Abstract
Background
Primary care physicians’ (PCPs) play a central role in oral health promotion. This study aimed to identify predictors of oral health competency among primary healthcare physicians and to assess their perceptions regarding oral health education and training.
Methods
This cross-sectional study targeted all PCPs (n = 323) working in primary healthcare centers in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed via WhatsApp. Ten oral health competencies were assessed using a scale from 0 to 4, where 0 indicates no experience and 4 indicates expert-level experience. Associations between oral health competency scores and demographic factors, prior oral health education/training, and perceptions of PCPs’ about oral health education were examined. Linear regression (Coefficients and 95% confidence intervals (CIs)) and logistic regression (Odds ratios (ORs and 95% CIs) analyses were performed.
Results
Mean oral health competency score of PCPs was 14.2 (SD = 6.8, n = 107). Nearly 36% and 44% reported no or limited experience in taking oral health histories and performing oral examinations; 24% and 38% had no or limited experience in diagnosing dental caries; and 30% and 53% had no experience in assessing patients’ caries risk or in applying fluoride varnish for dental caries prevention. About 74% of PCPs expressed willingness to learn. The most preferred learning format was self-learning (37.4%), followed by live online (32.7%) and in-person courses (31.8%). Lack of prior oral health training was significantly correlated with lower competency scores (coefficient: -5.20, 95% CI: -8.66 to -1.74), while positive perceptions of oral health education were correlated with higher scores (coefficient: 0.33, 95% CI: 0.11 to 0.54).
Conclusion
This study highlights significant gaps in PCPs’ competencies in oral healthcare tasks. Key recommendations include integrating oral health training into medical curricula, offering subsidized continuing education programs, and promoting interprofessional collaboration. A systematic approach is essential to empower PCPs in leading oral health promotion and enhancing patient outcomes.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12903-025-07180-y.
key words: Primary Care Physicians, Oral Health, Clinical Competence, Dental Health Education, Continuing Medical Education, Saudi Arabia
Introduction
Poor oral health leads to adverse outcomes, including dental caries, tooth loss, oral infections, and an increased risk of pre-cancerous and cancerous oral lesions, as well as reduced responsiveness to dental treatment and susceptibility to fungal infections in the oral cavity [1–3]. Several studies have shown strong associations between oral health and systemic conditions, including diabetes, cardiovascular disease, and adverse pregnancy outcomes [4, 5]. For instance, periodontal disease can worsen glycemic control in diabetic patients, while systemic inflammation originating from the oral cavity has been linked to cardiovascular events and low birth weight in pregnant women [2, 6, 7]. Oral health status is influenced by socio-economic factors, education level, lifestyle behaviours, and access to preventive and curative dental services [8]. Effective prevention of oral diseases involves maintaining proper oral hygiene, adopting a balanced diet, avoiding tobacco use, and ensuring regular dental visits [9].
According to the 2022 WHO Global Oral Health Status Report, oral diseases affect approximately 3.5 billion individuals globally, with 75% residing in middle-income countries [10]. Dental caries in permanent teeth impacts nearly 2 billion people, and 514 million children suffer from caries in primary teeth [11]. The burden of oral disease is notably high in the Kingdom of Saudi Arabia (KSA). With widespread cases of dental caries and tooth loss due to periodontal disease [12–14]. A 2021 systematic review reported a 70% prevalence of dental caries among children, and a 2023 nationwide survey revealed a caries prevalence of 65.6% among schoolchildren, including 72.1% in primary teeth and 61.7% in permanent teeth [12]. Additionally, nearly 90% of adults in KSA are affected by periodontal diseases, which contribute to chronic inflammation, tooth loss, pain, and reduced quality of life, while also exacerbating systemic conditions [14].
Despite its significance, oral health is not yet adequately integrated into global and national health systems [11]. Primary care physicians (PCPs) occupy a central role within the healthcare system, particularly in primary healthcare centers (PHCs), where they often encounter patients presenting with both systemic and oral symptoms. For example, patients may report oral ulcers linked to gastrointestinal disorders, or facial pain related to sinus infections or temporomandibular joint dysfunction [15]. Given their accessibility, PCPs are often consulted more frequently than dentists for initial health concerns [16]. In 2018, national data in Saudi Arabia showed that while 24% of the population visited a PCP at least once per year, only 11.5% accessed dental care during the same period [17]. These patterns suggest that PCPs are well-positioned to promote oral health and facilitate early intervention.
Several studies in KSA have evaluated PCPs’ knowledge of oral health and found substantial gaps. For example, only 7% of family physicians have received formal training in oral health [18]. In a parallel study, 42% of Saudi Arabian medical practitioners would initiate dental consultations for patients prior to prescribing bisphosphonate medication for non-dental problems, stressing a lack of awareness about the maxillofacial consequences of such therapies and the need for specialized dental care [19]. Knowledge deficits have been identified in the management of xerostomia, obstructive sleep apnea, oral pain, and viral infections presenting with oral symptoms such as herpetic gingivostomatitis [18–20]. These studies emphasize the need for educating and training PCPs in oral health. By incorporating oral health education into their routine practices, physicians can bridge the gap in dental care utilization, empower patients to make informed decisions, and contribute to overall improvements in oral health outcomes within the population. Our study aims to identify predictors of oral health competency among primary healthcare physicians and to assess their perceptions regarding oral health education and training.
