Exploring the knowledge gap in dental stem cell therapy: educational challenges and adoption attitudes among Palestinian dentists

Abstract

Background

Dental stem cell therapy (DSCT) is a promising domain in regenerative dentistry, yet the knowledge base, perceived barriers, and adoption readiness among practicing dentists remain unclear. This study assessed knowledge, attitudes, perceived barriers, and willingness to adopt DSCT among Palestinian dentists.

Methods

We conducted a cross-sectional, web-based survey of licensed dentists in the West Bank (January–August 2024). Recruitment occurred via closed professional groups; one response per account was enforced. The knowledge index comprised six single-best multiple-choice questions (three options + “Don’t know”); scoring was 1 for correct and 0 for incorrect/“Don’t know” (range 0–6), classified as low (0–2), moderate (3–4), and high (5–6). Attitudes and ethical concerns were assessed using structured categorical items and Likert-type statements, and willingness to adopt DSCT was measured using a four-option item (“Yes,” “have reservations,” “not interested,” “No”), analysed as Yes vs. other responses. Bivariate associations used χ² with Cramér’s V; adjusted analyses used ordinal logistic regression for knowledge and binary logistic regression for willingness.

Results

Among 330 dentists, knowledge was low in 73.3%, moderate in 21.5%, and high in 5.2%; 69.7% reported willingness to adopt DSCT. Age was associated with higher knowledge (Cramér’s V 0.382; 95% CI 0.334–0.454). In adjusted analyses, older age independently predicted higher knowledge (e.g., > 50 vs. 23–30: aOR 8.88; 95% CI 1.87–42.05; p = 0.006). For willingness, orthodontists were less willing than general dentists (aOR 0.05; 95% CI 0.01–0.42), whereas a higher likelihood of pursuing continuing education predicted willingness (aOR 3.54; 95% CI 1.60–7.79). The most cited barriers were lack of knowledge (43.9%), cost (26.1%), and ethical concerns (14.5%).

Conclusions

Most dentists demonstrated low DSCT knowledge but substantial willingness to adopt. Targeted education (undergraduate and continuing), practical guidance, and clearer regulatory direction may help address knowledge gaps and perceived barriers in Palestine.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08880-x.

Introduction

Regenerative dentistry has emerged as a transformative approach for tissue repair and regeneration. Dental stem cells including dental pulp stem cells (DPSCs), stem cells from human exfoliated deciduous teeth (SHED), and periodontal ligament stem cells (PDLSCs) hold significant potential for endodontic repair, bone augmentation, and periodontal tissue regeneration [1–3]. However, despite technological advancements, the clinical adoption of stem cell-based therapies remains limited, partly due to persistent knowledge gaps, ethical concerns, and regulatory uncertainties [4, 5]. In addition, implementation barriers frequently reported across translational and clinical contexts include high costs, lack of standardised protocols and good manufacturing practice (GMP) compatible facilities, limited long-term clinical evidence, reimbursement constraints, and the absence of professional guidelines for routine use [4–7].

Structured education is essential for integrating regenerative dentistry into clinical practice. In certain settings (e.g., selected European and Commonwealth countries), competency-based educational frameworks and structured training pathways have been discussed and, in some cases, incorporated into professional development initiatives related to regenerative and cell-based therapies [6, 7]. Palestine remains focused on conventional treatment approaches with limited exposure to regenerative applications, including DSCT [8]. Evidence from other settings suggests that knowledge deficits are common and may limit readiness for safe implementation. For example, surveys in Saudi Arabia, Brazil, and Malaysia have reported low-to-moderate practitioner knowledge regarding core domains such as dental stem cell sources and types, potential clinical indications, stem cell banking concepts, and ethical/regulatory considerations, even when attitudes toward regenerative approaches were generally favourable [8–10]. These findings are relevant to the Palestinian context, where limited curricular exposure and constrained access to specialised training may further reduce familiarity with DSCT and increase uncertainty regarding feasibility and safe clinical integration.

