ABSTRACT
Background/Aim
Traumatic dental injuries (TDIs) require accurate documentation for diagnosis, treatment planning, and medico‐legal purposes. International guidelines strongly recommend the use of clinical photography, yet its use among pediatric dentists has not been consistently evaluated across countries. This study aimed to assess pediatric dentists' knowledge, attitudes, and practices regarding the photographic documentation of TDIs.
Materials and Methods
A multinational, mixed‐method cross‐sectional survey was conducted between April and June 2025. Quantitative data were analyzed, while qualitative insights from open‐ended responses were analyzed thematically and integrated with quantitative results. A non‐probability convenience sampling method was used to recruit participants through professional networks, academic societies, and social media platforms.
Results
A total of 404 participants from 14 countries responded, predominantly pediatric dentists (66.6%) with 5–20 years of experience. Most respondents (95.3%) considered photography important for documenting TDIs, but only 23.5% reported always using it. Smartphones were the most common tool (65.1%), while fewer used DSLR cameras (26.7%). Major barriers included uncooperative children (40.2%) and time constraints (27.4%). Formal training in photography was reported by 41.6% of participants. Multivariate regression showed that awareness of international guidelines (OR = 2.94; CI: 1.71–5.18, p < 0.001) and high perceived importance (OR = 4.63; CI: 1.56–18.21, p = 0.005) significantly predicted frequent use. Participants who were aware of IADT guidelines were almost three times more likely to use photography routinely, and those who perceived it as highly important were over four times more likely to do so. Thematic analysis highlighted ethical concerns, including uncertainty regarding parental consent and data storage, as well as training gaps and calls for standardized protocols.
Conclusions
Photography is essential for recording pediatric dental trauma, but is inconsistently used. Knowledge of guidelines and training influences implementation. Standardizing consent, training, and routine photography can bridge the gap between recommendations and practice.
Keywords: attitudes, clinical photography, documentation, knowledge, multinational survey, pediatric dental trauma, practices
1. Introduction
Traumatic dental injuries (TDIs) are a common emergency presentation in pediatric dentistry and require accurate diagnosis and documentation [1]. Specialist pediatric dentists play a pivotal role in the immediate and long‐term management of TDIs in both the primary and permanent dentitions [2]. Accurate documentation and timely emergency care are essential to prognosis and to preventing complications that may affect oral‐health‐related quality of life.
The International Association for Dental Traumatology (IADT) recommends photographic documentation of TDIs at initial and follow‐up visits because photographs support diagnostic accuracy, treatment planning, and medico‐legal reporting [3].
Within dentistry, clinical photography is widely used for documentation, communication, and medico‐legal purposes [4]. Previous surveys among general dental practitioners have reported variable uptake of photography, most commonly for treatment planning and documentation [5].
Most prior surveys examined general dentists and were conducted within single‐country settings rather than across regions [6, 7, 8]. One epidemiological study validated photographic assessment for identifying past trauma in schoolchildren, although it was not evaluated for recent injuries [9]. They demonstrated that it is a valid and reliable method for identifying past dental trauma, although the method was not evaluated for diagnosing recent injuries.
However, critical gaps remain regarding how pediatric dentists, who face unique barriers such as child cooperation, consent complexities, and acute workflow demands, perceive and implement photographic documentation. Moreover, no prior study has combined multinational quantitative data with qualitative insights to explore the gap between guideline recommendations and real‐world practice. This study provides the first multinational mixed‐methods analysis of pediatric dentists' knowledge, attitudes, and practices (KAP) regarding photographic documentation of TDIs, with the aim of informing standardized protocols and improving pediatric trauma care.
2. Methods
This observational study has been reported in accordance with the Preferred Reporting Items for Observational studies in Endodontics (PROBE) 2023 guidelines [10]. A completed PROBE 2023 checklist is provided as Supporting Information 1.
2.1. Study Design and Setting
This research involved a mixed‐methods, cross‐sectional study using non‐probability convenience sampling. The survey was distributed between April and June 2025, through academic networks, professional forums, email lists, and mainly on social media platforms, with no geographic restrictions. All responses were anonymously collected via a secure Google Forms platform. This open‐access recruitment approach was used to maximize outreach and gather diverse perspectives from practitioners on dental trauma documentation practices.
