Radiation safety awareness in dental radiology among oral health students: a pretest–posttest study of a structured educational intervention

Abstract

Background

Dental radiographic imaging is widely used in oral health care, and safe practice requires adequate awareness of radiation protection, dose optimization, and patient-specific exposure principles. This study evaluated radiation safety awareness in dental radiology among oral health students and assessed the short-term effect of a structured educational intervention.

Methods

This single-group pretest-posttest study was conducted among associate degree students enrolled in an Oral and Dental Health program in Türkiye during the 2025–2026 academic year. A 90-minute structured training session addressed broad radiation protection content, including ionizing radiation, radiation quantities and units, biological effects, personal monitoring, ALARA-based practice, shielding, collimation, thyroid protection, pregnancy-related radiographic issues, receptor selection, and exposure optimization in dental imaging. Knowledge was assessed immediately before and after the intervention using 15 repeated scored items focused on selected dental radiology safety topics rather than every educational objective of the training session. The questionnaire was developed de novo for this study and was interpreted as a study-specific instrument. Paired analyses were performed among students with complete matched pretest and posttest records. Total scores were compared using the Wilcoxon signed-rank test, internal consistency was assessed using Cronbach’s alpha, and item-level changes were evaluated using exploratory unadjusted McNemar tests.

Results

Ninety-three students participated, and 69 students had complete matched pretest and posttest records. Mean total knowledge scores increased from 3.06 ± 3.00 before training to 6.78 ± 3.83 after training, while median scores increased from 3.0 to 7.0. The improvement was statistically significant (p = 6.36 × 10 − 9), with a large effect size (r = 0.70). However, the absolute posttest score remained modest relative to the 15-point maximum. Internal consistency was good at both pretest and posttest. Secondary exploratory, unadjusted item-level improvements were most evident in clinically relevant dental radiology safety topics, including pregnancy-related radiographic issues, equipment positioning, rectangular collimation, paralleling technique, thyroid protection, receptor or film selection, digital radiography, patient holding of radiographic film, recognition of X-ray use, biological effects of radiation, and adjustment of exposure parameters for adult and pediatric patients.

Conclusions

A brief structured educational intervention was associated with significant immediate improvement in dental radiology radiation safety awareness among oral health students. However, the modest absolute posttest score and the single-group immediate posttest design indicate that the findings should be interpreted as short-term educational gains rather than evidence of sustained competence or behavioral change. The findings support early and repeated integration of focused radiation protection training into oral health curricula, particularly for topics directly related to patient protection, operator safety, and dose optimization.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12903-026-09279-2.

Introduction

Dental radiographic imaging is an essential component of contemporary oral health care. It is routinely used for diagnosis, treatment planning, and follow-up of dental caries, periodontal disease, periapical pathology, developmental abnormalities, and other oral conditions [1, 2]. Although radiation doses in conventional dental imaging are generally low, the cumulative relevance of repeated examinations, inappropriate exposure selection, and insufficient optimization should not be underestimated, particularly in settings where radiographic procedures are frequently performed or where cone-beam computed tomography is increasingly used [2, 3]. Therefore, radiation safety in dental radiology should be considered a core component of oral health practice and professional training rather than a peripheral technical issue.

Radiation protection in dental imaging requires more than general awareness that X-rays are used for diagnosis. Safe practice depends on understanding ionizing radiation, dose-related concepts, radiosensitive tissues, patient-specific exposure selection, occupational protection, and the principles of justification and optimization, including the “as low as reasonably achievable” approach [2, 4–7]. These principles have direct clinical implications in dental radiology, including appropriate use of collimation, thyroid protection, receptor or film selection, operator positioning, shielding, and adjustment of exposure parameters for adult and pediatric patients [6, 8]. Misconceptions in these areas may influence both patient protection and operator behavior, especially among students and early-career oral health personnel who are still developing clinical habits.

The importance of radiation safety awareness is particularly evident in practical decision-making scenarios. For example, uncertainty about dental radiography during pregnancy, the protective effect of rectangular collimation, the role of thyroid collars, or the dose advantages of digital receptors may lead to either unnecessary avoidance of indicated imaging or inadequate implementation of dose-reduction strategies [2, 6, 8]. In this context, radiation safety education should not only provide theoretical information but also address clinically relevant dental radiology practices that students are likely to encounter during training and future professional work.