To our knowledge, additional barriers in Palestine include the absence of local postgraduate stem cell-based training opportunities and the lack of standardised clinical guidance, where dentists often seek education abroad, and without national regulatory frameworks, concerns regarding patient safety, liability, and ethical practice persist. Compared with parts of Europe and the United States, where regulatory pathways and professional guidance help standardise stem cell-based applications, Palestinian dental curricula have limited emphasis on translational competence in regenerative dentistry, and national licensing standards specific to regenerative procedures are not established [11].

This study aims to evaluate Palestinian dentists’ knowledge, attitudes, and perceived barriers toward adopting dental stem cell therapy. By examining local trends and relating them to the international literature, it seeks to inform evidence-based curricular interventions and support the development of competency-based training programs tailored to Palestinian practitioners.

Methods

Study design and setting

We conducted a cross-sectional, web-based survey of licensed dental practitioners in the West Bank, Palestine. Participants were recruited via closed professional networks (alumni WhatsApp groups and moderated Facebook groups). Reporting followed STROBE (cross-sectional studies) and CHERRIES (web surveys) [12, 13]. The questionnaire was administered in Google Forms with a one-response-per-account restriction. Electronic informed consent was obtained prior to entry. No incentives were offered. Responses were anonymous, and analyses were performed on complete cases. The survey was open from January through August 2024.

Recruitment through closed online groups was chosen due to feasibility constraints during the study period; however, this approach may preferentially reach dentists who are more digitally connected or education-oriented, which could influence representativeness and may under-represent dentists who are less digitally engaged or less connected to professional networks, including those practicing in settings with limited access to these channels.

Participants and recruitment

Eligible participants were licensed dentists with at least one year of clinical practice in any specialty (public or private). Dental students and non-practicing professionals were excluded. Approximately 400 invitations were distributed; 350 responses were received. After excluding 20 incomplete entries, 330 complete surveys were analysed (completion rate 94.3%; participation ≈ 87.5%; usable ≈ 82.5%).

Sample Size

Assuming a source population of approximately 2,000–3,000 dentists, we applied Cochran’s formula with p = 0.50, Z = 1.96, and e = 0.05, and the finite population correction, yielding a target of ~ n=323–341. We pre-specified n = 330 to maintain ≥ 80% power for medium effects at α = 0.05 (G*Power 3.1) [14, 15].

Questionnaire development

We adapted items from previously validated surveys conducted in Saudi Arabia, Brazil, and Malaysia [8–10]. Questionnaire development followed a structured process: a focused literature-informed review of existing instruments guided an initial item pool aligned with the study constructs (knowledge, attitudes/ethical concerns, perceived barriers, and future perspectives). An expert panel (3 dental educators, 1 bioethicist, and 1 biostatistician) evaluated item relevance, clarity, and construct coverage. The draft questionnaire was piloted with 30 practicing dentists to assess clarity, comprehension, and completion flow. Based on pilot feedback and expert review, wording and formatting were refined to reduce ambiguity and improve readability; response formats were standardised (including consistent placement of “Don’t know” in knowledge items). Items with weak discrimination (corrected item–total correlation < 0.30) were revised or removed prior to final deployment. The final questionnaire is provided in the Supplementary Survey instrument file.

Questionnaire structure

The final questionnaire consisted of five main sections:

1. Demographic information: age, gender, years of experience, specialty, and level of education.

2. General knowledge of DSCT: six factual items covering classification and validated sources of dental stem cells, standard clinical guidance relevant to regenerative endodontic procedures, isolation/characterisation principles, and the roles of scaffolds and growth factors in tissue engineering.

3. Attitudes toward DSCT: willingness to adopt DSCT upon clinical approval (response options: “Yes,” “have reservations,” “not interested,” “No”) and additional structured attitude/ethical concern items.

4. Barriers to adoption: pre-specified options (“lack of knowledge,” “high cost,” “ethical concerns,” “lack of training,” “regulatory issues”) plus an open “other” category.

