This mixed-methods study reveals a significant knowledge-to-practice gap in oral microbiome counseling among dental practitioners in Saudi Arabia, consistent with global trends where scientific knowledge often fails to translate into clinical practice [9, 23, 24]. Despite moderate-to-high objective knowledge of the oral microbiome (mean score: 9.1 ± 1.9 out of 13), only 25.2% of participants reported high confidence and 14.7% very high confidence in patient counseling (Q20, N = 285), highlighting a disconnect driven by educational, practical, and perceptual barriers. These findings underscore the urgent need for targeted strategies to integrate microbiome science into routine dental care, particularly in Saudi Arabia, where the high prevalence of systemic diseases, such as diabetes (18.7%) and cardiovascular disease (accounting for 42% of mortality), amplifies the relevance of oral-systemic health linkages [7, 8].
The survey results indicate strong recognition of the oral microbiome’s clinical relevance, with 73.3% of practitioners agreeing that nutritional counseling influences the oral microbiome (Q15) and 63.2% acknowledging the role of the oral-gut axis in diagnosis and treatment planning (Q16). Additionally, 85.7% supported formal microbiome training (Q17), reflecting a desire for enhanced education. However, reliance on informal knowledge sources, such as social media (24.2%, Q18), over dental curricula (14.4%, Q18), and infrequent knowledge updates (89.1% updating monthly or less, Q19), suggest educational gaps that limit clinical application. These findings align with prior studies that have noted insufficient microbiome integration in dental education [9].
The association between higher knowledge levels and greater counseling confidence (Spearman’s ρ ≈ 0.70, p < 0.001) supports Bandura’s self-efficacy theory, which posits that competence fosters confidence [16]. This finding aligns with those of Wilkes et al. (2017) [22], who reported that primary care providers with formal genetics training exhibited greater counseling confidence. However, our study indicates that knowledge alone is insufficient, as systemic barriers—such as limited formal training (52.6%, Q21) and reliance on informal sources like social media (24.2%, Q18)—hinder clinical translation. This reliance on social media, while reflecting modern learning trends, raises concerns about information reliability, consistent with Hamasha et al. (2019) [25], who noted variable quality in online dental education resources.
Qualitative insights further contextualize these barriers, aligning with global challenges in dental practice. The lack of structured microbiome training, reported by 52.6% of participants (Q21), echoes Taşdemir and Alkan (2015) [26], who found that over 70% of Turkish physicians did not apply oral-systemic knowledge due to educational gaps. Time constraints, cited by 17.9% (Q21), reflect broader challenges in dental practice, where procedural priorities often overshadow preventive counseling [27]. Perceived patient disinterest (29.5%, Q21) suggests a need for improved patient education strategies, as low public awareness of oral-systemic links may undermine counseling efforts [28]. These barriers form a self-reinforcing cycle that limits counseling, despite strong practitioner recognition of microbiome relevance (Q15, Q16).
The findings are particularly significant in Saudi Arabia, where Vision 2030 emphasizes the importance of preventive healthcare [18, 19]. Integrating microbiome-informed counseling could enhance preventive care, especially for patients with systemic conditions. Unlike prior studies focusing solely on knowledge gaps, our mixed-methods approach combines quantitative predictors (e.g., initial training, OR = 3.21, 95% CI: 1.82–5.65, p < 0.001) with qualitative barriers, providing a robust foundation for educational and practice reforms.
One of the key strengths of this study lies in its mixed-methods design, which allowed for a comprehensive exploration of the knowledge-to-practice gap by integrating both quantitative patterns and qualitative insights. By capturing numerical associations alongside practitioners’ lived experiences, the study provides a richer and more nuanced understanding of the barriers to microbiome counseling. The inclusion of a diverse, multi-specialty sample from various regions across Saudi Arabia further enhances the credibility and generalizability of the findings. Rigorous thematic coding and statistical analysis ensured methodological robustness across both strands of data.
Despite its strengths, this study has several limitations that should be acknowledged. The cross-sectional design limits causal inferences about knowledge, confidence, and counseling behaviors. Self-reported data may be subject to social desirability bias, potentially inflating reported confidence (e.g., 47.9% high confidence, Q20) or counseling frequency. Administering the questionnaire in English may have excluded non-fluent practitioners, thereby reducing the inclusivity of the sample. Additionally, the placement of Section D (Clinical Application) after Section C (Self-Perceived Knowledge) may have introduced response bias, as questions about the oral microbiome’s clinical relevance (e.g., Q15–Q17) could have prompted participants with inadequate knowledge to reflect and potentially adjust their responses. Although saturation of factors was achieved with 30 qualitative responses, the small subset limits the depth of contextual insights. Missing data (in one case, N = 285 for most analyses) and the absence of longitudinal follow-up limit insights into behavioral changes over time. Future research should employ longitudinal designs, randomize question order to mitigate response bias, and incorporate patient perspectives to gain a deeper understanding of communication dynamics.
Clinical implications and recommendations
To address the identified barriers, we propose a targeted implementation framework that integrates oral microbiome counseling into dental practice, aligning with Saudi Vision 2030’s preventive health goals. The framework addresses three primary barriers: lack of formal training (52.6%, Q21), time constraints (17.9%, Q21), and perceived patient disinterest (29.5%, Q21). Proposed strategies include:
-
1.
Curriculum Integration and CPD: Incorporate microbiome science into dental curricula and develop case-based continuing professional development (CPD) modules to enhance knowledge and confidence (OR = 3.21 for training) [29, 30].
-
2.
Microbiome Moments: Implement brief, 2-minute counseling sessions during routine cleanings, supported by electronic health record (EHR) prompts for high-risk patients, to address time constraints [31].
-
3.
Patient Engagement: Train auxiliary staff to initiate microbiome discussions and use visual aids to boost patient interest, addressing low awareness [28].
Supportive Tools: Mobile microlearning platforms for just-in-time education and EHR-integrated prompts to streamline counseling.
Expected outcomes
-
Increased practitioner confidence (projected OR = 3.21).
-
40% increase in microbiome-related counseling frequency.
-
Enhanced alignment with Saudi Vision 2030’s preventive care objectives.
These strategies leverage existing infrastructure, such as mobile technology and EHR systems, to create sustainable, scalable solutions for integrating microbiome science into routine dental care.
link