Previous studies have reported variable and sometimes insufficient radiation protection knowledge among dentists, dental students, radiographers, and other health personnel [9–14]. In Turkey, variability in dental radiographic practice has also been reported, supporting the need for structured radiation protection awareness during oral health training [15]. However, much of the available evidence is cross-sectional and focuses on describing baseline knowledge or attitudes. Fewer studies have evaluated whether a focused educational intervention can improve knowledge in specific dental radiology safety domains, particularly among oral and dental health associate degree students.

Therefore, this study aimed to evaluate radiation safety awareness in dental radiology among oral health students and to assess the short-term effect of a structured educational intervention on knowledge related to radiation protection, dose optimization, patient-specific exposure practices, and operator safety. The study also examined item-level changes in clinically relevant dental radiology topics to identify which safety domains were most responsive to the intervention.

Methods

Study design and setting

This single-group pretest–posttest study was conducted to evaluate radiation safety awareness in dental radiology among oral health students and to assess the short-term effect of a structured educational intervention. The study was carried out during the 2025–2026 academic year in the Oral and Dental Health Program of a foundation university in Türkiye.

The intervention and assessments were designed to focus on radiation protection concepts directly relevant to dental radiology practice, including patient protection, operator safety, dose optimization, collimation, thyroid protection, pregnancy-related radiographic considerations, receptor selection, and adjustment of exposure parameters for adult and pediatric patients.

Ethical approval and consent to participate

The study was approved by the Scientific Research Ethics Committee of the Faculty of Health Sciences at Altınbaş University (IRB approval no. 2025/1; December 4, 2025). All study procedures involving human participants and human data were performed in accordance with relevant guidelines and regulations, including the principles of the Declaration of Helsinki.

All participants received written information about the purpose and procedures of the study before participation. Electronic informed consent was obtained from all participants. Student identification numbers were used only to match pretest and posttest responses and were removed after the matching process. All data were de-identified before analysis.

Participants

All eligible students enrolled in the Oral and Dental Health Program and attending the radiation safety training module were invited to participate. A total of 93 students participated in the study. Participation was voluntary.

No formal a priori sample size calculation was performed. This study was designed as an exploratory educational intervention and used a convenience sample of eligible students available during the training module. All eligible students attending the module were invited to participate, and the final paired sample was determined by student participation and completeness of matched pretest-posttest data.

The pretest was administered immediately before the educational intervention, and the posttest was administered immediately after the intervention. For the primary within-participant analysis, only students with complete matched pretest and posttest records were included. Accordingly, paired analyses were performed using data from 69 students with complete matched responses.

Educational intervention

The educational intervention consisted of a 90-minute structured and interactive training session delivered by a certified medical physicist with experience in radiation safety education. The session was developed to address both general radiation protection principles and practical dental radiology safety issues.

The training content included sources and properties of ionizing radiation, radiation quantities and units, biological effects of radiation, personal monitoring, occupational exposure principles, patient protection, and the principles of justification and optimization. Particular emphasis was placed on the ALARA principle, shielding, rectangular collimation, thyroid protection, operator positioning, receptor or film selection, digital radiography, pregnancy-related radiographic decision-making, and adjustment of exposure parameters according to patient age and clinical indication.

The intervention was designed to connect theoretical radiation protection concepts with practical decisions encountered in dental imaging.

Questionnaire and outcome measures

Data were collected using an electronic questionnaire administered through Google Forms. The questionnaire included demographic and background variables together with 15 repeated scored knowledge items related to radiation safety and dental radiology practice. These 15 repeated items were selected to sample clinically relevant dental radiology safety issues targeted by the intervention, not to reproduce every educational objective covered in the training session. Broader topics such as ionizing radiation concepts, radiation quantities and units, personal monitoring, occupational exposure, ALARA, and justification formed part of the educational content, whereas only the repeated items listed in Supplementary Questionnaire S1 were used to calculate total scores and conduct item-level analyses. The questionnaire was developed de novo specifically for this study and had not been previously published elsewhere. Its content was mapped to the objectives of the educational intervention and to relevant dental radiology radiation protection literature and recommendations [2, 4–8]. The draft questionnaire was reviewed by the study authors for content relevance, wording clarity, and face validity before administration. However, no independent expert-panel content validity index, formal cognitive interviewing, or separate pilot psychometric validation was performed. Therefore, the validity evidence for the instrument should be considered limited and study-specific. The English language version of the questionnaire is provided as Supplementary Questionnaire S1.