5. Future perspectives: anticipated applications, interest in postgraduate training, and views on incorporating regenerative dentistry into undergraduate education.

Measures and Scoring

Knowledge scoring and classification

Knowledge was assessed using six single-best multiple-choice items (three options plus ‘Don’t know’). Responses were scored as 1 = correct and 0 = incorrect/‘Don’t know’ to form a summed knowledge index (range 0–6). Because these items function as a brief factual knowledge test rather than a unidimensional psychometric scale, internal consistency reliability was not emphasized in the main analysis. Item-level accuracy is reported in Supplementary Table S5. For interpretability, cut-offs were pre-specified as low (0–2), moderate (3–4), and high (5–6), corresponding to ≤ 2 correct answers (≤ 33%), 3–4 correct answers (50–67%), and ≥ 5 correct answers (≥ 83%), respectively. These thresholds reflect natural groupings for a six-item score and are consistent with defensible standard-setting approaches and rule-of-thumb “mastery” thresholds (≈ 80%) used in educational assessment [16].

Attitudes, willingness, and continuing education likelihood

Willingness to adopt DSCT was assessed by the item: “Would you adopt dental stem cell therapy upon clinical approval?” with response options “Yes,” “have reservations,” “not interested,” or “No.” For multivariable analyses, willingness was coded as a binary outcome (Yes = 1 vs. Other = 0). Continuing education (CE) likelihood was modeled using the item: “How likely are you to participate in continuing education programs?” with categories Neither likely nor unlikely / Unlikely / Likely.

Statistical Analysis

Analyses used complete cases (N = 330). First, descriptive statistics (n, %) summarised participant characteristics and item-level response distributions. Second, bivariate associations were tested using χ² tests with effect size reported as Cramér’s V; 95% confidence intervals for Cramér’s V were obtained via nonparametric bootstrapping (1,000 resamples). Item-level 95% confidence intervals were calculated using Wilson intervals.

The following categorical associations were examined using χ²/Cramér’s V:

• Knowledge level (low/moderate/high) × age group, gender, years of experience, specialty, and education level.

• Willingness (Yes vs. Other) × age group, gender, years of experience, specialty, and education level.

• Main barrier category × years of experience (for Fig. 4 and Supplementary Table S10).

Fig. 4.

Main barrier category by years of experience (N=330; single-choice item). Perceived barriers to adoption of dental stem cell therapy by years of experience. Reported barriers stratified by years of professional experience. Less experienced dentists (0–10 years) primarily cited lack of knowledge, while more experienced practitioners (> 10 years) highlighted financial and ethical concerns. The association between years of experience and barriers was significant (χ² = 43.16, p = 0.003; Cramér’s V = 0.21). See Supplementary Table S10

Third, multivariable models were fitted to identify independent predictors. Predictors of knowledge (ordinal; proportional-odds ordinal logistic regression) and willingness (binary; logistic regression) were modeled adjusting for age group, gender, specialty, education, and CE likelihood. Model fit was assessed with likelihood-ratio tests; for the ordinal model, the proportional-odds assumption was evaluated using standard diagnostics (Test of Parallel Lines). Adjusted odds ratios (aORs) with 95% confidence intervals are reported. For the willingness model, McFadden’s pseudo-R² is reported.

“Other specialties” (n = 63), combining Oral surgery (n = 12), Pediatric dentistry (n = 14), Periodontics (n = 8), and the small-count specialties grouped in Table S6 (n = 29). Regression models used category collapsing only where needed to address sparse cells (n < 10) or quasi-complete separation (Table S7).

