Multinational survey of pediatric dentists' knowledge and clinical practices in dentomaxillofacial imaging

This study aimed to evaluate pediatric dentists’ knowledge and clinical practices regarding dentomaxillofacial imaging, with particular emphasis on guideline-consistent indication selection, radiation protection, and dose-optimization principles, in accordance with established international guidelines (EAPD, AAPD, and DIMITRA).

A structured cross-sectional questionnaire was distributed to pediatric dentists from 8 countries (Egypt, Jordan, Mexico, Pakistan, Poland, Saudi Arabia, Türkiye, and the United States) through a convenience and snowball sampling approach. The survey assessed knowledge of radiation protection, radiographic parameters, cone-beam CT (CBCT) indications and resolution selection, and routine clinical practices. Descriptive and comparative statistical analyses were performed.

A total of 488 pediatric dentists participated, with a mean knowledge score of 39.9 ± 4.7, and 75.8% demonstrated moderate knowledge. Awareness of dose-reduction strategies was limited, as 41.6% identified rectangular collimation as the most effective radiation protection measure and 17.7% recognized its impact on radiation dose. Knowledge of dose-optimization principles varied: 68.0% of respondents demonstrated knowledge of the ALARA/ALADA principle, whereas 46.5% demonstrated knowledge of the ALADAIP concept. Clinical practices showed patterns that were partially consistent with guideline recommendations. Regarding CBCT, 57.4% had not received formal training, 43.6% were uncertain about appropriate field-of-view selection, and 91.0% reported fewer than 5 scans per month.

Pediatric dentists demonstrated moderate radiation knowledge but inconsistent application of radiation protection principles. These findings indicate a gap between theoretical knowledge and clinical practice. Targeted, practice-oriented education is needed to improve dose optimization and CBCT-related decision-making. Findings should be interpreted with caution due to the non-probability sampling design.

This multinational study highlights persistent gaps in pediatric dental imaging practices and supports the need for standardized, competency-based training to improve radiation safety.