Are dental practitioners prepared to recognize stomatognathic movement disorders? A cross-sectional study of knowledge, diagnostic confidence, and educational needs

Abstract

Background

Stomatognathic movement disorders (SMDs) are uncommon but clinically significant neurological conditions that frequently present with orofacial manifestations. Because affected patients may initially seek care from dental practitioners, limited awareness of these disorders could contribute to diagnostic confusion with temporomandibular disorders (TMDs) and may have implications for timely referral and appropriate patient management. This study evaluated dental practitioners’ knowledge, diagnostic confidence, and educational preparedness regarding SMDs.

Methods

A cross-sectional survey was conducted among dental practitioners using a validated self-administered online questionnaire. Knowledge scores were calculated out of 25 points and expressed as percentages. Comparative analyses were performed across educational levels using one-way ANOVA, chi-square tests, and multivariable logistic regression.

Results

A total of 156 dental practitioners participated. Mean knowledge scores differed significantly across academic level (Bachelor: 44.05%, Master: 48.95%, Doctorate: 63.71%; p < 0.001). Doctoral-level education independently predicted adequate knowledge (OR = 8.54, 95% CI: 2.09–34.97; p = 0.003), whereas master’s-level showed no significant effect. Knowledge gaps were observed in several domains, particularly in distinguishing SMDs from TMDs and in the management of oromandibular dystonia. Only a minority of participants correctly recognized that temporomandibular joint radiographs are not routinely required prior to treatment. Self-reported clinical confidence was generally low, with only 1.1% of general dentists reporting the ability to independently manage suspected SMD cases. Nevertheless, 94.9% of participants supported integrating SMD-related content into dental curricula.

Conclusion

The surveyed dental practitioners demonstrated important knowledge gaps regarding SMDs. These findings highlight opportunities to strengthen undergraduate and continuing dental education in the recognition, differentiation from TMDs, and appropriate referral of patients with suspected SMDs.

Introduction

Stomatognathic movement disorders (SMDs) comprise a heterogeneous group of neurological conditions characterized by involuntary motor activity involving the orofacial and masticatory system. Clinically, these disorders manifest as sustained or intermittent muscle contractions or as continuous, repetitive movements affecting the masticatory muscles, lips, cheeks, tongue, and pharynx. The SMD spectrum includes well-defined entities such as oromandibular dystonia (OMD), hemimasticatory spasm (HMS), orofacial dyskinesia, and functional (psychogenic) stomatognathic movement disorders (FSMDs) [1]. Collectively, these conditions can profoundly disrupt fundamental oral functions, including speech, mastication, and swallowing, thereby exerting a substantial negative impact on patients’ quality of life and psychosocial well-being [2].

Although comprehensive epidemiological data on SMDs are limited, available evidence suggests that these disorders are sufficiently prevalent to warrant their recognition as a relevant and clinically significant component of contemporary dental practice [1, 3–6]. Importantly, the clinical presentation of SMDs frequently overlaps with more common dental and orofacial conditions, particularly temporomandibular disorders (TMD) and bruxism [7, 8]. This overlap poses a major diagnostic challenge, increasing the likelihood of misinterpretation and diagnostic error in routine dental settings.

Dental professionals, both general dentists and specialists, may be among the first healthcare providers consulted by patients presenting with chronic orofacial pain, functional disturbances, or unexplained jaw movements. Consequently, their ability to recognize SMDs and to differentiate them from dental or musculoskeletal conditions is important [3, 4]. Limited recognition of these disorders may contribute to diagnostic uncertainty and could have implications for timely referral and appropriate patient management [3, 4, 9, 10].

Despite a growing body of literature addressing the clinical features, pathophysiology, and therapeutic approaches to SMDs [1, 11–14], empirical data evaluating dental professionals’ knowledge, diagnostic preparedness, and educational exposure to these disorders remain remarkably limited.

To the best of our knowledge, no previous investigation in any country has systematically quantified dental practitioners’ knowledge, self-reported diagnostic confidence, or educational preparedness regarding SMDs. This represents a critical gap in the literature, particularly given the frontline role of dentists in the care pathway of affected patients.