The demographic and background variables included gender, age group, employment in a health care setting, and previous radiation safety training. The 15 repeated scored items focused on dental radiology safety statements regarding pregnancy-related radiographic practice, positioning of radiation-emitting equipment, rectangular collimation, paralleling technique, operator lead-apron use, thyroid collar use, E/F-speed versus D-speed films, patient holding of radiographic film, digital versus conventional radiography, recognition that dental imaging uses X-rays, biological effects of radiation, exposure-parameter adjustment for adults and children, and misconceptions about periapical radiography safety.

For the primary pretest–posttest analysis, 15 repeated knowledge items were scored. Each item was coded as correct or incorrect. Correct responses were assigned 1 point, and incorrect responses were assigned 0 points. The total knowledge score was calculated by summing the 15 repeated items, resulting in a possible score range of 0 to 15.

For multi-response items, an answer was considered correct only if all correct options were selected without selecting incorrect options. This scoring approach was used to reduce the likelihood of overestimating knowledge in items requiring complete conceptual understanding.

Data collection and data management

Both the pretest and posttest were completed electronically on students’ own devices. Pretest responses were collected immediately before the training session, and posttest responses were collected immediately after the session.

Student identification numbers were used only for matching the two assessments. After matching, identifiers were removed, and the dataset was de-identified before statistical analysis. Data were exported to Microsoft Excel, checked for completeness and consistency, and then transferred to the statistical analysis environment. No imputation was performed for the primary paired analysis.

Participants with unmatched or incomplete pretest–posttest records were excluded from the paired analysis but were retained in the descriptive summary of the full participant group when appropriate.

Statistical analysis

Descriptive statistics were used to summarize participant characteristics and knowledge scores. Categorical variables were reported as frequencies and percentages. Continuous variables were reported as mean ± standard deviation and median with minimum–maximum values, as appropriate.

The normality of pretest–posttest difference scores was evaluated using the Shapiro–Wilk test. Because the difference scores were not normally distributed, the Wilcoxon signed-rank test was used to compare pretest and posttest total knowledge scores. The effect size for the Wilcoxon signed-rank test was calculated as r=|Z|/√N, where Z represents the test statistic and N represents the number of paired observations.

Internal consistency of the repeated knowledge items was assessed separately for the pretest and posttest using Cronbach’s alpha. Item-level changes in the proportion of correct responses were evaluated using McNemar’s test for paired categorical data. No correction for multiple comparisons was applied to the item-level McNemar tests because these analyses were intended to identify descriptive patterns across knowledge domains rather than to provide confirmatory item-level inference. Therefore, item-level p values were interpreted as exploratory, secondary, and descriptive and should be considered cautiously. A two-sided p value of < 0.05 was considered statistically significant for the primary total-score comparison.

Results

Participant characteristics

A total of 93 oral health students participated in the study. The mean age was 20.8 ± 1.4 years. Most participants were female (64/93, 68.8%), and 29 participants (31.2%) were male. Forty-eight students (51.6%) were aged ≤ 20 years, and 45 students (48.4%) were aged > 20 years. Twenty-four participants (25.8%) reported employment in a health care setting, whereas 69 participants (74.2%) were not employed in health care. Only 16 students (17.2%) reported previous radiation safety training, while 77 students (82.8%) had no prior training. Participant characteristics are summarized in Table 1.

Table 1.

Participant characteristics of oral health students included in the study (N = 93)

Variable	Category	n (%)
Gender	Female	64 (68.8)
	Male	29 (31.2)
Age group	≤ 20 years	48 (51.6)
	> 20 years	45 (48.4)
Employment in health care	Yes	24 (25.8)
	No	69 (74.2)
Prior radiation safety training	Yes	16 (17.2)
	No	77 (82.8)

For the primary paired analysis, 69 students had complete matched pretest and posttest responses. Twenty-four students were excluded from the paired analysis because one assessment was missing or the responses could not be matched.