2.2. Participants and Recruitment
Eligible participants included pediatric dentists and pediatric dental residents currently involved in the management of pediatric dental trauma. Practitioners not actively caring for traumatic dental injuries in children were excluded. Participation in the survey was voluntary and only conducted after informed consent.
2.3. Sample Size
The sample size was calculated using OpenEpi, Version 3.01, based on an estimated population of 30,000 pediatric dentists worldwide, derived from membership data from national pediatric dentistry societies affiliated with the International Association of Pediatric Dentistry (IAPD) [11]. Assuming a 5% margin of error, a 95% confidence level, and a 50% response distribution, the minimum required sample was 385 participants [12]. To ensure representation and accommodate subgroup analysis, the target was increased to approximately 460 participants.
2.4. Instrument Development and Structure
A structured, self‐administered questionnaire consisting of 25 items was developed based on current literature, expert input, and international guidelines for documenting TDIs. The instrument addressed five domains: [1] Demographics and Professional Background, [2] Knowledge and Awareness, [3] Attitudes, [4] Clinical Practices, and [5] Open‐Ended Reflections. The Demographics and Professional Background domain collected data on participants' age group, gender, years of clinical experience, professional status, type of practice, and country of practice. Item formats included multiple choice, binary (yes/no), and 5‐point Likert scales. The final version is provided as Supporting Information 2.
2.5. Questionnaire Validity and Reliability
2.5.1. Face Validity
Face validity was confirmed through expert review by a panel of three experienced professionals in pediatric dentistry and dental trauma. These experts qualitatively evaluated the instrument for linguistic clarity, clinical suitability, and content relevance. Their feedback prompted revisions to item wording and order, and the removal of items unrelated to photography (e.g., radiographic content).
2.5.2. Content Validity
Content validity was assessed using the Content Validity Index (CVI) methodology as described by Polit and Beck [13] A panel of six subject matter experts in pediatric dentistry and dental traumatology independently evaluated each item in the questionnaire for relevance, clarity, and contextual appropriateness using a 4‐point ordinal scale (1 = not relevant, 4 = highly relevant). The Item‐Level CVI (I‐CVI) was calculated as the proportion of experts rating an item as either 3 or 4. The Scale‐Level CVI (S‐CVI/Ave) was computed as the average of all I‐CVIs for each domain. The final S‐CVI/Ave scores were 1.00 for relevance, 0.99 for clarity, and 0.97 for contextual fit, all of which exceeded the recommended threshold of 0.90, indicating excellent content validity of the instrument. Internal consistency was evaluated using Cronbach's alpha for the core knowledge, attitude, and practice domains.
2.6. Pilot Testing and Data Collection
Before distribution, the final instrument was pilot tested with 30 pediatric dental professionals to evaluate item clarity, ease of navigation, and estimated completion time. No major revisions were needed after this phase. The survey stayed open for 6 weeks, and responses were collected through a secure online platform. Only complete submissions were included in the final dataset, and IP filtering was used to prevent duplicate entries.
2.7. Statistical Analysis
Data were analyzed using IBM SPSS Statistics, version 27.0 (IBM Corp., Armonk, NY). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participant demographics and responses across the KAP domains. Group comparisons were conducted using Chi‐square tests for categorical variables, and independent‐samples t‐tests or one‐way ANOVA for continuous variables, as appropriate.
To identify predictors of frequent use of photographic documentation in clinical practice, a Firth's penalized logistic regression model was applied to address sparse cell counts and reduce small‐sample bias. Multicollinearity among predictor variables was assessed using the Variance Inflation Factor (VIF), with a VIF value > 5 considered indicative of problematic collinearity. Statistical significance was determined at an alpha level of p < 0.05. The GVIF diagnostics for the final model are presented in (Table S1). A measure of internal consistency, such as Cronbach's alpha, is used to test the reliability of the items of the scale. Alpha values above 0.70 were considered acceptable.