The present study was designed to address this gap. Its primary objective was to systematically evaluate the level of knowledge regarding SMDs among dental practitioners. Secondary objectives were to assess self-reported diagnostic confidence and to explore professional perceptions regarding the need for integrating SMD-related content into formal dental education curricula and continuing professional development programs.

Materials and methods

Study design and ethical considerations

This study employed a cross-sectional descriptive and analytical design. Because this was an exploratory study and no centralized, accessible, and routinely updated national registry of licensed dental practitioners was available in Yemen, a non-probability convenience sampling strategy was adopted. Ethical approval was obtained from the Ethics Committee of Ibn Al-Nafis University for Medical Sciences (Protocol No. 20/4/25). Participation was voluntary and anonymous, and informed consent was implied through completion of the online questionnaire. All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki and its subsequent amendments.

Study population and setting

This study included licensed dental practitioners currently practicing in Yemen. Eligibility criteria required participants to hold at least a Bachelor of Dental Surgery (BDS) degree or an equivalent qualification and to be actively engaged in clinical practice. Dental students and interns were excluded.

Participants were recruited using a non-probability convenience sampling approach between May and June 2025. Initial invitations were extended through the researchers’ professional and personal networks on social media platforms, followed by dissemination through private dental groups to broaden recruitment across different regions and professional backgrounds. Data were collected using a structured, self-administered online questionnaire administered via Google Forms, facilitating efficient nationwide distribution.

To broaden participant recruitment and reduce potential selection bias, the survey was disseminated through multiple independent professional groups rather than a single network. Nevertheless, practitioners with a particular interest in orofacial pain or SMDs may have been more inclined to participate, potentially introducing self-selection bias. Furthermore, because the survey was distributed through open-access online platforms and professional social media groups, the number of practitioners who received or viewed the invitation could not be determined. Consequently, a conventional response rate could not be calculated.

Participants were categorized according to their highest academic qualification into three groups: general dentists holding a BDS degree, master’s degree holders, and doctoral degree holders in recognized dental specialties. This stratification enabled comparative analyses of knowledge, diagnostic confidence, and educational needs across different levels of professional training.

No formal priori sample size calculation was performed because this was an exploratory study investigating a topic for which no previous data were available to support an evidence-based sample size estimation. Therefore, the final sample size was determined pragmatically by the number of eligible practitioners who completed the survey during the data collection period. Participants who did not complete all mandatory questionnaire items were excluded from the final analysis.

Questionnaire development, validation, and scoring

A self-administered questionnaire was developed for this study by the research team (Supplementary File 1). Its content was derived from an extensive review of the peer-reviewed literature concerning SMDs [2, 7, 8, 15–19]. The instrument was designed to assess demographic characteristics, knowledge regarding SMDs, self-assessed clinical confidence, and perceived educational needs.

Demographic variables included gender, highest academic qualification, dental specialty, and years of professional experience. For participants holding master’s or doctoral degrees, years of professional experience were recorded from the time of obtaining their highest qualification. The knowledge assessment constituted the core component of the instrument and comprised 13 items covering key domains related to SMDs, including types and subtypes of disorders, etiological factors, clinical manifestations, diagnostic considerations, and current management strategies. Items 1–4 were multiple-response questions, allowing participants to select all applicable options, whereas items 5–13 were single-response items requiring agreement or disagreement.

For knowledge scoring, each correctly selected response in multiple-response items (Q1–Q4) was scored as one point and treated as an independent knowledge indicator. Question 1 contained one intentionally incorrect distractor (temporomandibular disorders [TMD]); selecting this option received no point, and no negative marking was applied. Thus, Question 1 contributed a maximum of three points. For Questions 2–4, all listed options were correct, and each correctly selected option contributed one point, with the maximum score for each question equal to the number of correct options available.

The total knowledge score was calculated as the sum of correct responses across all questions (Q1–Q4: 16 points; Q5–Q13: 9 points), yielding a maximum possible score of 25 points, which was subsequently expressed as a percentage. Participants scoring ≥50% were classified as having adequate knowledge. This threshold has been widely used in exploratory Knowledge, Attitude, and Practice (KAP) studies as a pragmatic criterion for distinguishing adequate from inadequate knowledge [20–23].