Change in total radiation safety knowledge scores

Among the 69 students included in the paired analysis, total radiation safety knowledge scores increased after the structured educational intervention. The mean total score increased from 3.06 ± 3.00 at pretest to 6.78 ± 3.83 at posttest. Median scores increased from 3.0 to 7.0. Because the distribution of pretest-posttest difference scores was not normal, the Wilcoxon signed-rank test was used. The increase in total knowledge score was statistically significant (p = 6.36 × 10 − 9), with a large effect size (r = 0.70). Nevertheless, the mean posttest score remained modest relative to the maximum possible score of 15, indicating that important knowledge gaps persisted after the single training session.

Internal consistency of the repeated knowledge items was good at both time points. Cronbach’s alpha was 0.81 before the intervention and 0.82 after the intervention. These values suggest acceptable internal consistency for the repeated knowledge score in this study-specific sample, although they should not be interpreted as evidence of full psychometric validation of the de novo questionnaire. The overall change in total knowledge scores is shown in Table 2; Fig. 1.

Table 2.

Pretest and posttest radiation safety knowledge scores among matched participants (n = 69)

Variable	Pretest	Posttest
Total knowledge score, mean ± SD	3.06 ± 3.00	6.78 ± 3.83
Median	3.0	7.0
Minimum–maximum	0–12	0–14
Cronbach’s alpha	0.81	0.82
p value		6.36 × 10 − 9
Effect size		r = 0.70

Knowledge scores were calculated using 15 repeated items. The Wilcoxon signed-rank test was used because pretest-posttest difference scores were not normally distributed

Fig. 1.

Pretest and posttest total radiation safety knowledge scores among matched participants. Total radiation safety knowledge scores were calculated using 15 repeated items among matched participants (n = 69). Scores increased significantly after the structured educational intervention, from 3.06 ± 3.00 at pretest to 6.78 ± 3.83 at posttest (Wilcoxon signed-rank test, p = 6.36 × 10 − 9; effect size r = 0.70). Higher scores indicate greater radiation safety knowledge. Boxes represent the interquartile range, horizontal lines indicate medians, whiskers indicate non-outlier ranges, and dots represent individual participants

Item-level changes in dental radiology radiation safety awareness

As a secondary exploratory analysis, item-level results showed improvement in several clinically relevant dental radiology safety domains. In unadjusted McNemar analyses, 13 of the 15 repeated knowledge items showed statistically significant improvement after the intervention. These item-level findings were used descriptively and were not interpreted as confirmatory evidence for individual questionnaire items.

The most pronounced improvements were observed in items related to dental imaging and pregnancy, equipment positioning, rectangular collimation, paralleling technique, thyroid protection, receptor or film selection, patient holding of radiographic film, digital radiography, recognition that dental imaging uses X-rays, biological effects of radiation, pediatric exposure adjustment, and the safety misconception that periapical radiography is completely safe. Correct responses increased from 7.2% to 44.9% for the item on periapical dental films during pregnancy, from 7.2% to 39.1% for rectangular collimation, from 8.7% to 42.0% for the paralleling technique, from 10.1% to 44.9% for harm related to patient holding of radiographic film, from 14.5% to 43.5% for digital radiography, and from 37.7% to 73.9% for recognition that dental imaging uses X-rays. Two items did not show statistically significant improvement: the blanket statement that radiological examinations during pregnancy are prohibited and the statement that the operator needs to wear a lead apron during dental radiographic procedures other than periapical imaging. These findings suggest that although the intervention produced meaningful short-term gains, some dental radiology radiation safety concepts may require repeated instruction, practical demonstration, or reinforcement during clinical training. Full item-level results are presented in Table 3, and the main exploratory item-level improvements are illustrated in Fig. 2.

Table 3.