Methods
Study design and population
This study is a cross-sectional investigation aimed at assessing PCPs’ competencies in oral healthcare practices, their willingness to participate in oral health education and training. The study targeted PCPs working in the Ministry of Health PHCs across Jeddah, Saudi Arabia. At the time of the study, there were 47 PHCs in Jeddah. A total of 323 physicians worked in these centers across various ranks and specialties, primarily general practitioners and family medicine specialists.
The study adhered to the principles outlined in the Declaration of Helsinki and obtained ethical approval from the Research Ethics Committee of the Faculty of Dentistry, King Abdulaziz University (063-06−20), as well as the Institutional Review Board of the Ministry of Health (20-665E).
Study questionnaire
A comprehensive, self-administered questionnaire was developed based on a review of relevant literature to assess PCPs’ oral healthcare competencies, perceptions of oral health education, and willingness to participate in oral health training. It was administered in English without translation, as the target PCP population was proficient in the English language. The questionnaire consisted of four main sections: (1) demographic information (2), self-reported competency in oral health practices (3), perceptions of oral health education, and (4) willingness to participate in oral health training. Face and content validity were confirmed by a panel of oral health experts (including professionals from dental public health, general dentistry, and pediatric dentistry). The survey was pilot tested with a group of 20 PCPs who were not included in the study analysis, to ensure clarity, relevance, and overall reliability prior to final implementation. The pilot test yielded a Cronbach’s alpha of 0.85, indicating good internal consistency for the seven items assessing PCPs’ perceptions of oral health education and training. Face and content validity were confirmed by a panel of oral health experts (including professionals from dental public health, general dentistry, and dental education). A copy of the questionnaire is provided as supplementary material, and a detailed explanation of survey construction and validation is provided elsewhere [21].
A list containing the names and phone numbers of all 323 physicians was obtained. A link to the survey was sent to the physicians via WhatsApp messaging application. One week later, the first reminder was sent to them. Two weeks later, the link was sent again to the participants, followed by a second reminder one week later. Informed consent was obtained from all participants, and anonymity was maintained throughout the study.
Study variables
The dependent variable was the competency of PCPs in oral healthcare practices. The ten competencies assessed in this study were: [1] taking oral health history and performing an oral examination [2], diagnosing dental caries [3], determining the patient’s risk for dental caries [4], diagnosing oral manifestations of systemic diseases [5], answering patients’ questions about oral health [6], advising patients against consuming a diet that causes dental caries [7], advising patients on oral hygiene practices [8], counselling patients about adverse oral health effects of tobacco [9], applying intraoral fluoride varnish for preventing dental caries, and [11] evaluating and managing dental emergencies. The selection of these competencies was guided by existing literature and guidelines to ensure relevance and comprehensiveness for PCPs’ roles in oral health [22–26]. The competency levels were self-reported by PCPs on a scale from 0 to 4, where 0 indicated no experience, 1 indicated limited experience, 2 indicated intermediate experience, 3 indicated advanced experience, and 4 indicated expert-level experience. For analytical purposes, the competency scores were recategorized into binary groups: (A) Not competent: participants reporting “No experience” (score = 0) or “Limited experience” (score = 1), and (B) Competent: participants reporting “Intermediate experience” (score = 2), “Advanced experience” (score = 3), or “Expert-level experience” (score = 4). Additionally, a composite score was calculated by summing the individual scores across all ten competencies. The composite score ranged from 0 to 40, with higher scores representing greater overall proficiency in oral healthcare tasks.
Independent variables included demographic factors such as gender (male or female), nationality (Saudi or Non-Saudi), and job rank (general practitioner, specialist, consultant, or other); prior oral health education or training (yes or no); and perceptions of PCPs about oral health education and/or training. Perception scores were derived from participants’ responses to seven Likert-scale statements evaluating their views on the importance of oral health education and training in primary care. Each response option was assigned a Likert score as follows: Strongly Disagree: 0, Disagree: 1, Neutral: 2, Agree: 3, and Strongly Agree: 4. These statements were: [1] Physicians, in general, do not receive sufficient education on oral health [2], The Saudi Commission for Health Specialties should mandate training in oral health care for primary healthcare practitioners [3], The Saudi Commission for Health Specialties should facilitate/organize training in oral health care for PCPs [4], I would pay to attend a course/training in oral health [5], The diagnosis of oral conditions should be a part of medical training [6], Evaluation and management of common dental emergencies should be part of medical training, and [7] Oral-public-health programs/community services should be part of medical training. The perception statements were both evidence-based and contextually adapted to align with the study’s objectives and to ensure cultural appropriateness and relevance in the Saudi Arabian setting [27, 28]. The total perception score for each participant was calculated by summing the scores for all seven statements, resulting in a possible range of 0 to 28. Higher scores indicated stronger, more favourable perceptions regarding the significance of oral health education and training in primary care. Additional variables included the reasons for PCPs’ lack of interest in pursuing oral health education, as well as their preferred format and approach for oral health education.
