Knowledge and clinical practices of Saudi dentists regarding supplementary techniques for achieving pulpal anesthesia: a cross-sectional study

Abstract Background Effective local anesthesia is essential for pain control in endodontics and restorative dentistry. However, conventional techniques such as the inferior alveolar nerve block often fail to achieve predictable pulpal anesthesia, particularly in mandibular molars with symptomatic irreversible pulpitis. Supplementary techniques, including intraligamentary (IL) and intraosseous (IO) injections, provide alternative approaches that may enhance anesthetic success and improve patient outcomes. Methods A cross-sectional survey was conducted among dentists at King Abdulaziz University Dental Hospital (KAUDH), Jeddah, Saudi Arabia. A structured questionnaire assessed demographics, knowledge, awareness, and clinical practices related to supplementary anesthesia techniques. Knowledge was evaluated using a composite score derived from four single-best-answer questions (range 0–4). Data were analyzed using IBM SPSS Statistics version 26.0. Descriptive statistics and multivariable logistic regression were performed, with statistical significance set at p < 0.05. Results Of 398 invited participants, 344 responded (response rate: 86.4%). Awareness of IL was high (98.1%). Based on the four-item composite knowledge score, 69% of participants demonstrated good overall knowledge, whereas only 38.4% demonstrated good IL-specific knowledge, indicating a technique-specific knowledge gap. Clinically, IL was most commonly used for endodontic procedures (81.4%), followed by extractions (60.2%), tooth preparation (42.7%), and restorative procedures (35.5%), with 60.5% reporting a favorable patient response. IO anesthesia was used by 77.9% of participants, predominantly in the posterior mandible (76.5%), and 94% reported using vasoconstrictor-containing solutions. Multivariable logistic regression identified no statistically significant predictors of good IL-specific knowledge; however, findings should be interpreted cautiously due to wide confidence intervals and limited precision. Conclusion Although dentists demonstrated high awareness and widespread clinical use of supplementary anesthetic techniques, important deficiencies in IL-specific knowledge persisted despite relatively high overall theoretical knowledge. These findings highlight the need to strengthen education and clinical training to support the appropriate selection and application of supplementary anesthesia techniques in challenging clinical situations and ultimately improve patient care.