Exploratory unadjusted item-level changes in dental radiology radiation safety knowledge among matched participants (n = 69)

Item	Correct pretest n (%)	Correct posttest n (%)	Change, percentage points	McNemar p
Panoramic dental films can be taken during pregnancy	8 (11.6)	23 (33.3)	+ 21.7	0.0026
Periapical dental films can be taken during pregnancy	5 (7.2)	31 (44.9)	+ 37.7	< 0.0001
Radiologic examination during pregnancy is prohibited	11 (15.9)	13 (18.8)	+ 2.9	0.8238
Positioning of radiation-emitting equipment matters for protection	25 (36.2)	40 (58.0)	+ 21.7	0.0107
Rectangular collimation reduces patient dose	5 (7.2)	27 (39.1)	+ 31.9	< 0.0001
Paralleling technique reduces thyroid dose compared with bisecting-angle technique	6 (8.7)	29 (42.0)	+ 33.3	< 0.0001
The operator needs to wear a lead apron during dental radiographic procedures other than periapical imaging	27 (39.1)	36 (52.2)	+ 13.0	0.1877
A thyroid collar should be used for every patient during dental radiographic imaging	11 (15.9)	23 (33.3)	+ 17.4	0.0042
E/F-speed films are preferred over D-speed films	5 (7.2)	22 (31.9)	+ 24.6	0.0002
There is harm if the patient holds the radiographic film by hand during periapical radiography	7 (10.1)	31 (44.9)	+ 34.8	< 0.0001
Digital radiography gives less dose than conventional radiography	10 (14.5)	30 (43.5)	+ 29.0	0.0002
Dental imaging uses X-rays	26 (37.7)	51 (73.9)	+ 36.2	< 0.0001
Radiation is not harmful to living cells	33 (47.8)	44 (63.8)	+ 15.9	0.0433
Same exposure parameters are used for adults and children	20 (29.0)	38 (55.1)	+ 26.1	0.0009
Periapical radiography is completely safe and has no health effects	12 (17.4)	30 (43.5)	+ 26.1	0.0014

Correct response rates were calculated among matched participants. McNemar’s test was used for paired categorical comparisons. Item-level analyses were secondary, exploratory, and unadjusted for multiple comparisons; these results should be interpreted descriptively rather than as confirmatory item-specific tests. For negatively worded items, the reported n (%) indicates the number and percentage of participants selecting the correct response

Fig. 2.

Secondary exploratory unadjusted item-level improvements in dental radiology radiation safety knowledge. The figure shows pretest and posttest correct response rates for knowledge items that improved in secondary exploratory unadjusted item-level McNemar analyses. Only items with unadjusted McNemar p < 0.05 are shown. Negatively worded items are displayed in the correct-answer direction for readability. The largest improvements were observed in items related to dental imaging and pregnancy, rectangular collimation, paralleling technique, patient holding of radiographic film, digital radiography, and recognition that dental imaging uses X-rays. Full item-level results are presented in Table 3

Discussion

This study showed that a structured 90-minute educational intervention was associated with a significant immediate improvement in dental radiology radiation safety awareness among oral health students. The increase in total knowledge scores and the large effect size suggest that a brief, focused intervention may improve understanding when the content is directly linked to practical dental imaging decisions. This finding is important because dental radiography is widely used in oral health care, and safe practice depends not only on technical image acquisition but also on appropriate radiation protection behavior, patient-specific exposure selection, and awareness of dose optimization principles [1–4].

Despite this statistically significant improvement, the absolute posttest performance should be interpreted cautiously. The mean posttest score was 6.78 out of a possible 15 points, indicating that residual knowledge gaps remained after a single 90-minute session. The intervention should therefore be considered an initial educational step rather than sufficient preparation for safe independent clinical practice. Longitudinal reinforcement, repeated training, case-based discussion, and supervised practical teaching are likely necessary to consolidate radiation safety knowledge and promote safer behavior in dental imaging settings.

The internal consistency findings also require cautious interpretation. Cronbach’s alpha was 0.81 at pretest and 0.82 at posttest, indicating good internal consistency of the repeated knowledge score in this study-specific sample. However, the instrument was developed de novo and covered several radiation safety domains rather than a single homogeneous construct. Accordingly, Cronbach’s alpha was used descriptively and should not be interpreted as evidence of full psychometric validation of the questionnaire.