The questionnaire also included an item assessing self-rated clinical confidence, which evaluated participants’ intended management approach when encountering a suspected SMD case (e.g., referral to a specialist, independent management, or uncertainty). The final section addressed educational needs, exploring participants’ perspectives on integrating SMD-related content into dental curricula and their interest in pursuing continuing professional development in this area.

Content validity was evaluated by an independent panel of three experts in SMDs (two neurologists and one oral and maxillofacial surgery specialist) using Aiken’s V coefficient. All questionnaire items demonstrated strong content validity, with Aiken’s V values ranging from 0.88 to 1.00. The questionnaire was subsequently pilot-tested on 20 licensed dental practitioners (whose responses were not included in the final analysis) to assess clarity, comprehensibility, and feasibility. No substantive modifications were required following pilot testing. The internal consistency of the dichotomously scored knowledge items was assessed using the Kuder–Richardson Formula 20 (KR-20), yielding acceptable reliability (KR-20 = 0.712).

Statistical analysis

Data were analyzed using IBM SPSS Statistics version 26 and R software (version 4.3). The normality of continuous knowledge scores was assessed using the Shapiro–Wilk test. Because the knowledge scores approximated a normal distribution, parametric methods were considered appropriate for group comparisons.

Descriptive statistics were used to summarize participants’ demographic characteristics and questionnaire responses. One-way analysis of variance (ANOVA), followed by Tukey’s Honestly Significant Difference (HSD) post hoc test, was used to compare mean knowledge scores across educational levels. Effect size was reported using eta-squared (η²), with values of 0.01, 0.06, and 0.14 indicating small, medium, and large effects, respectively, according to Cohen’s guidelines. Chi-square tests of independence were used to compare categorical variables, while Fisher’s exact test with Monte Carlo simulation (10,000 replicates) was applied when expected cell counts were <5.

Multivariable logistic regression analysis was performed to identify independent predictors of adequate knowledge (≥50%). The model included educational level, gender, university type, and years of clinical experience as independent variables. Model fit was evaluated using the Hosmer–Lemeshow goodness-of-fit test. Results are presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs)

Because multiple item-level comparisons were performed, these analyses were considered exploratory, and no formal adjustment for multiple testing was applied. Accordingly, the corresponding p-values should be interpreted with appropriate caution. All statistical tests were two-tailed, and a p-value < 0.05 was considered statistically significant.

Ethics approval and consent to participate

Participation in this study was voluntary and anonymous. Completion of the questionnaire constituted implied informed consent. The consent procedure and study protocol were approved by the Ethics Committee of Ibn Al-Nafis University for Medical Sciences (Identifier: 20/4/25). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments.

Results

Participant characteristics

A total of 156 dental practitioners completed the survey and were included in the final analysis. The sample comprised 87 general dentists holding a Bachelor of Dental Surgery degree (55.8%), 55 master’s degree holders (35.3%), and 14 doctoral degree holders (9.0%). Overall, 99 participants were male (63.5%), and 57 were female (36.5%). The mean duration of clinical experience was 9.79 years, and 40.4% of participants reported having ≥9 years of practice experience.

Regarding educational background, participants graduated from local (72.4%), regional Arab (16.7%), and international (10.9%) universities, reflecting a diverse academic and training background (Table 1).

Table 1.

Demographic characteristics and educational background (N = 156).

Variable	Bachelor’s (BDS) (n = 87)	Master’s Degree (n = 55)	Doctorate (PhD) (n = 14)	Overall (N = 156)
Gender (Male/Female)	54 / 33	34 / 21	11 / 3	99 / 57
Avg. Experience (Years)	9.16	10.43	11.25	9.79
University Type
Local	72 (82.8%)	35 (63.7%)	6 (42.9%)	113 (72.4%)
Regional (Arab)	14 (16.1%)	7 (12.7%)	5 (35.7%)	26 (16.7%)
International	1 (1.1%)	13 (23.6%)	3 (21.4%)	17 (10.9%)

Overall knowledge scores

Knowledge scores ranged from 5 to 24 points (out of a maximum possible score of 25), corresponding to a mean percentage score of 47.54%. Based on the predefined threshold (≥50%), 37.2% of participants (58/156) were classified as having adequate knowledge.