Statistical analysis
Descriptive statistics, including frequencies and percentages, were used to summarize demographic characteristics, competency levels, perceptions of oral health education among PCPs, and other variables in the study. Linear regression analysis was performed to identify factors predicting higher competencies in oral healthcare practice. Coefficients and their corresponding 95% confidence intervals (CIs) were calculated to evaluate the strength and precision of the associations. Multivariable logistic regression models were used to identify predictors of higher competency levels. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated to measure the strength and precision of the associations between predictors and the likelihood of achieving high competency levels. This approach provided insight into the factors that significantly influence proficiency in specific oral health care tasks. All analyses were conducted using Stata 12.1 (StataCorp LP, College Station, TX, USA).
Results
A total of 130 responded to the survey, yielding a response rate of 40.3%. However, only 107 completed the entire questionnaire. Table 1 illustrates the demographic characteristics of the PCPs in the study sample from Jeddah, Saudi Arabia. Out of all responding PCPs, 71 (65.4%) were female, and 104 (97.2%) were Saudi nationals. General practitioners comprise the most incredible group of professionals (45, 42.1%), followed by specialists (37, 34.6%), and consultants (23, 21.5%).
Table 1.
Characteristics of participating primary healthcare physicians, N = 107
| Variable | N (%) |
|---|---|
| Gender | |
| Male | 37 (34.6) |
| Female | 70 (65.4) |
| Nationality | |
| Saudi | 104 (97.2) |
| Non-Saudi | 3 (2.8) |
| Rank | |
| General practitioner | 45 (42.1) |
| Specialist | 37 (34.6) |
| Consultant | 23 (21.5) |
| Other | 2 (1.9) |
Among the 107 PCPs surveyed, the mean competency score was 14.15 (SD = 6.80, range = 0–34). A considerable proportion demonstrated limited experience across various oral health competencies. For example, 35.5% and 43.9% of PCPs reported no or limited experience in taking oral health histories and performing oral examinations. Similarly, 24.3% and 38.3% of PCPs had no or limited experience in diagnosing dental caries. Furthermore, 29.9% and 53.3% of the PCPs had no experience in assessing patients’ caries risk or in applying fluoride varnish for dental caries prevention. Regarding advice on oral hygiene practices, a notable number of PCPs had intermediate experience (41.1%), while fewer had advanced (22.4%) or expert (4.7%) levels of expertise. Finally, only a small percentage of PCPs reached expert levels in most oral health competencies, with none attaining the expert level for taking oral histories and performing oral examinations, and only 2% for managing dental emergencies. In general, most surveyed PCPs positioned themselves between no or limited experience, and few demonstrated proficiency in higher-level oral health competencies. Table 2 presents the details of these findings.
Table 2.
Oral health competencies of primary healthcare physicians, N = 107
| Competency | No experience N (%) |
Limited experience N (%) |
Intermediate experience N (%) |
Advanced experience N (%) |
Expert level N (%) |
|---|---|---|---|---|---|
| 1. Take oral health history and perform an oral examination | 38 (35.5) | 47 (43.9) | 19 (17.8) | 3 (2.8) | 0 (0) |
| 2. Diagnose dental caries | 26 (24.3) | 41 (38.3) | 32 (29.9) | 6 (5.6) | 2 (1.87) |
| 3. Determine the patient’s risk for dental caries | 32 (29.9) | 40 (37.4) | 27 (25.2) | 7 (6.5) | 1 (0.9) |
| 4. Diagnose oral manifestations of systemic diseases | 15 (14.0) | 31 (29.0) | 44 (41.1) | 13 (12.2) | 4 (3.7) |
| 5. Answer patient’s questions about oral health | 11 (10.3) | 48 (44.9) | 40 (37.4) | 7 (6.5) | 1 (0.9) |
| 6. Advise patients against consuming a diet that causes dental caries | 8 (7.5) | 34 (31.8) | 37 (34.6) | 21 (19.6) | 7 (6.5) |
| 7. Advise patients on oral hygiene practices | 7 (6.5) | 27 (25.2) | 44 (41.1) | 24 (22.4) | 5 (4.7) |
| 8. Counseling patients about adverse oral health effects of tobacco | 8 (7.5) | 28 (26.2) | 30 (28.0) | 28 (26.2) | 13 (12.2) |
| 9. Apply intraoral Fluoride varnish for preventing dental caries | 57 (53.3) | 25 (23.4) | 19 (17.8) | 5 (4.7) | 1 (0.9) |
| 10. Evaluate and manage dental emergencies as needed | 25 (23.4) | 42 (39.3) | 33 (30.8) | 5 (4.7) | 2 (1.9) |
Only 17 out of the 107 PCPs surveyed (15.9%) had previously taken oral healthcare courses. Of these, 9 (52.9%) received their oral health training as part of their undergraduate medical school curriculum, 4 (23.5%) during a residency program, and 7 (41.2%) through independent continuing education courses. When the PCPs were asked about their interest in pursuing further oral healthcare education and training, 79 out of 107 (73.8%) expressed interest. Various reasons were given by participants who were not interested in pursuing further oral healthcare education and training (Table 3). The most common reasons were a lack of time to take additional courses (16, 15.0%) and the perception that providing oral healthcare services is not part of their job (13, 12.1%). Other reasons included the need for courses to be specifically tailored to family physicians, a perception that oral health falls under specialist care rather than general practice, and that it is primarily a dentist’s responsibility.
Table 3.