The present findings are consistent with previous reports showing that radiation protection knowledge among dental students, dentists, radiographers, and other health personnel is often variable and incomplete [9–14]. Furmaniak et al. reported heterogeneous radiation awareness among dentists, radiographers, and students, emphasizing the need for stronger educational strategies in radiation protection [11]. Similarly, Paolicchi et al. showed that knowledge of radiation doses and protection principles among radiographers was not uniformly adequate, suggesting that formal training alone may not be sufficient unless radiation safety concepts are reinforced in a clinically meaningful way [12]. In line with these studies, the low baseline scores observed in the present study suggest that oral health students may enter clinical training with important gaps in radiation safety awareness. However, unlike many cross-sectional studies that primarily describe existing knowledge levels, the present study demonstrates that these gaps are modifiable through a structured educational intervention. This interpretation is also consistent with evidence that educational interventions can improve clinicians’ radiation protection knowledge [16].

A key strength of the present study is that the intervention and assessment addressed both general radiation protection principles and dental radiology-specific safety practices. Radiation safety in dentistry requires more than knowing that X-rays are ionizing radiation. Students must understand justification, optimization, ALARA-based practice, shielding, collimation, receptor selection, occupational protection, radiosensitive tissues, and patient-specific exposure adjustment [2, 4–8]. This multidimensional approach is supported by previous literature emphasizing that radiation protection in dental radiology should include biologic effects, equipment-related protection, operator safety, and patient management rather than being limited to general theoretical knowledge [2, 6, 8].

The item-level findings provide clinically relevant insight into which domains responded most clearly to the intervention. Significant improvements were observed in topics related to panoramic and periapical radiography during pregnancy, equipment positioning, rectangular collimation, paralleling technique, thyroid collar use, E/F-speed film preference, patient holding of radiographic film, digital radiography, recognition that dental imaging uses X-rays, biological effects of radiation, adjustment of exposure parameters for adult and pediatric patients, and the safety misconception that periapical radiography has no health effects. These domains correspond closely to practical radiation protection decisions encountered in dental imaging. Tsapaki emphasized that dose optimization in dental radiology depends on appropriate technique selection, collimation, receptor choice, and patient-specific exposure management [2]. Similarly, Praveen et al. highlighted the importance of awareness, protection measures, and practical recommendations in dental radiography [9]. Therefore, the observed gains in these items suggest that the intervention improved not only abstract knowledge but also awareness of clinically actionable radiation safety concepts.

The improvement in pregnancy-related radiographic knowledge is particularly relevant. Misconceptions about dental imaging during pregnancy may lead either to unnecessary avoidance of indicated diagnostic procedures or to inappropriate protection practices. Radiation protection education should therefore help students distinguish between justified, optimized dental radiography and unnecessary exposure. In the present study, improvement in pregnancy-related items suggests that targeted teaching can clarify this issue. This is consistent with the broader radiation protection literature, which emphasizes that safety should be based on justification and optimization rather than fear-based avoidance of all radiographic procedures [2, 4–7].

The increase in correct responses related to rectangular collimation, thyroid protection, receptor selection, and digital radiography also has practical importance. These topics are directly connected to dose reduction in dental radiology. Previous studies have emphasized that collimation, appropriate receptor or film speed, digital imaging, and thyroid shielding can contribute to lowering patient exposure when used correctly [2, 6, 8]. The present study supports the view that these practical topics should be explicitly included in oral health curricula. Because students are likely to transfer early educational habits into clinical practice, improved awareness in these domains may contribute to safer imaging behavior over time.

Despite the overall improvement, two items did not show statistically significant change. These concerned the blanket misconception that radiological examinations during pregnancy are prohibited and the statement that the operator needs to wear a lead apron during dental radiographic procedures other than periapical imaging. This suggests that some concepts may require more than a single lecture-based intervention, particularly when they involve nuanced clinical judgment or occupational protection practices. Practical demonstrations, case-based scenarios, simulation, repeated reinforcement, and clinical supervision may be necessary to translate theoretical knowledge into stable radiation safety behavior. This interpretation is consistent with previous studies showing that radiation protection awareness is not always uniformly distributed across knowledge domains and that practical behavior may lag behind theoretical understanding [9–14].

