Orthodontic knowledge and referral patterns among non-orthodontic dental providers in Saudi Arabia: a cross-sectional study

Non-orthodontic dental providers are often the first to identify malocclusion and initiate referrals to orthodontists. Therefore, their orthodontic knowledge may be an important determinant of timely orthodontic care. This study aimed to assess orthodontic knowledge and referral patterns among non-orthodontic dental providers in Saudi Arabia, investigate the association between knowledge and referrals, and compare knowledge levels and referral patterns between general dentists and non-orthodontic specialists. A cross-sectional survey was conducted among 225 non-orthodontic dental providers in Saudi Arabia (62.2% non-orthodontic specialists and 37.8% general dentists, mean age = 37.2 ± 8.3 years). A structured questionnaire assessed participants’ demographics, orthodontic knowledge, and referral patterns. Knowledge was scored by summing correct responses and categorized as low, moderate, or high. Associations were examined using chi-square and Fisher’s exact tests. Multivariable binary logistic regression was used to estimate adjusted odds ratios for having made an orthodontic referral. The mean orthodontic knowledge score was 4.3 ± 1.3, with 52.4% of participants classified as having high knowledge. General dentists demonstrated significantly higher knowledge levels than non-orthodontic specialists ( P = 0.007). Although 74.7% had ever referred a patient to an orthodontist, only 24.5% reported referring often or always during the previous year. The likelihood of having made an orthodontic referral increased significantly across knowledge levels, from 39.1% among low-knowledge providers to 65.5% among moderate-knowledge and 88.1% among high-knowledge providers ( P < 0.001). Past-year referral frequency also differed significantly by knowledge level ( P < 0.001). In multivariable analysis, moderate (OR = 4.9, 95%CI = 1.5–16.4) and high (OR = 10.9, 95%CI = 3.2–36.9) knowledge remained independently associated with having made an orthodontic referral compared to low knowledge. General dentists were also more likely to have made a referral compared to specialists (OR = 3.7, 95%CI = 1.4–9.4). Non-orthodontic dental providers demonstrated knowledge of several core orthodontic concepts, although gaps in interceptive orthodontic knowledge were identified. Referral was common but inconsistent, and greater orthodontic knowledge was associated with a higher likelihood of referral. General dentists demonstrated higher knowledge levels and were more likely to have referred patients than non-orthodontic specialists. Targeted undergraduate education and multidisciplinary continuing professional development may strengthen orthodontic knowledge and promote appropriate referral practices.