Reasons for lack of interest of primary healthcare physicians in oral health training, N = 28
| Reason | Physicians, N (%) |
|---|---|
| My education regarding oral health is sufficient | 3 (10.7%) |
| Lack of time to take additional courses | 16 (57.1%) |
| Not interested in oral health | 7 (25.0%) |
| Providing oral health care services is not part of my job | 13 (46.4%) |
| Patients have a greater need for general health care than oral care | 2 (7.1%) |
| I cannot afford it financially | 2 (7.1%) |
| Other (please specify) | 4 (14.3%) |
Participants were able to choose more than one answer
When we asked the PCPs who were interested in further oral health education about their preferred format for learning about oral health, the most preferred option was self-learning (40, 37.4%) through resources such as online browsing, PowerPoint slides, videos, and books. Other popular formats included taking live online courses (35, 32.7%) and attending live in-person courses (34, 31.8%). A mixed approach combining online and live courses was preferred by 32 PCPs (29.9%), while 34 PCPs (31.8%) favoured peer learning, such as consulting a dental colleague. When asked about the best approach to offering a course in oral health, 40 PCPs (38.1%) believed it should be a part of the medical school curriculum. In contrast, 30 (28.6%) felt it should be integrated into residency programs. Another 35 respondents (33.3%) suggested offering a separate continuing education course for oral health (Table 4).
Table 4.
Preferred formats and approaches for oral health education among primary healthcare physicians, N = 79
| Format | Physicians N (%) |
|---|---|
| Preferred format for providing oral health education | |
| Self-learning (browsing online, PowerPoint slides, videos, books, etc…) | 40 (37.4) |
| Take a live online course | 35 (32.7) |
| Attend a live in-person course | 34 (31.8) |
| A mix of online and live courses | 32 (29.9) |
| Peer-learning like asking a dentist colleague | 34 (31.8) |
| Attending dental conferences and seminars | 23 (21.5) |
| Shadowing a dentist in a dental clinic | 25 (23.4) |
| Best approach for offering oral health education | |
| Incorporated into the medical school curriculum | 40 (38.1) |
| Incorporated into the residency program curriculum | 30 (28.6) |
| A separate continuous education course | 35 (33.3) |
Participants were asked to choose their top three options
Some numbers did not add up to the total because of missing values
The mean perception score of PCPs regarding oral health education was 16.2 (SD = 5.9; range = 0–28). The surveyed PCPs’ perceptions regarding oral healthcare education and training are shown in Table 5. Most (61.2%) agreed or strongly agreed that physicians, in general, do not receive sufficient education on oral health, with 26.2% remaining neutral and 12.6% disagreeing. Regarding the role of the Saudi Commission for Health Specialties, 58.3% of respondents believed that the Commission should facilitate or organize training in oral healthcare for primary healthcare practitioners. In comparison, 39.8% believed that such training should be mandated, while 34.0% remained neutral on this point. When asked if they would personally pay to attend a course or training in oral health, only 27.2% agreed, with a larger portion either neutral (34.9%) or disagreeing (37.9%). More than half of the PCPs agreed that medical training should include the diagnosis of oral conditions (55.3%), the management of dental emergencies (52.4%), and oral public health programs (52.5%).
Table 5.
Primary healthcare physicians’ perceptions about oral health education, N = 107
| Perceptions | Strongly disagree (n, %) |
Disagree (n, %) |
Neutral (n, %) |
Agree (n, %) |
Strongly agree (n, %) |
|---|---|---|---|---|---|
| Physicians, in general, do not receive sufficient education on oral health | 10 (9.3) | 4 (3.7) | 28 (26.2) | 31 (29.0) | 34 (31.8) |
| The Saudi Commission for Health Specialties should mandate training in oral healthcare for primary healthcare practitioners | 8 (7.5) | 20 (18.7) | 36 (33.6) | 29 (27.1) | 14 (13.1) |
| The Saudi Commission for Health Specialties should facilitate/organize training in oral healthcare for primary healthcare practitioners | 8 (7.5) | 12 (11.2) | 24 (22.4) | 46 (43.0) | 17 (15.9) |
| I would pay to attend a course/training in oral health | 18 (16.8) | 23 (21.5) | 37 (34.6) | 25 (23.4) | 4 (3.7) |
| The diagnosis of oral conditions should be a part of medical training | 7 (6.5) | 10 (9.3) | 30 (28.0) | 48 (44.9) | 12 (11.2) |
| Evaluation and management of common dental emergencies should be part of medical training | 10 (9.3) | 13 (12.1) | 27 (25.2) | 42 (39.3) | 15 (14.0) |
| Oral-public-health programs/community services should be part of medical training | 9 (8.4) | 11 (10.3) | 31 (29.0) | 48 (44.9) | 8 (7.5) |
Table 6 presents the results of the linear regression analysis examining the factors correlated with overall oral health competency scores. Having received prior education or training in oral healthcare was a significant predictor of success. Physicians without such training had significantly lower competency scores compared to those with training (multivariate coefficient: −5.20, 95% CI: −8.66 to −1.74). In other words, for every instance of having received oral healthcare training, there is a gain of approximately 5.2 points in physicians’ oral healthcare competencies. Similarly, the oral health education perception score was positively correlated with higher oral health competency scores. (multivariate coefficient: 0.33, 95% CI: 0.11 to 0.54).
Table 6.