2.8. Qualitative Analysis
Qualitative data were collected through two open‐ended questions at the end of the questionnaire. Open‐ended responses were analysed with NVivo software with an inductive reflexive thematic analysis. The data familiarisation was reached through multiple re‐reads of all the comments, after which inductively generated initial codes were applied to the entire dataset by one analyst. The codes were repeatedly revised and clustered into higher‐order themes that reflected patterns common to the participants' experiences. Rigor was taken care of by means of iterative coding, constant comparison of inscriptions with the actual information, and keeping an audit trail in the NVivo that recorded the coding decisions and theme elaboration. To enhance trustworthiness, peer validation was undertaken, whereby the final themes were reviewed and discussed with the research team to ensure credibility and accurate representation of participants' views. This qualitative strand was then integrated with the quantitative findings within a convergent mixed‐methods framework, allowing triangulation of practitioner‐reported barriers, attitudes, and behaviors.
3. Results
3.1. Sample Characteristics
A total of 404 participants from 14 countries completed the survey. The mean age of the participants was 37.3 ± 8.9 years. Most participants were from Egypt (31.5%), Saudi Arabia (22.3%), and India (11.8%), followed by Pakistan (8.2%) and the United Arab Emirates (4.5%). Additional respondents represented Iraq, Libya, Morocco, Bahrain, Kuwait, Oman, Qatar, and several other countries, reflecting perspectives primarily from the Middle East and South Asia. Most respondents were female (75%) and aged 31–40 years (46.8%) (Table 1). Cronbach's alpha was 0.892, indicating excellent internal consistency.
TABLE 1.
Socio‐demographic characteristics of participants.
| Characteristics | Frequency (n) | Percentage (%) |
|---|---|---|
| Age | ||
| Under 30 | 90 | 22.3 |
| 31–40 | 189 | 46.8 |
| 41–50 | 86 | 21.3 |
| Over 50 | 39 | 9.7 |
| Age (Mean ± SD) | 37.33 ± 8.89 | |
| Gender | ||
| Female | 303 | 75 |
| Male | 101 | 25 |
| Years in dental practice | ||
| Less than 5 years | 76 | 18.8 |
| 5–10 years | 121 | 30 |
| 11–20 years | 139 | 34.4 |
| More than 20 years | 68 | 16.8 |
| Professional Status | ||
| Pediatric dental resident | 25 | 6.2 |
| Pediatric dentist | 269 | 66.6 |
| Professor | 7 | 1.7 |
| PhD of Pediatric Dentistry | 75 | 18.6 |
| Others | 28 | 6.9 |
| Type of practice | ||
| Government hospital and Academic institution | 162 | 40.1 |
| Private Clinic and Academic Institution | 242 | 59.9 |
| Country of practice | ||
| Saudi Arabia | 91 | 22.5 |
| Egypt | 132 | 32.7 |
| Other Gulf countries | 50 | 12.3 |
| Other MENA | 35 | 8.7 |
| India | 47 | 11.6 |
| Other countries | 49 | 12.1 |
Note: Values are presented as frequency (n) and percentage (%).
3.2. Perceived Importance and Situational Use of Photography in Trauma Documentation
There was almost unanimous agreement on the significance of photography in documenting TDIs in children. Most respondents rated it as either important or very important. Child cooperation was the most influential factor, “very important,” followed by infection control, lighting, and time constraints (Table 2). The most frequently cited benefits were treatment planning and accurate diagnosis, followed by improved patient communication and then legal reasons (Figure 1). Photography of dental trauma was primarily used for high‐severity dental trauma cases rather than routine documentation (Figure 2).
TABLE 2.
Factors influencing the use of photography in documenting pediatric dental trauma.
| Rating the importance of factors | Not important (%) | Slightly important (%) | Neutral (%) | Important (%) | Very important (%) |
|---|---|---|---|---|---|
| Photography to document dental trauma in children |
2 (0.5%) |
0 (0.0%) |
17 (4.2%) |
172 (42.6%) |
213 (52.7%) |
| Cooperation level of the child |
9 (2.2%) |
39 (9.7%) |
137 (33.9%) |
97 (24%) |
122 (30.2%) |
| Lighting setup |
19 (4.7%) |
58 (14.4%) |
130 (32.2%) |
108 (26.7%) |
89 (22%) |
| Infection control |
10 (2.5%) |
43 (10.6%) |
128 (31.7%) |
92 (22.8%) |
131 (32.4%) |
| Time required for photography |
15 (3.7%) |
53 (13.1%) |
141 (34.9%) |
111 (27.5%) |
84 (20.8%) |
| Consent process |
21 (5.2%) |
41 (10.1%) |
116 (28.7%) |
92 (22.8%) |
134 (33.2%) |
| Case severity |
21 (5.2%) |
57 (14.1%) | 128 (31.7%) | 92 (22.8%) |
106 (26.2%) |
| Staff support availability |
7 (1.7%) |
44 (10.9%) |
152 (37.6%) |
102 (25.2%) |
99 (24.5%) |
Note: Respondents' ratings of factors influencing the use of photography in dental trauma documentation on a five‐point Likert scale from “not important” to “very important.”
