Knowledge, Attitude, and Practice of Dental Practitioners about Probiotics in Jazan: A Mixed-Methods Study

Abstract

Objectives Probiotics help maintain oral health and contribute to developing healthy microbial equilibrium by positively interacting with oral microbiomes. Recently, evidence has supported using probiotics in reducing the risk of dental caries, periodontitis, and halitosis. This study aimed to evaluate the level of knowledge, attitude, and practice regarding probiotics among dental practitioners in the Jazan region of Saudi Arabia.

Materials and Methods A mixed-methods study design was employed, and the data were collected through a concurrent triangulation design. For quantitative analysis, there were a total of 202 dental practitioners, while 8 participants were included for qualitative analysis. Thematic analysis was done with the help of tech software, and themes were developed. The Mann–Whitney test was performed to analyze quantitative data to check knowledge and attitude. A chi-square test was employed to check the difference between knowledge and years of practice. p-Value <0.05 was set to be statistically significant.

Results In the quantitative analysis, it was reported that both male and female participants had adequate knowledge of probiotics. However, statistical significance was recorded in the knowledge among the groups practicing for more than 5 years (p = 0.025) and 1 year of practice. A statistically significant difference was reported in prescribing probiotics where male practitioners were willing to recommend the probiotics (p = 0.003). The themes developed during qualitative analysis were “knowledge regarding probiotics,” “need for more knowledge,” and “attitude towards prescribing.”

Conclusion This study suggested adequate knowledge among dental practitioners for using probiotics in the Jazan region. Lack of evidence regarding the importance of probiotics in maintaining oral health should be addressed.

Keywords

knowledge - attitude - mixed-methods study - probiotics - concurrent triangulation design - dental practitioners

Introduction

The human body is considered to be a habitat for a wide range of bacteria and microorganisms. Studies have reported that around 1.5 million bacterial cells are present per human body cells.[1] [2] [3] These bacteria provide various health benefits to humans, such as maintaining lipid metabolism, regulating immune response, protecting against harmful pathogens, and energy supply.[4] [5] [6] This bacterial composition is host-specific and changes throughout a person's life. The factors that affect the composition and balance of microflora are age, dietary habits, and an individual's systemic diseases.[7] [8]

An imbalance in the oral microflora causes oral diseases such as dental caries, periodontitis, and halitosis.[7] [8] Therefore, the treatment for replacing pathogenic microflora with commensal is recommended. This treatment consists of dietary supplementation like probiotics and oral biotics. The World Health Organization defines probiotics as “live microorganisms that, when administered in adequate quantities, provide health benefits to the hosts.”[8] [9] [10] Miller et al first identified this microflora in 1907, after which various studies have demonstrated the effect of probiotics on humans.[11] [12] [13] Multiple studies have evaluated probiotics' effect on oral health and the amount of probiotics helpful in maintaining the oral environment. Studies have demonstrated how probiotics affect oral health, such as changes in salivary immunoglobulin A, decrease in plaque deposition, release of antimicrobial substances, and changes in salivary secretion.[11] [12] [13]

Even though the positive effect of probiotics has been established in the literature, the data are limited in dentistry. One of the major problems is the lack of knowledge and attitude toward using probiotics among consumers and health care professionals (HCPs).[11] [12] [13] [14] [15] [16] Despite studies on the positive effect of probiotics, HPCs hesitate to recommend it to their patients due to conflicting reports.[17] Additionally, HPCs have difficulty processing large volumes of information regarding probiotics' beneficial and harmful effects. Moreover, the effectiveness of probiotics depends on various factors, such as bacterial strain, dosage, and duration of the supplementation regimen. This parameter heterogeneity misleads the information regarding probiotics, making HPCs skeptical about prescribing these live microbes.[17] [18] [19] Previous research has indicated that HCPs, including dentists, have adequate knowledge of probiotics. The lack of knowledge regarding probiotics and their treatment efficacy suggests dentists need to be educated on this topic.

Moreover, as future dental workers, dental students and interns must know more about probiotics to provide proper recommendations to the patient. This knowledge will help to build a bridge for conducting future studies supporting the utilization of probiotics in controlling oral flora. Few studies published in Saudi Arabia check the knowledge and attitudes of dental students, medical students, interns, and other HCPs.[1] [2] [3] [13] [15] [20] All the studies reported the requirement of curriculum-based education to support the utilization of probiotics. Moreover, all the studies utilized predesigned questionnaires to evaluate the knowledge of HCPs.[1] [2] [3] [13] [15] [20] To date, no survey of probiotics has used a mixed-methods analysis to evaluate the in-depth knowledge of dental practitioners. Hence, the current study aimed to evaluate the knowledge, attitude, and practice regarding probiotics among dental practitioners in the Jazan region of Saudi Arabia.

