Investigating the Role of Personalized Nutritional Counseling in Enhancing Oral Health Management: A Cross-Sectional Survey among Saudi Arabian Dental Practitioners

Abstract

Objectives This study evaluated Saudi Arabian dental practitioners' knowledge, practices, and perceptions regarding personalized nutritional counseling (PNC) and its integration into oral health management.

Materials and Methods A total of 207 dental practitioners in Saudi Arabia were the subjects of a cross-sectional survey.

The survey consisted of four sections: (1) knowledge and practices of PNC, (2) training and resources, (3) challenges and barriers, and (4) perceptions of the impact of PNC on oral health management. The data were stratified by age, gender, years of experience, specialization, and workplace setting.

Statistical Analysis 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 Out of 207 practitioners, most (80%) of respondents acknowledged the importance of nutrition in oral health, yet only 20% regularly provided nutritional counseling. Gender showed a significant association, with females more likely to consider dietary habits (72%, p = 0.003) and medical history (85%, p = 0.005) during counseling. Notably, confidence levels in nutritional counseling increased with experience, with those with more than 10 years of experience being significantly more confident (p < 0.001). Private clinic professionals were also more likely to offer personalized nutritional guidance (36.4%) compared to those in government (3.8%) and teaching institutions (30.3%; (p < 0.001). Common barriers identified included insufficient training (65%, p = 0.024) and time constraints (45%, p = 0.062). Moreover, the perceived impact of nutritional counseling on oral health management was significant, with 70% of participants agreeing that it enhances overall patient outcomes.

Conclusion The findings suggest that while dental practitioners recognize the value of PNC, significant barriers impede its consistent application. Addressing these barriers through enhanced training and resources is essential for integrating nutritional counseling into routine oral health care practices, ultimately benefiting patient outcomes. There is a strong call for improved training and resources to equip dental practitioners to provide personalized nutritional advice.

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

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

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

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.

Conflict of Interest

None declared.

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Artikel online veröffentlicht:
03. Februar 2025