Ethics declaration

Ethics Approval and consent to participate

The study protocol was reviewed by the Bahçeşehir University Non-Interventional Studies Ethics Committee (Approval No. 2025-12/11). The committee determined that the study met the criteria for exemption from full ethical review, as it involved an anonymous, minimal-risk survey and did not include the collection of identifiable personal data. Electronic informed consent was obtained from all participants prior to participation. Before accessing the questionnaire, participants were provided with an information page detailing the study purpose, the voluntary nature of participation, confidentiality, and the right to withdraw at any time without consequences. Proceeding to the survey constituted informed consent. All procedures were conducted in accordance with the Declaration of Helsinki.

Results

Demographic Characteristics

Respondents were 57.3% female (n = 189) and 42.7% male (n = 141). Age distribution: 23–30 years (41.2%, n = 136), 31–40 years (29.1%, n = 96), 41–50 years (21.5%, n = 71), and > 50 years (8.2%, n = 27). Specialties included general dentists (71.5%, n = 236), endodontists (4.8%, n = 16), orthodontists (4.5%, n = 15), pediatric dentists (4.2%, n = 14), and oral surgeons (3.6%, n = 12). Years of experience: >15 years (32.1%, n = 106), 0–5 years (30.0%, n = 99), 6–10 years (19.1%, n = 63), and 11–15 years (18.8%, n = 62). Participant demographics, specialties, education level, knowledge categories, willingness, and reported barriers are summarized in Supplementary Table S1.

Knowledge levels

Overall, 73.3% (n = 242) were classified as low, 21.5% (n = 71) moderate, and 5.2% (n = 17) high (Fig. 1).

Fig. 1.

Knowledge levels of dental stem cell therapy among participants. Knowledge levels of dental stem cell therapy among Palestinian dentists (n = 330). Stacked bar chart showing the distribution of knowledge categories derived from a 6-item single-best MCQ index. Categories: Low = 0–2, Moderate = 3–4, High = 5–6 correct answers (scoring: 1 for correct; 0 for incorrect/ “Don’t know”)

Item-level performance

Younger dentists exhibited significantly lower knowledge than older peers (Fig. 2). Knowledge differences by age, specialty, and experience are detailed in Supplementary Tables S2–S4.

Fig. 2.

Age vs. knowledge level of dental stem cell theraphy. Association between age group and knowledge level. Clustered distribution of knowledge categories by age group. A significant association was observed (χ² = 96.14, p < 0.001; Cramér’s V = 0.382; 95% CI 0.334–0.454)

Attitudes Toward Adoption

Item-level performance

At the item level, accuracy ranged from 2.7% in Q5 (scaffolds/growth-factor role) to 55.8% in Q4 (validated sources) and Q6 (REP irrigant protocol) (N = 330; 95% Wilson CIs). See Supplementary Table S5/Figure S1.

Attitudes toward adoption

Overall, 69.7% (n = 230) of participants expressed willingness to integrate dental stem cell therapy into their practice once it becomes clinically approved and they receive appropriate knowledge and training. Bivariate associations between specialty and willingness were significant (p < 0.001; Cramér’s V = 0.333; 95% CI 0.270–0.435). Descriptively, oral surgery and endodontics showed high proportions of ‘Yes’ (Fig. 3); in adjusted analysis, only Orthodontics differed significantly (lower willingness vs general dentistry). See Supplementary Table S6 and Table S7 for the adjusted.

Fig. 3.

Specialty vs willingness to adopt dental stem cell therapy. Willingness to adopt dental stem cell therapy by specialty. Counts of respondents in each specialty expressing willingness (Yes’) versus other responses. Note: Values reflect descriptive proportions. Bivariate association: Cramér’s V = 0.333 (95% CI 0.270–0.435), p < 0.001. See Supplementary Table S7 for adjusted specialty effects

Perceived barriers

The main barriers were lack of knowledge (43.9%, n = 145), high cost (26.1%, n = 86), and ethical considerations (14.5%, n = 48). See Supplementary Table S1.