Materials and Methods

Study Design

A mixed-methods study or a combination of qualitative and quantitative studies was conducted among the dental practitioners of the Jazan region of Saudi Arabia from November 2023 to February 2024. A convenience sampling technique was utilized to collect data. The cross-sectional design for collecting quantitative data was employed to evaluate the knowledge, attitude, and practice of using probiotics for oral health care among dental practitioners and to analyze the relation among these factors. The study used a concurrent triangulation design ([Fig. 1]), collecting qualitative and quantitative data concurrently. Subsequently, a qualitative case study was conducted to support the result of qualitative research and explore the factors contributing to using probiotics in regular dental practice. Each participant read about the purpose of the study and gave informed consent to participate. The participants had the right to withdraw from the study at any stage. Dental practitioners from Jazan who had practicing experience of a minimum of 1 year were eligible to participate in the study. The study did not include dental practitioners who did not provide consent.

Fig. 1 Concurrent triangular design of mixed methods study.

Sample Calculation

Like in previous studies, the sample size was calculated using an online sample size calculator (http://www.raosoft.com/samplesize.html).[2] [20] The sample size for the given study was calculated by assuming the total dental practitioners in the Jazan region (n = 1,000) at a marginal error of 5% and a confidence interval of 95%, following which the required sample size was around 150. To account for the nonresponse rate and reduced data collection error, the projected sample population for quantitative analysis was 202.

A customized questionnaire consisting of 15 close-ended questions was used for this study ([Supplementary Material S1] [online only]). The questionnaire was designed in English and was sent to the oral medicine experts for validation. A pilot study was performed with 20 oral medicine experts to check the questionnaire's reliability and validity. The comments from the experts were considered, and the questionnaire was modified accordingly.

Qualitative data were collected by the researcher through focus group interviews, observation of participants, and document analysis, by means of methodological triangulation.[21] Participants for focus group interviews were the partitioners interested in sharing insight into the importance of probiotics in regular dental practice. A systematic review conducted by Hennink and Kaiser suggested that a minimum of 5 to 10 participants are enough to reach the data saturation.[22] Hence, 8 participants, 2 general dentists, 2 oral medicine specialists, 2 periodontists, and 2 oral surgeons, participated in focus group interviewing and discussing the topic until the data saturation was achieved. The focus group interview was conducted in English as the mode of higher education in Saudi Arabia is English. However, in case of doubt, the questions were explained in Arabic. Following the guidelines for focus group interviewing, the questions were open-ended about the knowledge, frequency, and patient response to probiotics utilization in dental practice ([Supplementary Table S1] [online only]). On completion, the researchers transcribed the interview tapes. The main instructor checked all the transcripts to ensure the primary researchers did not modify the focus group interviews.

Data Analysis

The tech approach of open coding was utilized to analyze qualitative data. Themes and categories were sorted manually, and theme descriptions were developed regarding dental practitioners' views on probiotics in oral care. The research team discussed all the coding and themes developed through the analysis.

The statistical package of social science version 22 was employed for quantitative data. Descriptive statistics were presented to check the mean and standard deviation. The Kolmogorov–Smirnov test determined the normality of data, which was determined to be nonnormally distributed. Hence, the Mann–Whitney test was performed to check demographic data and attitude. At the same time, a chi-square test was employed to check the difference between knowledge and years of practice with demographic variables. p-Value <0.05 was set to be statistically significant for all the tests.

Results

Quantitative Analysis Results

A total of 202 dental practitioners (male = 76 and female = 126) from the Jazan region took part in this study. [Table 1] and [Fig. 1] indicate that HCPs with 0 to 5 years (mean = 24.42) and above 10 years (mean = 24.95) of practice demonstrate significantly higher knowledge levels regarding probiotics for oral health benefits (p = 0.025) compared with those with 5 to 10 years of practice, while no significant differences were observed in attitude across different years of practice.