The findings are also relevant in the Turkish oral health education context. Ilguy et al. previously reported variability in dental radiological practice in Turkey, indicating that radiation protection behaviors and imaging practices may differ across settings [15]. Senisik et al. also reported variable radiation awareness among radiation workers in Turkey [14]. The present study adds to this national context by showing that structured radiation safety education can improve awareness among oral health students before or during early clinical exposure. This supports the need to introduce radiation protection principles early in oral health training and to reinforce them systematically throughout the curriculum.

This study has several limitations. First, the single-group pretest-posttest design without a control group limits causal inference. Although the improvement after the intervention was statistically significant, the absence of a comparison group means that improvement may have been influenced in part by familiarity with the questionnaire, testing effects, repeated-item recall, or other unmeasured factors. Second, the posttest was administered immediately after the intervention using repeated items; therefore, the study evaluated short-term knowledge gain rather than long-term retention, and recall or test-retest effects cannot be excluded. Third, no formal a priori sample size calculation was performed, and the study used a convenience sample from a single institution, which limits generalizability. Fourth, the questionnaire was developed specifically for this study, the 15 repeated scored items sampled selected clinically relevant dental radiology safety topics rather than comprehensively measuring every educational content area, and the instrument did not undergo independent expert-panel validation, cognitive interviewing, or separate pilot psychometric testing before application. Fifth, the item-level McNemar analyses involved multiple comparisons and were not adjusted for multiplicity; these results should therefore be interpreted as exploratory. Sixth, the paired analysis included only students with complete matched records, which may have introduced attrition-related bias. Finally, improved questionnaire performance does not necessarily indicate sustained behavioral change in clinical dental radiology practice.

Future studies should include multicenter samples, control or comparison groups, delayed posttests, and practical assessments of radiation safety behavior. Longitudinal designs would be particularly useful for determining whether short-term improvements in knowledge are retained and whether they translate into safer imaging practices. Future research should also compare different teaching formats, such as lecture-based training, simulation, case-based learning, and blended learning approaches, to determine which methods are most effective for improving dental radiology radiation safety awareness.

In summary, this study provides evidence of significant short-term gains in dental radiology radiation safety awareness after a brief, structured educational intervention. The most meaningful gains occurred in practical safety domains directly related to patient protection, operator safety, and dose optimization. However, the modest absolute posttest scores and the immediate single-group design highlight the need for repeated, clinically oriented reinforcement of radiation safety principles during dental radiology education.

Conclusion

This single-group pretest-posttest study showed that a brief, structured educational intervention was associated with significant immediate improvement in dental radiology radiation safety awareness among oral health students. The most relevant gains were observed in practical safety domains directly related to patient protection, operator safety, and dose optimization, including pregnancy-related radiographic considerations, equipment positioning, rectangular collimation, paralleling technique, thyroid protection, receptor or film selection, patient holding of radiographic film, digital radiography, biological effects of radiation, and adjustment of exposure parameters for adult and pediatric patients.

These findings suggest that focused radiation protection training can help address important knowledge gaps before or during early clinical exposure in oral health education. However, the mean posttest score remained modest relative to the maximum possible score, and the study assessed immediate knowledge using a single-group design. The intervention should therefore be viewed as an important initial step rather than evidence of complete or sustained radiation safety competence. Future multicenter studies with control groups, delayed follow-up assessments, and practical evaluations of radiation safety behavior are needed to determine whether improved awareness translates into retained knowledge and safer dental imaging practice.

Abbreviations

ALARA

As Low As Reasonably Achievable

CBCT

Cone-beam computed tomography

SD

Standard deviation

Authors' contributions

AMS contributed to the conception and design of the study, delivery of the training intervention, data analysis, interpretation of results, manuscript drafting, and critical revision of the manuscript. BKG contributed to participant coordination, data collection, interpretation of results, and manuscript revision. Both authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

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

Declarations

Ethics approval and consent to participate

This study was approved by the Scientific Research Ethics Committee of the Faculty of Health Sciences at Altınbaş University (IRB approval no. 2025/1; December 4, 2025). All study procedures involving human participants and human data were performed in accordance with relevant guidelines and regulations, including the principles of the Declaration of Helsinki. All participants received written study information and provided electronic informed consent before participation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.