FIGURE 1.
Reported benefits of using clinical photography in documenting pediatric dental trauma. Respondents identified treatment planning, patient/guardian education, medico‐legal purposes, caregiver communication, and diagnostic accuracy as the main benefits.
FIGURE 2.
Clinical situations in which photography was used to document pediatric dental trauma. Severe trauma cases were the most common indication, followed by legal documentation, suspected abuse, and soft tissue injuries.
3.3. Barriers to Implementing Photography
Challenges in the clinical application of dental photography have been widely reported. The most common barrier was uncooperative children, followed by time constraints, particularly in emergency settings (Figure 3).
FIGURE 3.
Barriers to implementing clinical photography in documenting pediatric dental trauma. Uncooperative children and time constraints were the most frequently reported challenges, followed by lack of training and privacy concerns.
3.4. Current Practices and Training in Dental Photography
Patterns in photography use reveal various approaches. Some individuals report always using photography, while many use it occasionally. Smartphones are the most commonly used devices. Over half obtain verbal consent, and a significant portion use written consent (Table 3).
TABLE 3.
Practitioner approaches to clinical photography for documenting pediatric dental trauma.
| Items | Frequency (n) | Percentage (%) |
|---|---|---|
| Frequency of photography to document dental trauma in children | ||
| Never | 12 | 3 |
| Rarely | 46 | 11.4 |
| Sometimes | 132 | 32.7 |
| Often | 119 | 29.5 |
| Always | 95 | 23.5 |
| Formal training in dental photography | ||
| Yes | 168 | 41.6 |
| No | 167 | 41.3 |
| Planning to attend a training course | 69 | 17.1 |
| Total | 404 | 100 |
| Device used primarily for dental photography | ||
| DSLR or mirrorless camera | 108 | 26.7 |
| Intra—Oral Camera | 25 | 6.2 |
| Smartphone (Mobile) | 263 | 65.1 |
| I do not take photos | 8 | 2 |
| Patient consent before taking photography | ||
| Written consent | 157 | 38.9 |
| Verbal consent | 207 | 51.2 |
| No consent | 40 | 9.9 |
Note: Frequencies and percentages are reported for device use, consent practices, training, and frequency of use.
3.5. Qualitative Insights: Thematic Analysis
Thematic analysis identified six key themes reflecting practitioners' perspectives on photographing pediatric dental trauma. These included practical barriers such as child cooperation and time constraints; for example, one participant wrote, “It's hard to take clear photos when the child is crying or anxious.” Participants also reported training gaps, limited technical confidence, and ethical concerns related to consent and data privacy. Participants stressed the clinical importance of photography for documentation, follow‐up, and communicating with caregivers, expressing a preference for equipment, especially the convenience of smartphones. Finally, they pointed out the need for institutional standardization, advocating for clear protocols and the integration of photography into routine documentation (Table 4).
TABLE 4.
Thematic analysis on comments or experiences related to dental photography and documentation of trauma cases.
| Theme | Code examples | Description |
|---|---|---|
| Practical and emotional barriers | Difficulty photographing children, extreme trauma, parent restlessness, time constraints | Real‐world obstacles that prevent successful photography in trauma cases |
| Skill and training gaps | More formal training, expert camera operator, practice makes perfect | Lack of training or confidence in taking quality dental photographs |
| Ethical and regulatory concerns | Parent and child consent, GDPR issues, parent concern about sharing photos | Legal and ethical considerations regarding consent and data use |
| Clinical utility and follow‐up support | Follow‐up, before and after photos, treatment planning, parent education | Use of photography to enhance clinical care and communication |
| Practical solutions and equipment use | Phone cameras, camera quality, need an assistant, cheek retraction | Preferences and needs around tools and process optimization |
| Institutional change and standardization | Awareness, photography made routine, assign trauma clinics | Calls for guideline development and system‐wide adoption |
Note: Themes were derived from open‐ended survey responses using inductive thematic analysis.