Table 1 Comparison of mean knowledge and attitude scores among study subjects based on their experience

Characteristic	Years of practice	N	Mean	Std. deviation	95% confidence interval for mean		Minimum	Maximum	p-Value
					Lower bound	Upper bound
Knowledge	0–5 years	114	24.42	4.009	23.68	25.16	9	35	0.025
	5–10 years	49	22.57	5.017	21.13	24.01	10	35
	Above 10 years	39	24.95	5.286	23.24	26.66	7	35
	Total	202	24.07	4.593	23.44	24.71	7	35
Attitude	0–5 years	114	17.58	2.890	17.04	18.12	9	25	0.675
	5–10 years	49	17.22	3.933	16.09	18.35	7	25
	Above 10 years	39	17.87	4.200	16.51	19.23	5	25
	Total	202	17.55	3.431	17.07	18.03	5	25

The chi-square test result in [Table 2] indicates significant mean differences in knowledge scores between HCPs with 0 to 5 years (p-value = 0.047) and 5 to 10 years of practice (p-value = 0.041), indicating higher knowledge levels in the former group. Additionally, the knowledge regarding probiotics differs among the years of practice groups. The result, however, revealed that the number of dentists practicing for more than 5 years (mean: 2.377) was higher than those of the other two groups.

Table 2 Pair-wise comparison of mean knowledge scores among study subjects based on their experience

Characteristic	(I) Years of practice	(J) Years of practice	Mean difference (I – J)	Std. error	p-Value	95% confidence interval
						Lower bound	Upper bound
Knowledge	0–5 years	5–10 years	1.850[a]	0.774	0.047	0.02	3.68
		Above 10 years	−0.528	0.841	0.805	−2.51	1.46
	5–10 years	0–5 years	−1.850[a]	0.774	0.047	−3.68	−0.02
		Above 10 years	−2.377[a]	0.972	0.041	−4.67	−0.08
	Above 10 years	0–5 years	0.528	0.841	0.805	−1.46	2.51
		5–10 years	2.377[a]	0.972	0.041	0.08	4.67
		Above 10 years	−0.647	0.738	0.656	−2.39	1.10

^a The mean difference is significant at the 0.05 level.

[Table 3] indicates the difference between the genders regarding knowledge about probiotic utilization. Males scored higher on knowledge than females. The chi-square test ([Table 3]) demonstrates the gender-based knowledge regarding the role of probiotics in maintaining oral microbiota, indicating a statistically significant result (p-value = 0.003). This result shows that male participants strongly agreed that probiotics maintain the oral microbiota.

Table 3 Gender-based perceptions of probiotics' role in maintaining oral microbiota balance

Gender		Probiotics can help maintain a balanced oral microbiota					Total	p-Value
		Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Male	Count	7	10	20	26	13	76	0.003
	% within gender	9.2%	13.2%	26.3%	34.2%	17.1%	100.0%
Female	Count	3	8	47	60	8	126
	% within gender	2.4%	6.3%	37.3%	47.6%	6.3%	100.0%
Total	Count	10	18	67	86	21	202
	% within gender	5.0%	8.9%	33.2%	42.6%	10.4%	100.0%

The practice of prescribing probiotics among the male participants was higher compared with females (p-value = 0.025; [Table 4]). There is a significant difference in willingness to recommend probiotic products for oral health benefits between males and females (p = 0.025), with a higher proportion of males expressing willingness than females.

Table 4 Gender-based willingness to recommend probiotic products for oral health benefits

Gender		9. I am willing to recommend probiotic products to patients for oral health benefits.					Total	p-Value
		Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Male	Count	4	12	21	29	10	76	0.025
	% within gender	5.3%	15.8%	27.6%	38.2%	13.2%	100.0%
Female	Count	7	9	38	67	5	126
	% within gender	5.6%	7.1%	30.2%	53.2%	4.0%	100.0%
Total	Count	11	21	59	96	15	202
	% within gender	5.4%	10.4%	29.2%	47.5%	7.4%	100.0%

[Table 5] demonstrates the result of the practice of recommendation of probiotics among the groups. The result signifies a statistical difference amongst the groups (p-value = 0.001), indicating that practitioners with more experience prescribe probiotics frequently compared with the other groups.