Predictors of oral health competency among primary healthcare physicians, N = 101
| Variable | N | Univariate Coefficient (95% CI) |
Multivariate Coefficient (95% CI) |
|---|---|---|---|
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | −0.18 (−2.80, 2.44) | 0.49 (−2.04, 3.03) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.57 (−1.31, 4.45) | 1.61 (−1.09, 4.30) |
| Consultant | 22 | 1.33 (−1.81, 4.47) | 1.85 (−1.06, 4.77) |
| Ever received any education or training in oral health care | |||
| Yes | 15 | 1.0 | 1.0 |
| No | 86 | −5.10 (−8.62, −1.58) | −5.20 (−8.66, −1.74) |
| Perceptions of oral health education | 101 | 0.33 (0.12, 0.54) | 0.33 (0.11, 0.54) |
The analysis included 101 participants instead of 107 due to the following adjustments: (1) presence of a dental clinic was removed from the regression because only one participant reported not having a dental clinic in the center; (2) nationality was excluded as only three participants were non-Saudi; and (3) the “others” category in rank was excluded because it included only two participants
95% CI 95% confidence interval
In Table 7, we examined the association between having ever received oral health education or training and individual oral healthcare competencies. In this analysis, an odds ratio (OR) of 1 indicates no association; values less than 1 indicate a reduced likelihood of demonstrating competency, while values larger than 1 indicate an increased likelihood of demonstrating competency. We found that PCPs who had never received such education or training were significantly less likely to demonstrate competency in six key areas, after adjusting for gender, rank, and perceptions about oral health education. These competencies were: (1) obtaining oral health history and performing oral examinations (adjusted OR = 0.15, 95% CI: 0.04–0.53); (2) assessing a patient’s risk for dental caries (adjusted OR = 0.16, 95% CI: 0.05–0.58); (3) diagnosing dental caries (adjusted OR = 0.22, 95% CI: 0.07–0.76); (4) applying fluoride varnish (adjusted OR = 0.15, 95% CI: 0.04–0.53); (5) managing dental emergencies (adjusted OR = 0.16, 95% CI: 0.04–0.60); and (6) advising patients against consuming a cariogenic diet (adjusted OR = 0.20, 95% CI: 0.04–0.97). For example, an OR of 0.15 for obtaining oral health history and performing oral examinations indicates that PCPs without prior oral health training had about 85% lower odds of competency in this skill compared with trained counterparts, underscoring a substantial gap in clinical preparedness when training is absent.
Table 7.
Predictors of individual oral healthcare competencies among primary healthcare physicians, N = 101
| Variable | n | Univariate OR (95% CI) |
Multivariate OR (95% CI) |
|---|---|---|---|
| Competency 1: Take oral health history and perform an oral examination | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.45 (0.17, 1.21) | 0.46 (0.15, 1.43) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.20 (0.39, 3.71) | 1.43 (0.40, 5.09) |
| Consultant | 22 | 1.36 (0.39, 4.78) | 1.46 (0.35, 6.00) |
| Ever received any education or training in oral health care | |||
| Yes | 15 | 1.0 | 1.0 |
| No | 86 | 0.1418919 (0.04, 0.46) | 0.15 (0.04, 0.53) |
| Perceptions of oral health education | 101 | 1.06 (0.97, 1.16) | 1.08 (0.97, 1.19) |
| Competency 2: Diagnose dental caries | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.71 (0.31, 1.65) | 0.70 (0.28, 1.75) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.58 (0.63, 3.95) | 1.72 (0.63, 4.65) |
| Consultant | 22 | 1.14 (0.39, 3.32) | 1.23 (0.39, 3.84) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.24 (0.08, 0.77) | 0.22 (0.07, 0.76) |
| Perceptions of oral health education | 1.05 (0.98, 1.13) | 1.05 (0.97, 1.14) | |
| Competency 3: Determine the patient’s risk for dental caries | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.89 (0.38, 2.13) | 0.99 (0.37, 2.62) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 0.87 (0.34, 2.23) | 0.82 (0.29, 2.33) |
| Consultant | 22 | 0.68 (0.22, 2.08) | 0.69 (0.21, 2.32) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.18 (0.06, 0.59) | 0.16 (0.05, 0.58) |
| Perceptions of oral health education | 1.07 (0.99, 1.15) | 1.08 (0.97, 1.18) | |
| Competency 4: Diagnose oral manifestations of systemic diseases | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.75 (0.33, 1.75) | 0.72 (0.29, 1.76) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.29 (0.52, 3.20) | 1.25 (0.48, 3.31) |
| Consultant | 22 | 1.16 (0.41, 3.25) | 1.31 (0.44, 3.88) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.30 (0.08, 1.14) | 0.29 (0.07, 1.16) |
| Perceptions of oral health education | 1.06 (0.99, 1.13) | 1.07 (0.99, 1.15) | |
| Competency 5: Answer patient’s questions about oral health | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.65 (0.29, 1.49) | 0.56 (0.23, 1.41) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.65 (0.67, 4.06) | 1.57 (0.59, 4.18) |
| Consultant | 22 | 1.65 (0.59, 4.62) | 1.98 (0.65, 6.04) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | ||
| No | 101 | 0.34 (0.11, 1.09) | 0.33 (0.09, 1.20) |