Mean knowledge scores increased progressively with academic level, with bachelor’s degree holders achieving a mean score of 44.05% (adequate knowledge: 31.0%), master’s degree holders 48.95% (38.2%), and doctoral degree holders 63.71% (71.4%) (Table 2).

Table 2.

Knowledge scores by educational level and post hoc comparisons.

Category	Group/Comparison	Mean (%)	SD	Mean difference	p-value
Descriptive statistics	Bachelor	44.05	15.95	—	—
	Master	48.95	15.26	—	—
	Doctorate	63.71	18.39	—	—
Post Hoc (Tukey HSD)	Bachelor vs Doctorate	—	—	19.66	<0.001
	Master vs Doctorate	—	—	14.76	0.007
	Bachelor vs Master	—	—	4.90	0.178

One-way ANOVA revealed a statistically significant difference in mean knowledge scores across educational levels (F(2,153) = 9.52, p < 0.001, η² = 0.111), indicating a moderate effect size. Post hoc analysis using Tukey’s HSD test demonstrated that doctoral degree holders scored significantly higher than both bachelor’s and master’s degree holders, whereas no statistically significant difference was observed between the bachelor’s and master’s groups (Table 2).

Predictors of adequate knowledge

Multivariable logistic regression identified doctoral-level education and male gender as independent predictors of adequate knowledge (Table 3). Master’s-level education did not significantly predict adequate knowledge. University type and clinical experience were not significant predictors. The model demonstrated adequate fit (Hosmer–Lemeshow χ² = 8.29, p = 0.406).

Table 3.

Multivariable logistic regression predicting adequate Knowledge (≥50%) among dental practitioners (N = 156).

Predictor	OR	95% CI	p-value
Gender (Male vs Female)	3.27	1.49–7.19	0.003**
Education (Master vs Bachelor)	1.24	0.55–2.79	0.604
Education (Doctorate vs Bachelor)	8.54	2.09–34.97	0.003**
University (Regional Arab vs Local)	0.62	0.22–1.74	0.367
University (International vs Local)	2.44	0.63–9.49	0.197
Experience (3–4 years vs 1–2 years)	0.65	0.19–2.16	0.479
Experience (5–8 years vs 1–2 years)	0.56	0.22–1.46	0.235
Experience (≥9 years vs 1–2 years)	0.44	0.17–1.16	0.098

OR odds ratio, CI Confidence interval.

*p < 0.05; **p < 0.01.

Item-level knowledge assessment

Item-level analysis indicated variability in participants’ knowledge across several domains, including classification, etiology, and management, with particular difficulty observed in distinguishing SMDs from TMDs (Tables 4 and 5). Overall, participants with doctoral degrees tended to demonstrate higher proportions of correct responses than both bachelor’s and master’s degree holders, especially in identifying specific SMD subtypes, etiological factors, and appropriate treatment approaches.

Table 4.

Correct responses to multiple-response knowledge items (Q1–Q4) by education level.

Item	Response option	Bachelor (n = 87)	Master (n = 55)	Doctorate (n = 14)	p-value
Q1. Types of SMDs	Did not select TMD♦	34.5	50.9	57.1	0.078
	Oromandibular dystonia	50.6	72.7	85.7	0.005**
	Hemimasticatory spasm	33.3	41.8	71.4	0.024*
	Orofacial dyskinesia	21.8	41.8	42.9	0.027*
Q2. Etiology of OMD	Neurodegenerative diseases	71.3	80.0	85.7	0.328
	Head trauma	49.4	49.1	64.3	0.564
	Tricyclic antidepressants	23.0	40.0	57.1	0.013*
	Stroke	32.2	30.9	71.4	0.017*
Q3. Subtypes of OMD	Jaw closing	52.9	56.4	57.1	0.901
	Jaw opening	40.2	45.5	78.6	0.028*
	Jaw deviation	55.2	74.5	78.6	0.032*
	Lip dystonia	36.8	32.7	64.3	0.090
	Lingual dystonia	20.7	23.6	35.7	0.505
Q4. Treatment of idiopathic OMD	Anticholinergic medications	31.0	30.9	42.9	0.679
	GABAergic agents	27.6	32.7	42.9	0.502
	Benzodiazepines	49.4	52.7	71.4	0.310
	Botulinum toxin	58.6	76.4	85.7	0.023*

Data are presented as the percentage of participants selecting each correct response option.