Table 5 Recommendation of probiotics for oral health benefits across different years of practice

No. of years of practice		13. Have you ever recommended probiotics to any of your patients for oral health benefits?		Total	p-Value
		No	Yes
0–5 years	Count	78	36	114	0.001
	% within group	68.4%	31.6%	100.0%
5–10 years	Count	25	24	49
	% within group	51.0%	49.0%	100.0%
Above 10 years	Count	14	25	39
	% within group	35.9%	64.1%	100.0%
Total	Count	117	85	202
	% within group	57.9%	42.1%	100.0%

The frequency of discussing probiotics as an option with patients is significantly influenced by the practitioner's attitude (p = 0.020) regarding probiotics. Specifically, those discussing probiotics frequently tend to have more positive attitudes than those rarely or occasionally. However, the frequency of discussing probiotics as an option with patients significantly is not influenced by the practitioner's attitude (p = 0.090) regarding probiotics ([Table 6]).

Table 6 Mean knowledge and attitude scores of health care professionals based on their frequency of discussing probiotics with patients

Characteristic	How frequently do you discuss probiotics as an option with your patient?	N	Mean	Std. deviation	Std. error	95% confidence interval for mean		p-Value
						Lower bound	Upper bound
Knowledge	Rarely	101	23.27	4.523	0.450	22.37	24.16	0.090
	Occasionally	53	24.75	4.895	0.672	23.41	26.10
	Often	37	25.16	4.066	0.668	23.81	26.52
	Always	11	24.55	4.655	1.404	21.42	27.67
	Total	202	24.07	4.593	0.323	23.44	24.71
Attitude	Rarely	101	16.83	3.539	0.352	16.13	17.53	0.020
	Occasionally	53	18.02	3.505	0.482	17.05	18.99
	Often	37	18.68	2.484	0.408	17.85	19.50
	Always	11	18.09	3.727	1.124	15.59	20.59
	Total	202	17.55	3.431	0.241	17.07	18.03

There is a significant difference in attitude scores between the dental practitioners who discuss probiotics rarely and those who discuss probiotics often with the patients. Those discussing probiotics usually tend to have lower attitude scores than those who seldom do (p = 0.025) ([Table 7]).

Table 7 Pair-wise comparison of mean attitude scores of health care professionals based on their frequency of discussing probiotics with patients

Dependent variable	(I) 15. How frequently do you discuss probiotics as an option with your patients?	(GD) 15. How frequently do you discuss probiotics as an option with your patients?	Mean difference (I – J)	Std. error	p-Value	95% confidence interval
						Lower bound	Upper bound
Attitude	Rarely	Occasionally	−1.187	0.572	0.165	−2.67	0.29
		Often	−1.844[a]	0.648	0.025	−3.52	−0.16
		Always	−1.259	1.071	0.643	−4.03	1.52
	Occasionally	Rarely	1.187	0.572	0.165	−0.29	2.67
		Often	−0.657	0.723	0.800	−2.53	1.22
		Always	−0.072	1.117	1.000	−2.97	2.82
	Often	Rarely	1.844[a]	0.648	0.025	0.16	3.52
		Occasionally	0.657	0.723	0.800	−1.22	2.53
		Always	0.585	1.158	0.958	−2.42	3.59
	Always	Rarely	1.259	1.071	0.643	−1.52	4.03
		Occasionally	0.072	1.117	1.000	−2.82	2.97
		Often	−0.585	1.158	0.958	−3.59	2.42

^a The mean difference is significant at the 0.05 level.

Qualitative Analysis Results

In agreement with the quantitative analysis result, which demonstrates a good understanding of probiotics amongst the practitioners, the study participants indicated that they know the role of probiotics and their acceptance within dental practice. The focus group interview was between 30 and 45 minutes.

Probiotic Knowledge among the Dental Clinicians

All the focus group interview participants agreed that they knew about the probiotics. Most say that probiotics maintain gut health by reducing bacterial growth. A few young dentists mentioned learning about probiotics from social media. However, the role of probiotics in dentistry was low among all the participants.

“Not much knowledge, but know that probiotics are living organisms, reducing and balancing bacterial growth in tooth decay and read on social media.”

• –Dental practitioners with 0 to 5 years of practice

“Adequate knowledge learned from research, GIT disorder, periodontitis, caries, some examples of probiotics information.”

• –Dental practitioners with 5 to 10 years of practice

“Probiotics studied since college life help reduce bacterial growth, decrease inflammation and chronic inflammation, and reduce the chances of dental care and maintaining periodontal health.”