For analysis, years of experience were retained as four strata (0–5, 6–10, 11–15, > 15 years) to match Fig. 4 (stratum n: 99, 63, 62, 106). Distributions of the main barrier differed by experience (χ² (21) = 43.16, p = 0.003; Cramér’s V = 0.21, moderate). Less-experienced dentists (0–10 years) more often selected knowledge gaps, whereas more-experienced groups (≥ 11 years) more often selected cost, ethical, and regulatory barriers. (A separate yes/no attitude item showed 17.9% endorsed a general ethical concern; this item was independent of the “main barrier” question). See Supplementary Table S10.

As additional descriptives, 51.2% intended to attend DSCT-related education/training, and 65.8% of participants believed DSCT should be included in undergraduate curricula. See Supplementary Table S1.

Adjusted analyses

Knowledge Level (ordinal; low → moderate → high)

Using a proportional-odds ordinal logistic model adjusting for age group, gender, specialty, education, and continuing-education (CE) likelihood, both age and education were independently associated with higher knowledge (e.g., > 50 vs. 23–30: aOR 8.88; 95% CI 1.87–42.05; p = 0.006). Older groups showed higher odds of being in a higher knowledge category. Postgraduate degrees were associated with higher knowledge than a Bachelor’s (Master’s vs. Bachelor’s: aOR 5.51, 1.30–23.40; Doctorate vs. Bachelor’s: aOR 27.84, 3.78–205.19).

Specialty differences were notable (e.g., Endodontist vs. General dentist aOR 16.68, 95% CI 2.61–106.61; p = 0.003), with several specialties showing higher odds of greater knowledge. Gender and CE likelihood were not independently associated (both p > 0.05). See Supplementary Table S9.1. The proportional-odds assumption was not rejected in a sensitivity analysis using the score index knowledge outcome (Test of Parallel Lines via LR comparison: χ² (8) = 6.10, p = 0.64). See Supplementary Table S9.2.

Willingness to adopt DSCT (binary; Yes = 1 vs. Other = 0)

In multivariable logistic regression predicting willingness to adopt DSCT (Yes vs. all other responses; Table S7), older age was associated with lower willingness compared with the 23–30-year group (31–40 years: aOR 0.25, 95% CI 0.13–0.51; >50 years: aOR 0.09, 95% CI 0.03–0.31). Compared with general dentists, orthodontists showed substantially lower willingness (aOR 0.05, 95% CI 0.01–0.42). Prior DSCT-related continuing education (CE) was associated with higher willingness to adopt DSCT, though estimates were imprecise (wide confidence intervals). Findings should be interpreted cautiously due to potential sparse cells and residual confounding.

Reporting likely CE participation was positively associated with willingness (aOR 3.54 [1.60–7.79], p = 0.002), whereas unlikely was negatively associated (aOR 0.42 [0.20–0.85], p = 0.016).

Relative to 23–30 years, 31–40 and > 50 showed lower adjusted odds of willingness 41–50 was not significant (aOR 0.65 [0.24–1.76], p = 0.394). Education and gender were not independent predictors (p > 0.05). See Supplementary Table S7. The logistic model was significant by likelihood-ratio test (p = 1.062 × 10⁻¹¹) and showed McFadden pseudo-R² = 0.202.

These multivariable findings are consistent with the bivariate effects in Supplementary Table S8, which show a moderate association for age versus knowledge (Cramér’s V 0.382; 95% CI 0.334–0.454; p < 0.001) and specialty versus willingness (Cramér’s V 0.333; 95% CI 0.270–0.435; p < 0.001), while specialist status (yes/no) showed a small, non-significant association (Cramér’s V 0.080; 95% CI 0.006–0.185; p = 0.145).

Discussion

This study provides one of the first empirical assessments of Palestinian dentists’ knowledge, attitudes, and willingness to adopt dental stem cell therapy (DSCT) using an item-based knowledge index alongside perceived barrier. By quantifying both knowledge levels and adoption readiness and identifying demographic and professional correlates, our findings contribute locally relevant evidence to inform curriculum design, continuing education priorities, and future implementation planning for regenerative dentistry.

