This table presents the association between workplace settings (private clinics/hospitals,
government hospitals, and teaching institutes) and responses to various questions.
Significant differences were observed in the frequency of providing nutritional counseling,
the consideration of oral health status, levels of training, and confidence in offering
counseling, with p -values <0.001. Factors such as lack of time during appointments and the need for
further training also showed significant workplace variations. Nonsignificant differences
were noted in dietary habits, patient age, and perceived patient outcomes (p > 0.05). Chi-square test: NS: p > 0.05; not significant.
*
p < 0.05; significant.
**
p < 0.001; highly significant.
Discussion
This study investigates the impact of PNC on enhancing oral health management among
dental practitioners in Saudi Arabia. Our findings reveal significant correlations
between age, years of experience, and the frequency of nutritional counseling. The
participant pool comprised diverse age groups and specializations. While demographic
diversity was evident, the study found no significant associations between knowledge
scores and demographic variables, including age and years of experience (p > 0.05). This underscores the pressing need for ongoing educational initiatives that
cater to all demographics, ensuring that early-career and seasoned practitioners are
equipped with current knowledge and practices in PNC.
Nutrition is essential for oral and dental health. Globally, oral health issues, such
as dental caries and periodontal disease, affect approximately 3.5 billion individuals,
with dental caries being the most prevalent concern and a leading cause of day surgery
in children.[25 ]
[26 ]
[27 ] In Saudi Arabia, dental caries prevalence among children is alarming, reaching 96%
at age 6 and 93.7% at age 12.[28 ]
[29 ]
[30 ]
Shubayr et al examined the perceptions of oral health providers in Jazan, Saudi Arabia,
regarding oral health promotion (OHP). Through qualitative interviews, the study highlighted
providers' recognition of OHP's importance while identifying key obstacles such as
inadequate training, funding constraints, time limitations, and a lack of patient
interest. It further suggested opportunities for improvement, including recruiting
additional professionals, expanding training initiatives, and enhancing support systems.[31 ] This qualitative focus contrasts with the present cross-sectional survey, which
emphasizes PNC for oral health management.
The present study of 207 Saudi dental practitioners on PNC reveals significant gaps
in nutritional advice in routine oral care. A previous study on oral health care demand
in Riyadh primary health care (PHC) centers found similar issues.[32 ] Both studies highlight barriers within the health care system, though with different
focuses. Al-Jaber and Da'ar reported that 53% of patients visited a dentist only once
in the past year due to high costs and limited availability. In contrast, our study
found that a lack of resources and training in PNC hindered comprehensive care. Despite
64.4% of dental schools incorporating digital dental technologies (DDTs), inadequate
training remains a significant obstacle. While Al-Jaber and Da'ar noted that lower
patient satisfaction led to more dental visits, our study emphasizes the need for
personalized nutritional guidance to enhance preventive measures. Both studies advocate
for health policy reforms, such as increasing dentist availability in PHCs or integrating
nutritional counseling into dental training. These findings underscore the pressing
necessity for extensive oral health education and reforms in service delivery within
Saudi Arabia.
Previous and current research highlights significant obstacles in providing dental
care for individuals with special health care needs in Qatif, Saudi Arabia.[33 ] Our study identified key barriers to implementing PNC, including time constraints
during patient appointments (65.7%), inadequate training or knowledge (56%), and insufficient
patient interest (62.3%). Similarly, Alfaraj et al noted time constraints for caregivers
(60.8%) and transportation challenges (51.9%) as major obstacles to accessing dental
care.
Both studies emphasize the need for improved training; only 2.4% of our participants
reported extensive training in PNC, while 68.1% had minimal training. Alfaraj et al
found a significant skill deficiency among dental providers, particularly concerning
individuals with special needs. While Alfaraj et al focused on geographic barriers,
our research highlighted the need for better resource access and collaboration with
nutritionists. Both studies showed that 50.7% of respondents believe PNC positively
impacts oral health management, particularly in enhancing gum health (69.6%) and overall
hygiene (78.3%). These findings underscore the urgent need to address these barriers
to improve oral health outcomes for individuals with special needs and better integrate
nutrition into dental practice.
Our study suggests that age significantly influences dental practitioners' willingness
and ability to provide nutritional counseling, with older practitioners more likely
to offer it “often” or “always.” This trend may reflect the practical skills and confidence
gained through years of experience. Participants with over 20 years of experience
achieved a higher mean score of 12.69, indicating a better understanding of nutrition's
role in oral health management (ANOVA [analysis of variance]: F = 5.016; p = 0.002). Conversely, younger practitioners, particularly those under 40, reported
inconsistent or infrequent counseling, likely due to limited exposure to nutrition
in their education.
The findings reveal significant variations in nutritional counseling practices based
on workplace settings. Dental practitioners in private clinics demonstrated a higher
frequency of counseling than those in government hospitals and teaching institutes
(p < 0.001). Additionally, there was a notable disparity in training levels, with fewer
professionals in teaching institutes reporting extensive training (p < 0.001), highlighting potential gaps in educational curricula.
Barriers such as lack of time during appointments were significantly more pronounced
in government hospitals (p < 0.001), indicating that the structure of these settings may hinder effective counseling.
While most participants perceived a significant impact from nutritional counseling,
the lack of significant differences in perceived patient outcomes across workplaces
suggests that all settings could benefit from improved training and resources.
This corresponds with findings from other studies indicating that although the increasing
number of dental facilities has enhanced service access in Saudi Arabia, challenges
concerning accessibility remain. Many citizens favor private dental services over
government-provided care, perceiving them as superior.[34 ] This preference may result in inequities in access to dental services, especially
for individuals unable to afford private health care. Addressing these workplace disparities
through targeted training initiatives could enhance the consistency and effectiveness
of nutritional counseling practices across the dental profession.[35 ]
The minimal training reported by younger dentists suggests a need for enhanced educational
programs that focus on nutrition. Although 64.4% of dental schools have integrated
DDT into their curricula, barriers such as cost and staff resistance persist.[36 ] This study emphasizes the potential of PNC and digital tools to improve service
delivery, aligning with the broader health care digitization goals of Saudi Vision
2030.[37 ]
[38 ] Thus, tailored educational programs integrating technology and nutrition training
are essential for improving oral health outcomes.[39 ]
Conclusion
This study underscores the need to integrate comprehensive nutrition training into
dental curricula to address gaps in knowledge and confidence, particularly among younger
professionals. Collaborative approaches, such as multidisciplinary interactions between
dentists and nutritionists, can significantly enhance patient outcomes, aligning with
global trends in holistic health care.
The study's limitations should be considered. Its cross-sectional design cannot establish
causality, and self-reported data may introduce response bias due to social desirability
or recall issues. The small sample size, particularly among older age groups, limits
generalizability. Additionally, the single-country focus restricts applicability to
other health care systems or cultural contexts.
Future research should incorporate longitudinal designs to track changes in practices,
observational methods, or patient feedback to validate self-reports, and experimental
studies to identify effective educational interventions. Expanding the scope to diverse
regions and exploring the impact of dentist–nutritionist collaboration on patient
outcomes, including caries and periodontal health, would provide valuable insights
into advancing nutrition-integrated dental care.
