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

OBJECTIVES: 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). METHODS: A structured cross-sectional questionnaire was distributed to pediatric dentists from eight countries (Egypt, Jordan, Mexico, Pakistan, Poland, Saudi Arabia, Türkiye, and the USA) through a convenience and snowball sampling approach. The survey assessed knowledge of radiation protection, radiographic parameters, cone-beam computed tomography (CBCT) indications and resolution selection, and routine clinical practices. Descriptive and comparative analyses were performed. RESULTS: 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 five scans per month. CONCLUSIONS: 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. ADVANCES IN KNOWLEDGE: This multinational study highlights persistent gaps in pediatric dental imaging practices and supports the need for standardized, competency-based training to improve radiation safety.