Knowledge gaps and demographic influences

The most prominent finding was the high prevalence of low DSCT knowledge, with clear differences by age and education level. Beyond the item accuracy differences, respondents struggled most with mechanistic and translational concepts (e.g., scaffolds and growth factors), whereas items aligned with more established clinical guidance (validated sources and REP irrigants) showed comparatively better performance. The very low facility of item Q5 likely reflects its focus on advanced mechanistic content rather than a scoring or coding issue. This pattern suggests a gap in translational competence, where learners may need structured support to connect biomaterials and tissue-engineering principles with clinical decision-making rather than only recalling procedural guidance [6, 7, 11, 17]. Age-related differences were also observed; these may reflect cohort differences in exposure and accumulated learning opportunities rather than causation, with senior clinicians potentially gaining familiarity through clinical practice, continuing education, or self-directed learning [5, 6, 8, 9].

Internationally, similar knowledge deficits have been reported among dental practitioners in Saudi Arabia, Brazil, and Malaysia, particularly in domains related to stem cell sources/types, clinical indications, stem cell banking concepts, and ethical/regulatory considerations [8–10]. The pattern observed in our item-level results—stronger performance on established clinical guidance but weaker performance on translational concepts such as scaffolds and growth factors—supports the interpretation that the main gap may be mechanistic integration rather than awareness alone, consistent with surveys emphasizing limited structured training in regenerative dentistry [8–10, 18]. Despite low knowledge, willingness to adopt DSCT in our sample remained relatively high, mirroring reports from settings where attitudes are favorable, but implementation is constrained by training access, cost, and governance uncertainty [8–10, 18, 19]. These cross-country similarities suggest that educational and implementation barriers are not unique to Palestine; however, the absence of local postgraduate pathways and national guidance may amplify uncertainty and slow responsible adoption.

Willingness to adopt DSCT and the age-related discrepancy

Despite limited knowledge, most dentists reported willingness to adopt DSCT if clinically approved and accompanied by adequate training. Notably, older dentists showed higher knowledge but lower willingness in adjusted analyses. This discrepancy may reflect a more cautious adoption stance among senior clinicians, potentially driven by higher sensitivity to implementation risks (e.g., cost implications, regulatory uncertainty, liability, or patient-safety concerns) [8, 10] rather than lack of awareness. In contrast, younger dentists may be more open to innovation but underexposed to the foundational and translational science needed for confident, evidence-based adoption [6]. Future work should directly measure perceived risk, regulatory trust, financial feasibility, and professional liability perceptions to clarify mechanisms underlying this age divergence.

Specialty-based differences

Differences across specialties were also apparent. Descriptively, endodontists and oral surgeons showed high willingness proportions, consistent with the closer conceptual alignment between regenerative innovations and procedures involving pulp–dentin complex preservation and tissue repair. In adjusted analyses, orthodontists were less willing than general dentists. Because some specialty categories were small, resulting in wide confidence intervals, these subgroup estimates should be interpreted cautiously; nevertheless, the observed patterns support the need for specialty-tailored training and guidance, particularly for general dentists who constitute the largest segment of the workforce and may have fewer structured opportunities for exposure to regenerative modalities [6–8, 18].

Barriers and ethical considerations

Lack of knowledge and awareness was the most frequently cited barrier, followed by high cost and ethical concerns. These barriers align with broader reports that financial constraints and limited access to specialised training can inhibit clinical translation of regenerative approaches, particularly in resource-constrained settings [8, 9, 18, 19]. Ethical concerns, especially related to sourcing, consent, and patient safety may be amplified when national frameworks and professional guidelines are perceived as insufficiently clear [4, 5]. In settings with established governance structures and professional guidance, clearer pathways may reduce uncertainty and facilitate responsible implementation, as reflected in structured guidance and regulatory oversight reported in higher-resource contexts [20, 21].