*p < 0.05; **p < 0.01

^♦Reports distractor-avoidance rate and is not an additional scored point. 

HMS hemimasticatory spasm, OMD oromandibular dystonia, SMDs stomatognathic movement disorders, TMD Temporomandibular disorders.

Table 5.

Responses to single-response knowledge items (Q5–Q13) by education level.

Item	Evidence-based Answer	Bachelor (n = 87)	Master (n = 55)	Doctorate (n = 14)	p-value
Q5. Dental procedures may trigger OMD symptoms	Agree	87.4%	87.3%	64.3%	0.160
Q6. Hemimasticatory spasm is the most prevalent SMD	Disagree	27.6%	32.7%	50.0%	0.263
Q7. OMD symptoms are milder in the morning	Agree	59.8%	49.1%	85.7%	0.042*
Q8. OMD symptoms appear during sleep	Disagree	41.4%	58.2%	64.3%	0.075
Q9. Morphea/scleroderma is common in HMS	Agree	64.4%	47.3%	64.3%	0.118
Q10. Occlusal splint is very effective for OMD	Disagree	34.5%	41.8%	57.1%	0.239
Q11. OMD patients should undergo TMJ radiographs before treatment	Disagree	5.7%	9.1%	14.3%	0.601
Q12. Botulinum toxin is effective for focal OMD	Agree	69.0%	74.5%	85.7%	0.373
Q13. Myotomy surgery is very effective for jaw-opening dystonia	Disagree	57.5%	41.8%	71.4%	0.068

Data are presented as percentages of participants selecting the correct response. Fisher’s exact test (Monte Carlo simulation) was used for Q5, Q6, Q11, and Q12 where expected cell frequencies were < 5.

Knowledge of evidence-based treatment strategies improved progressively with educational level. The proportion of participants correctly identifying botulinum toxin as an effective treatment for focal OMD increased significantly from 58.6% among bachelor’s degree holders to 76.4% among master’s degree holders and 85.7% among doctoral degree holders (p = 0.023).

Despite this trend, several areas of limited knowledge were observed across all groups. Question 11, which addressed the need for routine of temporomandibular joint (TMJ) radiographs before initiating treatment, showed the lowest proportion of correct responses. Correct responses—defined as disagreement with the statement—were observed in only 5.7% of bachelor’s degree holders, 9.1% of master’s degree holders, and 14.3% of doctoral degree holders.

Clinical confidence and educational needs

Self-reported confidence in managing SMDs varied significantly across education levels (χ² = 18.33, df = 4, p = 0.001; Monte Carlo p = 0.001) (Table 6). Pairwise comparisons demonstrated that Bachelor’s degree holders were significantly more likely to refer patients and significantly less likely to manage cases independently than both Master’s (p < 0.001) and Doctorate groups (p = 0.006, Monte Carlo). No statistically significant difference was observed between Master’s and Doctorate participants (p = 0.626, Monte Carlo).

Table 6.

Self-reported confidence in managing SMDs by education level.

Response	Bachelor n. (%)	Master n. (%)	Doctorate n. (%)
Refer to specialist	76 (87.4)	39 (70.9)	9 (64.3)
Manage independently	1 (1.1)	12 (21.8)	3 (21.4)
Not sure	10 (11.5)	4 (7.3)	2 (14.3)

χ² = 18.33, df = 4, p = 0.001 (Monte Carlo p = 0.001).

There was strong consensus across all education levels regarding the need to integrate SMDs into the dental curriculum, with 94.9% overall agreement (Bachelor: 96.6%, Master: 90.9%, Doctorate: 100%; χ² = 3.04, p = 0.219). Interest in continuing education was high across all groups (Bachelor: 85.1%, Master: 89.1%, Doctorate: 92.9%), with no significant differences observed (χ² = 0.96, p = 0.625) Table 7.