• –Dental practitioners with 10 years of practice

Attitude toward Utilization of Probiotics in Regular Practice

When the participants were questioned about using probiotics in regular practice, everyone suggested the requirement of evidence-based studies to support using probiotics. Some participants mentioned the need for proper guidelines and strict protocol measures to prescribe probiotics in regular clinics. These were mentioned by experienced clinicians who believed that without guidelines and protocol, there are chances of misusing a drug. However, recently qualified dentists did not share any opinion on using probiotics in regular practice.

“Enough evidence-based research required to prescribe in clinics.”

• –Dental clinicians with 5 years of experience

“No approved guidelines to prescribe probiotics, lack of strong evidence, some case it may be harmful and regulated strictly to prescribed [sic] in regular clinics.”

• –Dental clinicians with more than 5 years of experience

“Contradictory results regarding probiotic use in dentistry have been published. Hence, precaution is required in prescribing probiotics to patients.”

• –Clinicians with more than 5 years of experience

Dentists even mentioned that if probiotics are prescribed in dental clinics, they should be tablets, mouthwashes, and chewing gums. They explained the reason as these forms of products could be efficiently utilized by the patients. Some dentists suggested a regular diet using probiotics such as yogurt, cheese, and fermented food.

“Probiotics, if prescribed in dental clinics, should be in the form of pills, mouthwash, and kinds of toothpaste that can be easily applicable and used by the patients.”

• –Dental clinicians with more than 5 years of experience

“Probiotics should be natural in our regular practice. Clinical practice should be prescribed whenever required.”

• –Dental clinicians with less than 5 years of experience

Need to Develop Knowledge Regarding Probiotics

All participants agreed that a lecture or course is required to explain the use of probiotics in dentistry. Participants believed that the knowledge provided to interns and sixth-year students dealing with patients could help them judge the cases requiring probiotics.

“More lectures and information are required in this field.”

• –Clinicians with 1 to 5 years of experience

“In periodontology and cariology lectures, probiotics should be introduced to reduce bacterial growth. This topic should be part of the curriculum as it improves oral and overall health.”

• –Clinicians with more than 5 years of experience

Discussion

To the authors' knowledge, this is the first mixed-methods study to explore the dentist's attitude, knowledge, and practice regarding probiotics utilization in the Jazan region. The utilization of probiotics in dentistry is limited, and the perception of dentists toward this is required. The current study utilized the mixed-methods study with a concurrent triangulation design. A descriptive and chi-square analysis was used to analyze the quantitative part of the study, and a thematic analysis was used to analyze the qualitative part. Studies suggest that quantitative findings enhance the qualitative findings and vice versa.[18] [20] [23] [24] Combining qualitative and quantitative data is helpful to generate detailed analysis and contextualized insight into a study. As a result, the current study has provided a comprehensive understanding of dentists' knowledge, attitudes, and practices in utilizing probiotics in regular practice. Mixed-methods studies have shown notable advantages over simple qualitative and quantitative studies; these studies are expensive and time-consuming.[21] Moreover, it requires skilled researchers to perform mixed-methods studies. Hence, a team of researchers experienced in qualitative and quantitative methods performed the current study.

The current study's qualitative and quantitative analysis suggests a significant gap in using probiotics among clinicians. Studies indicate that knowledge among clinicians influences the preventive measures employed. According to this study, the knowledge of utilizing probiotics was higher amongst practitioner who were practicing from 0 to 5 years compared with those who were 5 to 10 years old—in a study conducted in Saudi Arabia on practitioners in Al-kharj region reported 93% of dental practitioners had acceptable knowledge of probiotics.[3] However, their study did not consider years of practice as a variable. However, in an Iranian survey of medical practitioners, 43% of practitioners had an acceptable or good understanding of probiotics.[24] A recent study reported that approximately 72% of participants knew that probiotics are living organisms.

Similarly, in the study by Al Hossan et al in 2024, 58% of participants knew the definition of probiotics.[2] In the qualitative analysis of the current study, all eight dental practitioners were aware of the term probiotics. However, in a study conducted in Oman, there was inadequate knowledge about probiotics among medical and dental interns.[1] The researchers of the Omani study reported that 92% of medical interns and 96% of dental interns did not know about probiotics.[1] Chukwu et al reported similar findings, where practitioners had less knowledge regarding probiotics.[6] This could be due to inadequate knowledge about probiotics or lack of knowledge provided during college years regarding probiotics.