| Perceptions of oral health education | 1.09 (1.01, 1.17) | 1.10 (1.02, 1.20) | |
| Competency 6: Advise patients against consuming a diet that causes dental caries | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.91 (0.39, 2.12) | 1.01 (0.41, 2.49) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 0.95 (0.38, 2.36) | 0.99 (0.38, 2.60) |
| Consultant | 22 | 1.43 (0.49, 4.20) | 1.52 (0.50, 4.68) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.20 (0.04, 0.96) | 0.20 (0.04, 0.97) |
| Perceptions of oral health education | 1.02 (0.95, 1.09) | 1.03 (0.95, 1.11) | |
| Competency 7: Advise patients on oral hygiene practices | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 1.05 (0.43, 2.56) | 0.94 (0.37, 2.42) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.53 (0.58, 4.07) | 1.26 (0.45, 3.58) |
| Consultant | 22 | 1.47 (0.48, 4.51) | 1.80 (0.55, 5.89) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.52 (0.14, 1.98) | 0.46 (0.11, 1.94) |
| Perceptions of oral health education | 101 | 1.08 (1.01, 1.17) | 1.09 (1.01, 1.18) |
| Competency 8: Counseling patients about adverse oral health effects of tobacco | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 1.04 (0.44, 2.48) | 0.91 (0.36, 2.29) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.60 (0.62, 4.13) | 1.28 (0.47, 3.52) |
| Consultant | 22 | 1.78 (0.58, 5.40) | 2.23 (0.68, 7.28) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.68 (0.20, 2.32) | 0.64 (0.17, 2.41) |
| Perceptions of oral health education | 1.09 (1.01, 1.17) | 1.10 (1.02, 1.19) | |
| Competency 9: Apply intraoral Fluoride varnish for preventing dental caries | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.85 (0.33, 2.20) | 0.97 (0.33, 2.81) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 1.91 (0.69, 5.33) | 3.01 (0.93, 9.72) |
| Consultant | 22 | 0.89 (0.24, 3.28) | 0.78 (0.19, 3.25) |
| Ever received any education or training in oral health care | 15 | ||
| Yes | 86 | 1.0 | 1.0 |
| No | 101 | 0.20 (0.06, 0.63) | 0.15 (0.04, 0.53) |
| Perceptions of oral health education | 0.98 (0.91, 1.06) | 0.95 (0.87, 1.04) | |
| Competency 10: Evaluate and manage dental emergencies as needed | |||
| Gender | |||
| Male | 35 | 1.0 | 1.0 |
| Female | 66 | 0.97 (0.41, 2.26) | 0.89 (0.34, 2.35) |
| Rank | |||
| General practitioner | 45 | 1.0 | 1.0 |
| Specialist | 34 | 2.00 (0.80, 4.99) | 2.12 (0.78, 5.79) |
| Consultant | 22 | 0.59 (0.18, 1.90) | 0.58 (0.16, 2.07) |
| Ever received any education or training in oral health care | |||
| Yes | 15 | 1.0 | 1.0 |
| No | 86 | 0.23 (0.07, 0.73) | 0.16 (0.04, 0.60) |
| Perceptions of oral health education | 101 | 1.08 (1.00, 1.17) | 1.07 (0.98, 1.16) |
The analysis included 101 participants instead of 107 due to the following adjustments: (1) presence of a dental clinic was removed from the regression because only one participant reported not having a dental clinic in the center; (2) nationality was excluded as only three participants were non-Saudi; and (3) the “others” category in rank was excluded because it included only two participants
95% CI 95% confidence interval
Similarly, PCPs with positive perceptions of oral health education and training were more likely to demonstrate competency in (1) advising patients on oral hygiene practices (adjusted OR = 1.09, 95% CI: 1.01–1.18) (2), addressing patients’ questions about oral health (adjusted OR = 1.10, 95% CI: 1.02–1.20), and (3) counseling patients on the adverse oral health effects of tobacco (adjusted OR = 1.10, 95% CI: 1.02–1.19), after adjusting for gender, rank, and oral health education. Although the magnitude of these odds ratios was modest, the consistency across multiple counselling domains suggests a meaningful incremental benefit in communication and patient guidance.
Discussion
This study evaluated the oral health competencies and perceptions of PCPs regarding oral health education. Physician competency in oral healthcare is vital for integrated healthcare delivery, ensuring early detection, prevention, and intervention for oral diseases. Physicians, as primary care providers, can identify oral health issues, such as caries and oral cancer, at early stages and refer patients to appropriate dental care. This integration promotes continuity of care, particularly in managing systemic conditions with oral manifestations, reducing disease progression and improving overall health outcomes. Competent physicians also play a pivotal role in underserved areas, where they address oral health needs and foster collaboration between medical and dental teams to enhance patient-centred care [29]. Our findings are consistent with prior literature underscoring the importance of strengthening oral health competencies among PCPs [10, 30–38]. Nonetheless, the competency gaps observed in our study appear wider than those reported in some international contexts. Such differences may be attributed to contextual factors, including the availability of training programs, the organization of health systems, and the absence of structured oral health curricula designed for PCPs in Saudi Arabia.