Table 7.

Educational needs and training interest by education level.

Item	Response	Bachelor n. (%)	Master n. (%)	Doctorate n. (%)	p-value
Curriculum inclusion	Agree	84 (96.6)	50 (90.9)	14 (100.0)	0.219
	Disagree	3 (3.4)	5 (9.1)	0 (0.0)	—
Continuing education interest	Yes	74 (85.1)	49 (89.1)	13 (92.9)	0.625
	No	13 (14.9)	6 (10.9)	1 (7.1)	—

Discussion

This study provides the first systematic assessment of dental practitioners’ knowledge, diagnostic confidence, and educational preparedness regarding SMDs. The findings demonstrated important knowledge gaps across all educational levels, with only doctoral-level education independently associated with adequate knowledge. Self-reported confidence in managing suspected SMD cases was correspondingly low, particularly among general dentists. These findings appear consistent with a broader international literature showing that stomatognathic movement disorders sit at the interface of dentistry and neurology and can be difficult to recognize in routine practice [24]

The most important pattern in the present data was difficulty distinguishing SMDs from TMD and identifying appropriate management concepts. This is compatible with prior clinical literature showing that patients with oromandibular dystonia frequently present with symptoms that overlap with TMD, bruxism, jaw pain, or abnormal jaw activity, making differential diagnosis challenging for both dental and medical clinicians [1, 4, 25]. Current diagnostic approaches emphasize patterned and repetitive movements, task specificity, sensory tricks, and morning benefit, rather than a purely structural temporomandibular framework [19, 26, 27].

The clinical relevance of these findings is supported by previous reports indicating that patients with OMD often first present to dentists or oral surgeons, and misdiagnosis as TMD, bruxism, or psychiatric disease has been widely reported [28]. In a tertiary orofacial pain clinic series, nearly all patients with confirmed OMD had previously received a TMD diagnosis, and about half had undergone invasive dental or maxillofacial interventions [9]. International reports indicate that approximately 70% of patients with OMD first consult a dentist and about 60% consult an oral and maxillofacial surgeon, while prolonged diagnostic delays of several years have also been described [3, 29]. During this period, some patients undergo irreversible dental procedures, including occlusal adjustments, orthodontic treatment, prosthodontic rehabilitation, tooth extraction, or TMJ surgery before the underlying movement disorder is recognized [10]. These observations have largely been attributed to the clinical overlap between SMDs and more prevalent dental conditions, together with limited familiarity with orofacial movement disorders among dental professionals [29].

The present findings are consistent with these reports in demonstrating limited knowledge of SMDs and uncertainty regarding their differentiation from TMDs among dental practitioners. However, the present survey did not measure real-world referral behavior, diagnostic accuracy, or treatment decisions. Accordingly, the implications of the observed knowledge deficits should be interpreted as potential rather than proven clinical consequences.

Educational implications

The strong agreement among participants regarding the inclusion of stomatognathic movement disorder (SMD)-related content in dental curricula suggests a perceived need for additional education in this area. Although the present study did not investigate the underlying reasons for this perception, several explanations have been proposed in the literature. First, SMDs are relatively uncommon in routine dental practice, resulting in limited clinical exposure during undergraduate and postgraduate training [1]. Second, the clinical overlap between SMDs and more common disorders such as TMD and bruxism makes differentiation difficult without targeted education in movement disorder phenomenology [1]. Third, many diagnostic and management guidelines for focal dystonias originate primarily from neurology rather than dentistry, leaving dental curricula without clear discipline-specific educational frameworks [4, 30].

Importantly, the absence of a significant difference in knowledge between bachelor’s and master’s degree holders may suggest that current postgraduate dental training may not adequately address SMD-related competencies. Likewise, university type was also not a significant predictor of adequate knowledge. Although graduates of international universities showed trend toward higher knowledge levels, this difference did not reach statistical significance. These findings suggest that opportunities to strengthen education on SMDs may exist across different educational settings; however, further multicenter studies are needed to determine whether similar patterns are observed in other countries and educational systems.

