Understanding the Knowledge-to-Practice Gap in Oral Microbiome Counseling
The oral microbiome—comprising bacteria, fungi, viruses, and archaea—significantly affects both oral and systemic health. A new mixed-methods study of 286 dental practitioners across Saudi Arabia reveals a persistent gap between knowledge and clinical practice when it comes to counseling patients about the microbiome. Despite moderate-to-high objective knowledge (mean score 9.14 out of 13), many practitioners report only moderate confidence in counseling patients, and a sizable share indicate barriers in translating knowledge into routine care.
Key Findings: Knowledge, Confidence, and Barriers
Practitioners demonstrated a reasonable grasp of microbiome concepts, yet confidence did not consistently track this knowledge. About 39.6% reported high or very high confidence in counseling, while 14.4% felt very confident. The strongest predictor of counseling confidence was prior microbiome training (odds ratio 3.21), with ongoing CPD participation and journal use also contributing (OR 2.15). This aligns with behavioral science insights that competence should translate into confidence for effective practice.
Barriers were substantial: more than half (52.6%) cited a lack of formal training, followed by patient disinterest (29.5%) and time constraints (17.9%). The study also found that practitioners frequently rely on informal sources such as social media (24.2%), and underutilize the dental curriculum (14.4%) for microbiome learning. These barriers help explain why a strong belief in the relevance of microbiome science has not yet produced consistent counseling in clinics.
Qualitative Insights and Context
Open-ended responses highlighted four themes: professional barriers, time/workflow constraints, patient-related barriers, and conditional motivation. Qualitative data reinforced the quantitative results, illustrating how limited formal training and perceived patient apathy interact with busy clinical schedules to slow uptake of microbiome-informed counseling. Practitioners expressed willingness to engage when risk factors are clear, suggesting conditional motivation that could be mobilized with the right tools and workflows.
Implications for Saudi Vision 2030 and Preventive Care
Saudi Vision 2030 emphasizes preventive, value-based healthcare, making microbiome-informed counseling a strategic target. Integrating microbiome science into dental education and practice supports early prevention of diabetes, cardiovascular disease, and other systemic conditions linked to oral health. The study’s regression analyses underscore that training is a powerful lever to raise confidence and, presumably, counseling frequency.
Recommended Evidence-Based Solutions
The authors propose a practical implementation framework designed for rapid adoption in dental settings:
- Curriculum Integration and CPD: Embed microbiome science in dental curricula and offer case-based CPD modules to bolster knowledge and confidence. The strong association between formal training and counseling willingness supports this approach.
- Microbiome Moments: Introduce brief, two-minute counseling segments during routine cleanings, reinforced by electronic health record (EHR) prompts, to address time pressures in clinics.
- Patient Engagement: Use visual aids and empower auxiliary staff to initiate microbiome discussions, countering patient disinterest and expanding counseling opportunities.
- <strongSupport Tools: Develop mobile microlearning platforms for just-in-time education and ensure EHR prompts target high-risk patients.
Expected Outcomes and Future Directions
If implemented, the model could substantially increase counseling frequency and practitioner confidence, advancing preventive care in line with national health goals. A projected 40% rise in microbiome-related counseling and stronger alignment with Vision 2030 are anticipated outcomes. Longitudinal studies and patient perspectives will be essential next steps to validate effectiveness and refine strategies.