We found that a large proportion of physicians reported having either no experience or limited experience in key oral health services, such as taking oral health histories and performing oral examinations (79.4%), applying fluoride varnish to prevent dental caries (76.7%), and managing dental emergencies (62.7%). Similarly, diagnosing dental caries and determining risk for caries shows low advanced or expert-level competency, with less than 8% reaching these higher skill levels. The reported competency levels revealed significant gaps in oral healthcare proficiency, which were not influenced by gender or professional rank. Furthermore, limited proficiency in communicating essential oral health information to patients was evident, with only 6.5% reporting advanced experience in advising patients against caries-promoting diets and less than 13% demonstrating advanced proficiency in counselling on the adverse oral health effects of tobacco. Numerous national and international studies have reported similar findings, emphasizing a widespread deficiency in oral health education and training throughout medical education [10, 30–38]. For example, Alshathri et al. and Gambhir et al. both reported limited oral health competencies among primary care providers, consistent with our findings [16, 18]. In contrast, studies conducted in settings where training initiatives had already been implemented (e.g., Dwiel et al.) reported higher competency levels, suggesting that variation across contexts may be explained by differences in training exposure and the educational frameworks available to PCPs [31].
A substantial proportion of PCPs (76.7%) reported having no or only limited experience with intraoral fluoride varnish application, a key preventive measure against dental caries in children. This finding is consistent with a systematic analysis that documented application rates below 10% [32]. Likewise, Clark et al. and Harnagea et al. reported that uptake of fluoride varnish remains low among PCPs internationally, reinforcing the consistency of our results. By contrast, studies reporting somewhat higher uptake highlighted the influence of supportive policies and accessible training, suggesting that variations in reimbursement systems and scope-of-practice definitions may account for the lower adoption observed in our sample [32, 39]. Reported barriers include inadequate training, lack of reimbursement, perceived scope-of-practice restrictions, and limited awareness of fluoride varnish’s role in caries prevention [22, 39]. Nevertheless, evidence indicates that targeted training can significantly improve both the frequency and proficiency of fluoride varnish application [32].
Similarly, 62.7% of PCPs reported limited experience in managing dental emergencies, and only 6.6% demonstrated advanced or expert-level proficiency. This lack of preparedness aligns with previous studies that have highlighted inadequate training in recognizing and managing oral health emergencies [10, 22, 37–39]. Appleby et al. also reported comparable deficiencies among general practitioners in managing acute oral conditions, underscoring the global nature of this gap. In contrast, settings where oral health training has been systematically integrated into medical education showed greater preparedness among PCPs, suggesting that the healthcare system context plays a critical role in shaping competencies [19]. Delays or inappropriate referrals can negatively impact patient outcomes, particularly in underserved areas where PCPs are often the first point of contact. Evidence suggests that integrating dental emergency management into medical training significantly improves PCPs’ ability to respond effectively to urgent oral health needs [39].
Our study highlights that positive perceptions about oral health significantly influence oral health care competencies among PCPs, independent of prior training (Coefficient = 0.33, 95% CI: 0.11 to 0.54). For example, higher perception scores were associated with improved ability to answer patients’ questions about oral health (OR: 1.10, 95% CI: 1.02–1.19), advise patients on oral hygiene practices (OR: 1.09, 95% CI: 1.01–1.18), and counsel on the adverse oral health effects of tobacco (OR: 1.10, 95% CI: 1.02–1.19). These findings suggest that the perceptions healthcare providers hold about the importance of oral health can independently influence their behaviour, even if they have not received specific training in this area. Therefore, fostering a positive outlook on oral health may enhance PCPs’ engagement in delivering oral health care even when formal training is absent. Another study emphasizes the role of perceptions and attitudes in shaping professional behaviour. For instance, Harnagea et al. [32] demonstrated that a positive belief in the importance of oral health care motivates PCPs to integrate preventive practices into their routine [32]. Similarly, Douglass et al. noted that attitudes toward oral health strongly predict the likelihood of initiating oral health conversations with patients [37]. Our findings build on this evidence by demonstrating a direct association between perceptions and competency outcomes, even after adjusting for prior training. The more substantial influence of perceptions observed in our study, compared with some previous reports, may reflect contextual factors whereby motivated PCPs compensate for training gaps through self-directed learning or by seeking guidance from colleagues.
Our regression analysis revealed that participants with prior oral health education scored significantly higher on competency assessments, demonstrating an adjusted competency score 5.2 points higher than those without such training (95% CI: −8.66, −1.74). However, systemic and attitudinal barriers can hinder PCPs’ involvement in oral health education. Over half (57%) reported a lack of time for additional training, nearly half (46%) perceived oral health care as outside their scope of practice, and a quarter (25%) expressed a lack of interest in oral health. These findings underscore the need to clarify shared responsibilities for oral health within healthcare teams and highlight motivational barriers to effective collaboration. A lack of awareness about the importance of oral health often contributes to this [22, 30]. Financial barriers also contribute to the limited participation of PCPs in oral health training, with only 27% of PCPs indicating a willingness to pay for oral health training, reflecting limited ability or motivation to invest in such education. The findings are consistent with Simon et al. [22], who noted that non-payment for oral health services performed by PCPs and the perceived cost of training further discourage PCPs from acquiring these competencies [22]. Our results align with Lewis et al., who found that targeted pediatric training programs significantly improved oral health competencies, suggesting that limited access to such opportunities may explain the lower scores in our study [30]. Overall, training exposure is a consistent determinant of competency, though financial and organizational barriers may constrain its impact.