The current study recorded a significant difference among the genders regarding the attitude toward utilizing probiotics in regular practice. In this study, an attitude toward probiotics is used, and it is recommended in regular practice or explained to patients about the importance of probiotics. Male practitioners with more than 10 years of experience strongly supported the utilization of probiotics as a preventive measure in regular practice. In contrast, female participants did not have similar views. Similarly, in the study by Al Hossan et al, statistical significance was reported in the students' attitudes toward using probiotics.[2] Conversely, in an Indonesian study, only 35% of participants had a positive attitude toward regular usage of probiotics.[25] Chukwu et al found no significant difference between the genders when recommending probiotics.[6] However, in the qualitative analysis of this study, not all participants were positive about using probiotics in regular practice due to a lack of strong evidence. This difference could be related to the questions asked in the quantitative study; the answers were in agreement, while participants were free to express their views in the qualitative research. These results suggest that there is a need for practitioners to know about probiotics.

Another interesting finding of this study is the statistically significant result of discussing probiotics as a preventive measure for the patient. All the participants mentioned rarely discussing this preventive option with the patients. In the focus group interview, participants also mentioned that they rarely discuss probiotics as a prophylactic option. Participants in the interview cited a lack of strong evidence supporting the utilization of probiotics in dentistry. However, enough data are available for its utilization in maintaining general health. This conflicting result demands more research on probiotics as a preventive measure for oral health. The results from this study will motivate students to read more about scientific research to form an unbiased opinion about using probiotics for their patients' oral health.

The present study assessed the practice of dental practitioners regarding probiotics. Over half of the participants agreed to consume at least one form of probiotics. The most common form of probiotics consumed by the participants was yogurt and fermented food. This result shows that more factors may influence the use of probiotics, which can be examined in future research. Similarly, in the study by Al Hossan et al, 98% of health care students consumed probiotics.[2] These results contradict the study by Chukwu et al, where only 14.9% of participants mentioned consuming probiotics.[6] Another survey by Pradito et al concluded that only 9.5% of dental students consumed probiotics in their regular diets.[14] Most participants from this qualitative and quantitative analysis study believed that probiotics help improve digestive health; their significance in oral health is still unclear. This finding suggests the need for research on probiotics to maintain oral health.

Less than half of the participants indicated that they had not learned about probiotics in the curricula. The maximum number of participants mentioned were dentists with more than 10 years of experience. Moreover, all the participants from the present study indicated the need for an extra lecture or course to help them learn more about the importance of probiotics in controlling oral microbiota. Additionally, the participants mentioned that they knew about probiotics from social media and friends. A study on the health care of college students reported that the media are the most common sources of information about probiotics.[10] Future HCPs' knowledge and awareness will be increased by including probiotics in their coursework, which will also help them solidify their skills with reliable information.

The strength of this study is its mixed-methods analysis, which helped researchers to analyze sociodemographic factors related to knowledge, attitude, and practice along with external factors that affect the behavior and views of dental practitioners regarding probiotics. However, this study has various limitations. First, there is a chance of self-reported bias in the qualitative and quantitative analysis. Limitation and convenience sampling of participants make it difficult to generalize the results. More studies with larger sample sizes and randomization of samples are required to solve these difficulties. Here are some recommendations for further research: a mixed-methods study can be conducted in other regional and private universities to improve the accuracy and dependability of research focusing on knowledge, attitude, and practice of probiotics benefits. Self-questionnaires administered via paper surveys and one-on-one interviews under supervision can reduce the possibility of response bias, survey fraud, and data errors.

Conclusion

Within the limitations of this study, it could be concluded that the maximum of participants had an acceptable knowledge about probiotics. Statistical significance was recorded among the genders, with more positive and strong recommendations of probiotics among male dental practitioners than females. All the participants in the study mentioned the need for extra lectures on the importance of probiotics for oral health. In the focus group interview, participants were reluctant to utilize probiotics in clinical practice due to a lack of strong evidence supporting the benefits of probiotics in maintaining oral health. Hence, more mixed-methods studies are required to gather internal and external factors responsible for the lack of utilization of probiotics in regular practice.

Conflict of Interest

None declared.

Acknowledgment

None.

Ethical Approval

The Internal Ethical Committee of Jazan University (Ref. no. REC-45/05/877) approved this mixed-methods study. Informed consent was also taken from all the participants for qualitative and quantitative analyses.

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Artikel online veröffentlicht:
14. Februar 2025