3.6. Quantitative and Qualitative Integration of Barriers
The mixed‐methods synthesis showed strong agreement between statistical and thematic findings, with 67.6% reporting emotional and situational barriers such as stress and child anxiety, and qualitative insights reinforcing skill and equipment gaps noted by 20.3% of respondents. These links are outlined in (Table S2).
3.7. Predictors of Frequent Photography Use
3.7.1. Bivariate Analysis and Multivariate Regression
No significant associations were found between demographic factors (age, gender, years of experience) or workplace type and the frequency of photography use. However, multivariable regression confirmed that pediatric dentists who perceived photography as important or were aware of IADT guidelines were significant predictors of frequent use of photographic documentation (p < 0.001) [14]. (Table S3). Awareness of IADT recommendations was nearly three times more likely to perform photographic documentation of TDIs (OR = 2.94, CI: 1.71–5.18, p < 0.001). Those who valued photography highly were 4.63 times more likely to use it frequently (CI: 1.56–18.21, p = 0.005). (Tables 5 and 6).
TABLE 5.
Unadjusted Firth's penalised logistic regression of awareness and perceived importance of guidelines on their documentation practices in dental trauma cases.
| Items | Odds ratio | 95% confidence interval | p value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Awareness that IADT guidelines recommend documentation | ||||
| Yes | 3.01 | 1.74473 | 5.72 | 0.006* |
| Importance of photographing dental trauma in children | ||||
| Important | 4.44 | 1.477276 | 4.35 | 0.006* |
| Awareness that IADT guidelines recommend using photography for documentation | ||||
| Not sure | 1.53 | 0.83 | 2.29 | 0.174 |
| Yes, clearly stated | 2.87 | 1.61 | 5.02 | < 0.001* |
Abbreviations: CI, confidence interval; OR, odds ratio.
Statistically significant at p < 0.05.
TABLE 6.
Adjusted Firth penalized logistic regression of awareness and perceived importance of guidelines on their documentation practices in dental trauma cases.
| Items | Odds ratio | 95% confidence interval | p value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Awareness that IADT guidelines recommend documentation | ||||
| Yes | 2.94 | 1.71 | 5.18 | < 0.001 |
| Importance of photographing dental trauma in children | ||||
| Important | 4.63 | 1.56 | 18.21 | 0.005* |
| Awareness that IADT guidelines recommend using photography for documentation | ||||
| Not sure | 1.56 | 0.84 | 2.94 | 0.162 |
| Yes | 2.94 | 1.65 | 5.33 | < 0.001* |
| Years of experience | ||||
| 5–10 years | 0.92 | 0.5 | 1.7 | 0.799 |
| 11–20 years | 1.46 | 0.8 | 2.69 | 0.22 |
| More than 20 years | 1.65 | 0.81 | 3.39 | 0.17 |
| Type | ||||
| Government | 1.19 | 0.77 | 1.85 | 0.422 |
Abbreviations: CI, confidence interval; OR, odds ratio.
Statistically significant at p < 0.05.
4. Discussion
This study provides the first multi‐country mixed‐methods analysis of how pediatric dental professionals perceive and use clinical photography for TDIs, as well as the barriers they encounter. Advances in photographic equipment and techniques have facilitated the widespread adoption of photographic documentation in clinical practice [3, 4, 5]. It is even more important in traumatology when the medicolegal concerns are high [14, 15, 16, 17]. Since dental injuries mostly affect the anterior teeth and are associated with immediate or delayed consequences of poor esthetics, the photographic records also serve as the baseline record for the patient and clinician. This topic was covered in a review that offered detailed suggestions for using appropriate cameras, lenses, lighting conditions, accessories, and potential barriers with traumatized patients [3].