Understanding PCPs’ preferred training formats is essential for designing effective interventions. Self-directed learning (37.4%), live online courses (32.7%), and in-person courses (31.8%) were the most preferred formats of instruction. Evidence supports the effectiveness of flexible and accessible training methods in enhancing oral health competencies among PCPs [32]. Additionally, peer-learning approaches, such as consulting dentist colleagues (31.8%) and shadowing dentists in clinics (23.4%), reflect the growing emphasis on interprofessional collaboration, which has been shown to enhance oral health knowledge and foster team-based care [38]. Dwiel et al. and Appleby et al. similarly emphasized the value of collaborative, hands-on learning strategies for enhancing primary care providers’ skills, underscoring the universal importance of experiential and interprofessional training [19, 31]. In our study, however, participants showed a stronger preference for self-directed learning, likely reflecting the growing accessibility of digital platforms in Saudi Arabia. Most PCPs (38.1%) favoured integrating oral health education into medical school curricula, followed by 28.6% who preferred incorporation into residency programs. Aligning training initiatives with these preferences—through a mix of online and in-person formats—could enhance engagement and sustainability. Consistent with Harnagea et al., our findings support combining flexible formats with interprofessional education to bridge oral health training gaps [38] effectively.
Therefore, to address competency gaps of PCPs in oral healthcare, targeted educational interventions and systemic support are crucial. The Institute of Medicine emphasized the importance of embedding oral health education into pre-service training to create a sustainable foundation for addressing oral health disparities [23]. Integrating oral health training into medical school curricula and residency programs is essential for establishing a solid foundation in areas such as oral health communication, fluoride varnish application, and dental emergency management. Programs such as the Smiles for Life National Oral Health Curriculum, developed by the Society of Teachers of Family Medicine, offer comprehensive modules that emphasize the critical role of primary care clinicians in promoting oral health [24, 25]. These curricula serve as effective models for integrating oral health education into existing medical training frameworks.
Furthermore, continuing medical education (CME) courses, subsidized by government initiatives, can further bridge training gaps while avoiding financial barriers. Targeted training significantly improves PCPs’ proficiency [33], and provision of resources like oral health toolkits enhances confidence and integrates oral health into primary care [38]. Interprofessional collaboration with dental professionals has also been shown to improve teamwork and care coordination [26, 30]. Beyond knowledge, interventions that foster positive perceptions of oral health, such as campaigns, peer role modelling, and professional workshops, can enhance PCP engagement in oral health care [31]. Our findings align with Douglass et al. and Lewis et al., who showed that structured curricula and continuing medical education enhance oral health competencies among PCPs [30, 37]. Differences in adoption rates across studies likely reflect variations in institutional support and the integration of dental services within healthcare systems. Overall, training interventions are most effective when combined with systemic alignment, policy support, and interprofessional collaboration, enabling primary care providers to play a stronger role in improving oral health outcomes.
This study has several strengths that enhance its contribution to understanding the competencies of primary care providers in oral health care. The inclusion of a wide range of competencies, from medical history taking to managing dental emergencies, provides a holistic evaluation of PCPs’ skills. Additionally, the study’s focus on both competency levels and perceptions highlights the interplay between attitudes and skills, offering actionable insights for improving oral health education. However, the study has limitations. The sample size of 107 participants is representative of PCPs in Jeddah, which may restrict the applicability of the findings to different regions or healthcare systems with varying contexts and practices. Selection bias could also be present, as participation was voluntary and may have attracted physicians with a pre-existing interest in oral health. Finally, although the study identifies associations between variables and competency, its cross-sectional design does not permit causal inferences to be made. Similar limitations have been reported in prior national and international studies [10, 30–38], many of which used cross-sectional survey designs with limited generalizability. Future research should therefore employ longitudinal or interventional approaches better to evaluate the causal impact of training and system-level reforms.
Conclusion
This study highlights significant gaps in the competencies of primary care physicians in essential oral health care tasks, including taking oral health histories and performing oral examinations, determining patients’ risk for dental caries, applying fluoride varnish, and managing dental emergencies. Positive perceptions about oral health were found to independently enhance specific competencies, emphasizing the need to foster favourable attitudes alongside targeted education. Key recommendations include integrating oral health training into medical curricula, offering subsidized continuing education programs, and promoting interprofessional collaboration to bridge these gaps. A unified, systematic approach is essential to empower PCPs in leading oral health promotion and enhancing patient outcomes.
Supplementary Information
Acknowledgements
The authors gratefully acknowledge the assistance of Dr. Mahmoud Mouawad and Dr. Shahd Alassiri in data collection and in obtaining approval letters from the Ministry of Health and the Saudi Commission for Health Specialties.
Abbreviations
- PCPs
Primary Care Physicians
- PHCs
Primary Health Centres
- CIs
Confidence Interval
- OR
Odd Ratios
- CME
Continuing Medical Education
Authors’ contributions
All the authors contribute equally to the study.
Funding
No funding was required during this study.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
The study adhered to the principles of the Declaration of Helsinki and received ethical approval from the Research Ethics Committee of the Faculty of Dentistry, King Abdulaziz University (063-06-20), and the Institutional Review Board of the Ministry of Health (20-665E) (IRB). Informed consent was obtained from all participants, and anonymity was maintained throughout the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
No datasets were generated or analysed during the current study.