Implications for education and policy

Taken together, the findings support two immediate priorities: strengthening competency-oriented education and improving implementation readiness. Educationally, bridging the translational gap likely requires integrating regenerative concepts into undergraduate curricula and providing continuing education that combines scientific foundations with clinically contextualised training (e.g., case-based and skills-oriented learning) rather than relying solely on didactic exposure [7]. At the policy and systems level, clearer professional guidance and regulatory direction alongside feasible training pathways may reduce ethical uncertainty and strengthen clinician confidence in responsible translation [6, 20, 21]. Future research should move beyond knowledge and intention measures to assess competency-based performance outcomes, implementation feasibility (including cost), and longitudinal changes after structured training interventions, including evaluation of digital decision-support approaches and emerging AI-enabled workflows in regenerative dentistry [22].

Study limitations

This study has several limitations. Convenience sampling through closed professional online networks may have introduced selection and coverage biases if dentists who are less digitally engaged, less connected to professional groups, or less education-oriented differ systematically from participants. The online, self-administered format may have favoured respondents with a greater interest in regenerative dentistry, introducing response/self-selection bias. Although one response per account was enforced, submissions from multiple Google accounts cannot be fully excluded. Knowledge was assessed using a brief 6-item single-best-answer MCQ index in a web survey; such items are susceptible to guessing and provide limited content coverage, which may under- or overestimate true competence. The cross-sectional design precludes causal inference, so associations with age or experience cannot be attributed to curricular exposure or postgraduate training. Regulatory and policy barriers were not comprehensively measured beyond the barrier options included. Finally, some specialty categories had small counts, resulting in wide confidence intervals and potential instability in subgroup estimates; these findings should be interpreted cautiously, and future studies should consider planned category aggregation and/or larger specialty-stratified samples. Future studies should incorporate objective competency-based assessments and mixed-methods designs (e.g., interviews or focus groups) to contextualise risk perception, feasibility constraints, and ethical/regulatory concerns. Methodologically, probability-based or stratified sampling frames would further strengthen generalisability.

Conclusion

This cross-sectional survey found that most Palestinian dentists had low knowledge of dental stem cell therapy, although nearly two-thirds reported willingness to adopt DSCT if clinically approved and supported by adequate training. Knowledge was higher in older and more highly educated respondents, while willingness varied by specialty and was positively associated with intention to pursue continuing education; orthodontists showed lower adjusted willingness than general dentists. The most frequently reported barriers were lack of knowledge/awareness, high cost, and ethical concerns. These findings support strengthening DSCT content and translational competence within dental education and continuing professional development and highlight the need for clearer guidance and feasibility-oriented planning to address major implementation barriers.

Abbreviations

aOR

Adjusted odds ratio

CE

Continuing education

CHERRIES

Checklist for Reporting Results of Internet E—Surveys

CI

Confidence interval

DK

Don’t know (response option)

DPSCs

Dental pulp stem cells

DSCT

Dental stem cell therapy

EDTA

Ethylenediaminetetraacetic acid

FPC

Finite population correction

G*Power

General Power Analysis program (G*Power)

LR

Likelihood—ratio test

MCQs

Multiple—choice questions

MTA

Mineral trioxide aggregate

NaOCl

Sodium hypochlorite

OR

Odds ratio

PDLSCs

Periodontal ligament stem cells

REP(s)

Regenerative endodontic procedure(s)

SHED

Stem cells from human exfoliated deciduous teeth

SPSS

Statistical Package for the Social Sciences

STROBE

Strengthening the Reporting of Observational Studies in Epidemiology

V

Cramér’s V

Authors’ contributions

Zahedah R. conceived and designed the study, performed the data analysis, and drafted and revised the manuscript.Jaber M. contributed to data collection and survey distribution.Dinç B. provided an independent review of the study protocol for ethical compliance and reviewed the manuscript.All authors read and approved the final manuscript.

Funding

This study received no external funding support.

Data availability

All data analysed during this study, including the full questionnaire used and detailed results, are provided within this published article and its Supplementary Survey instrument and Supplementary Tables files.

Declarations

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.