Abstract
BACKGROUND: Evidence links the oral microbiome to systemic diseases, yet its integration into dental practice remains limited, particularly in Saudi Arabia, where non-communicable diseases are prevalent. Equipping dental practitioners with microbiome-related competencies is essential. This study evaluated the knowledge, confidence, and counseling practices of dental practitioners, identifying predictors and barriers to the clinical application of these practices. METHODS: A convergent mixed-methods design involved 286 dental practitioners (general dentists, specialists, academics) across Saudi Arabia. Participants completed a 23-item validated questionnaire (13 assessing objective knowledge, 8 evaluating beliefs, confidence, and barriers, 2 open-ended). Quantitative data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression. Qualitative data from 30 open-ended responses were qualitatively analyzed to explore contextual factors. RESULTS: Practitioners exhibited moderate-to-high objective knowledge (mean score: 9.14 ± 1.87 out of 13), with 55.9% in the medium category, 28.3% high, and 15.7% low. Confidence in counseling was moderate, with 39.6% reporting high or very high confidence. Prior microbiome training (OR = 3.21, 95% CI: 1.82-5.65, p < 0.001), frequent participation in Continuing Professional Development (CPD), and journal use (OR = 2.15, 95% CI: 1.25-3.70, p = 0.006) predicted higher confidence. Barriers included lack of formal training (52.6%), time constraints (17.9%), and patient disinterest (29.5%). Social media was a key knowledge source (24.2%), while dental curricula were underutilized (14.4%). Qualitative themes reinforced barriers and highlighted conditional motivation linked to patient risk factors. CONCLUSIONS: A notable knowledge-to-practice gap persists in oral microbiome counseling. We propose integrating microbiome science into dental curricula and utilizing mobile Continuing Professional Development (CPD) tools to enhance confidence and increase counseling frequency, thereby addressing training gaps and infrequent updates. Additionally, Electronic Health Record (EHR) prompts are recommended to overcome time constraints and patient disinterest, aligning with Saudi Vision 2030's goals for preventive care.