The current survey evaluated the KAP of pediatric dentists regarding photographic documentation of TDIs. It was completed by 404 dentists, primarily pediatric dentistry professionals (66.6%). In 2024, a global survey examined pediatric dentists' current use, attitudes, and confidence regarding clinical dental photography for children. A total of 390 pediatric dentists participated in the survey. Additionally, most participants in both surveys agreed that clinical photography is essential for diagnosis [18]. These findings align with advances in teledentistry, where photographic and videographic documentation enable remote diagnosis and triage of trauma cases, particularly when direct clinical access is restricted [19, 20]. Evidence from the COVID‐19 pandemic demonstrated that such systems effectively prioritized severe dental trauma and reduced unnecessary visits, underscoring the clinical and medico‐legal importance of high‐quality image documentation [21]. Building on this, artificial intelligence (AI) and mobile health (mHealth) technologies now show reliable diagnostic performance using photographic data alone, with studies reporting moderate to high accuracy for TDI assessment even without in‐person examination [22, 23]. Together, these developments highlight the expanding role of photography‐driven trauma documentation as a foundation for modern pediatric dental care, improving diagnostic reliability, access, and continuity across diverse clinical settings.
The thematic analysis revealed barriers such as child cooperation and time constraints, which resonate across diverse cultural settings and may limit the global applicability of photographic documentation in trauma care. In this study, uncooperative behavior among younger children emerged as the most frequent obstacle to obtaining high‐quality images. This challenge was particularly evident in cases involving the primary dentition, where smaller oral cavities, heightened anxiety, and acute pain often hindered the use of retractors or mirrors during photography. Such limitations not only reduce image quality but may also compromise diagnostic accuracy and consistency of follow‐up. These observations align with recent findings by a review [3] that emphasized that photographing traumatized children requires modifications to standard protocols due to anatomical and behavioral constraints. The authors noted that the use of mouth holders or cheek retractors is frequently impractical in young or injured patients, underscoring the need for adaptable techniques and clinicians' sensitivity. Despite these challenges, documenting trauma in the primary dentition remains crucial for accurate diagnosis, medico‐legal reporting, and monitoring of sequelae during tooth development. Addressing these pediatric‐specific challenges through age‐appropriate positioning, behavioral guidance, and photographic training could enhance both the feasibility and the quality of dental trauma documentation. While previous work suggested that photography may improve communication and cooperation in pediatric care [18], the present findings highlight the persistent need for structured, child‐centered documentation protocols tailored to younger age groups.
However, the pre‐visit preparation of the children and their families using video modeling or positive dental images can be considered a valuable behavior management strategy, with potentially greater benefits for children who present with elevated dental anxiety, especially during stressful events, such as TDIs [22].
Another barrier faced by the participants in the current survey was the time taken during clinical photography documentation. This finding was consistent with the British study, which reported that 41% of general practitioners identified time‐consuming tasks as a challenge during the photographic documentation of cases [5]. Most participants in this survey identified smartphones as their main tool for documenting TDIs, aligning with previous studies [18]. Despite professional guidelines recommending that mobile devices be used only in special circumstances and that clinical images not be stored locally [19]. Their widespread use reflects clinical practicality, particularly in urgent care contexts. Compared to DSLR cameras, smartphones are easier to use, have automated settings, and allow immediate review of images, helping with quick documentation in urgent trauma cases. Their availability and lower cost also make clinical photography more accessible, especially in areas with limited resources. However, smartphones might reduce image quality for detailed intraoral views and should be used carefully [20]. Although DSLR systems are still considered the best for dental documentation because of better optical control and accuracy [23, 24], recent advancements in smartphone imaging are gradually closing this gap [3]. Still, challenges such as equipment costs, limited training, and workflow integration continue to prevent consistent use in everyday practice [24, 25, 26].
Although the benefits of dental photography are well established, many dental professionals still do not incorporate it into their daily clinical routines. According to this survey, several factors may contribute to this, including concerns about disrupting the established clinical workflow and, most notably, the perceived high costs associated with purchasing equipment and obtaining specialized training. Additionally, many professionals view the technical learning curve related to dental photography as a barrier to its adoption [24, 25, 26].