The strong interest in continuing professional development observed in this study suggests that many participants perceive a need for additional education on SMDs. This finding indicates that educational initiatives, such as case-based learning, multidisciplinary workshops, online educational modules, and integration of SMD content into continuing education programs, may represent valuable approaches for addressing the knowledge gaps identified in this survey. Future studies are warranted to evaluate the effectiveness of such educational strategies in improving knowledge, diagnostic confidence, and clinical practice.

Strengths and limitations

This study has several important strengths. To the authors’ knowledge, it represents the first investigation to systematically quantify dental practitioners’ knowledge, diagnostic confidence, and educational preparedness regarding SMDs. The use of a validated questionnaire with strong content validity and acceptable internal consistency enhances confidence in the reliability of the findings. Additionally, the inclusion of practitioners from different educational levels enabled an exploratory comparative analysis to identify specific knowledge gaps that may inform future educational interventions.

Nevertheless, several significant limitations should be acknowledged. The use of a non-probability convenience sampling approach through social media and professional networks may have introduced self-selection bias, as Practitioners with greater interest in SMDs or orofacial pain may have been more likely to participate. In addition, because the survey was distributed through open-access online platforms, a conventional response rate could not be calculated, and the potential for nonresponse bias cannot be excluded.

The study was also conducted exclusively in Yemen, which limits the external generalizability of the findings to other countries with different educational frameworks and clinical practice environments. In addition, the relatively small number of doctoral degree holders (n = 14) reduced the statistical power and precision of subgroup estimates, prompting the item-level analyses to be presented purely as exploratory rather than confirmatory. Another vital limitation is that the study evaluated self-reported theoretical knowledge and self-assessed clinical confidence. These subjective survey metrics do not directly translate to actual diagnostic accuracy or clinical competence at the chairside.

Furthermore, certain questionnaire items carry inherent clinical nuances that are difficult to capture in a binary format. For instance, regarding the item on routine TMJ radiographs prior to treating OMD, “Disagree” was designated as the correct response because OMD is primarily a neurological condition where routine imaging does not guide evidence-based therapies such as botulinum toxin injections. However, advanced clinical contexts, such as cases involving secondary structural joint pathology, or persistent mechanical locking, may indeed warrant imaging. Finally, the cross-sectional design precludes assessment of causal relationships or changes in knowledge over time

Recommendations

The findings of this study suggest several areas that warrant consideration in future educational and professional development initiatives. Given the observed knowledge gaps, undergraduate and postgraduate dental curricula could place greater emphasis on SMDs, including their classification, clinical presentation, differentiation from TMDs and bruxism, underlying etiologies, and appropriate referral pathways.

The findings also indicate potential value in developing continuing professional education on SMD recognition and referral through professional organizations, specialty societies, and online learning platforms. In addition, future initiatives aimed at strengthening collaboration between dentistry and neurology, including multidisciplinary educational activities and the development of shared diagnostic resources, may help improve clinicians’ familiarity with these disorders.

Conclusion

This study provides exploratory evidence suggestive of important knowledge gaps regarding SMDs among the surveyed dental practitioners across different educational levels. The findings indicate a tendency toward persistent diagnostic misconceptions, particularly regarding the differentiation of SMDs from TMDs, and highlight potential deficiencies in current dental education and clinical preparedness. The strong support for curriculum integration and continuing education suggests that targeted educational interventions would likely be both accepted and beneficial. Improving dental practitioners’ theoretical understanding and clinical ability to recognize and appropriately refer patients with SMDs has the potential to reduce diagnostic delays, minimize the risk of unnecessary dental interventions, and ultimately improve patient outcomes and quality of life.

Author contributions

O.M.J. was responsible for the study conception and design. R.J., M.A., M.A., K.A., B.H., F.Z., A.Y.A. and M.S.A. contributed to data collection. O.M.J. and H.H.A. performed the data analysis. O.M.J. prepared the first draft of the manuscript. A.Y.A., M.S.A., and H.H.A. contributed to the revision and preparation of the final manuscript. All authors have read and approved the final version of the manuscript for publication.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare no competing interests.

Supplementary information

The online version contains supplementary material available at 10.1038/s41405-026-00470-9.