Ethical and regulatory issues also emerged as an essential dimension in this study. The mixed‐method analysis revealed that 12% of participants cited privacy concerns, and 23.3% referred to uncertainty about the legal aspects of using photography in clinical documentation. Qualitative responses reinforced these findings, emphasizing that both ethical and legal considerations, notably regarding consent and data use, must be addressed before photo documentation. Such variability in consent procedures, especially in pediatric settings, underscores the need for more explicit institutional and professional guidance.
Complete transparency regarding the use of clinical images is of utmost importance, with strict adherence to legal and ethical privacy standards [3]. Photos may also be used on social media, and existing studies have highlighted the role of social media in patient engagement, marketing, and professional outreach, as well as its potential as a tool to support education and knowledge dissemination [27] However, such use requires a distinct level of consent; explicit written authorization must be obtained from parents or guardians. This approach aligns with current professional and ethical guidelines, which emphasize that consent for clinical documentation does not extend to online or promotional use without separate approval [28].
Multivariate regression confirmed that awareness of IADT guidelines and high perceived importance were independent predictors of frequent photography use, underscoring the influence of professional education on clinical adoption. The results of the current survey revealed that practitioners who were aware of IADT guidelines were significantly more likely to use photography frequently. However, limited data are available on the awareness of pediatric dental professionals and the extent to which they adhere to established guidelines for managing dental trauma, particularly following the update of the IADT guidelines [29].
This study utilizes a large, diverse cross‐national sample and a rigorous mixed‐methods approach. However, limitations should be considered when interpreting the results. Relying on self‐reported data may introduce response bias, and the overrepresentation of regions such as Egypt and Saudi Arabia could limit the generalizability of the findings to other settings. Additionally, limited representation from Europe, North America, and Latin America may affect external validity. Consequently, the findings should primarily be viewed within the context of Middle Eastern and South Asian practice settings and may not fully reflect the attitudes and documentation practices of pediatric dentists elsewhere. Attitudes towards dental photography vary across continents, influenced by differences in training, healthcare infrastructure, and medico‐legal frameworks. Addressing these issues will help ensure that photographic documentation is not only technically effective but also ethically sound and consistently integrated into pediatric trauma care.
Future research should investigate how targeted training affects the frequency and quality of photographic documentation for TDIs. Additional studies are necessary to create and validate standardized consent processes and workflow templates for broader implementation. Incorporating AI‐powered quality control tools, integrating dental photography into mobile health (mHealth) platforms, and conducting long‐term longitudinal studies will help align guidelines with actual clinical practice. Finally, well‐designed multi‐center trials could evaluate whether structured photography training enhances pediatric trauma care worldwide. These findings provide practical guidance for policymakers, educators, and practitioners to better align actual practices with IADT standards.
This study highlights the vital role of photography in documenting pediatric trauma and the barriers to its routine use. Awareness of IADT guidelines and perceived clinical importance predict the frequency of documentation. Findings suggest the need for policies, consent protocols, and education to bridge the knowledge‐practice gap.
Author Contributions
Dr. Ahmed Fawzy and Dr. Nitesh Tewari conceptualized the study and supervised data collection. Dr. Narmin Helal performed the statistical analysis. Dr. Narmin Helal and Dr. Reem Wahby drafted the manuscript. All authors contributed to the interpretation of the data, critically reviewed the manuscript, and approved the final version.
Funding
The authors have nothing to report.
Ethics Statement
The study received ethical approval from the Institutional Review Board of the Russian Egyptian University (Approval No: FD‐ERU‐REC 26). Participants provided electronic informed consent before accessing the questionnaire. Responses were anonymized, and data confidentiality was maintained in accordance with international ethical standards.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Table S1: Variance inflation factor for the three main predictors.
Table S2: Mixed Methods Integration of qualitative and quantitative findings on barriers to clinical photography in pediatric dental trauma.
Table S3: Bivariate analysis of factors associated with the frequency of dental photography use for documenting traumatic dental injuries in children.
Acknowledgements
Open Access publishing facilitated by the Deanship of Scientific Research (DSR) at King Abdulaziz University, as part of the Wiley ‐ King Abdulaziz University agreement.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1: Variance inflation factor for the three main predictors.
Table S2: Mixed Methods Integration of qualitative and quantitative findings on barriers to clinical photography in pediatric dental trauma.
Table S3: Bivariate analysis of factors associated with the frequency of dental photography use for documenting traumatic dental injuries in children.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.