Dental Assistants Outscore Dentists on Environmental Health Knowledge in Saudi Survey

Dentistry is one of the most resource-intensive corners of modern healthcare. Every day, clinics generate streams of biomedical waste, consume large volumes of water and single-use plastics, handle chemical disinfectants and mercury-containing amalgam, and expose patients and staff to ionizing radiation. Yet a new study from Saudi Arabia suggests that the professionals who run these clinics may not know as much about the environmental footprint of their own workplaces as we might assume — and, surprisingly, that the least-qualified members of the dental team sometimes know the most.

The research, published in Frontiers in Public Health by Reem Al-Kattan of King Saud University, set out to measure environmental health literacy, or EHL, among oral healthcare professionals. EHL is a multidimensional concept: it covers not just factual knowledge about environmental hazards, but also attitudes toward them, confidence in one’s ability to respond, and actual practices. The idea is that a professional who can access, understand, evaluate, and apply environmental health information is far better placed to counsel patients, manage waste responsibly, and push their institution toward sustainable operations.

To capture that complexity, the study surveyed 384 oral healthcare workers across Saudi Arabia — 258 dentists and 126 non-dentist personnel, including academicians, dental assistants, and allied health professionals. Participants were recruited through email using convenience sampling, and each completed a structured questionnaire developed by the research team after a literature review, expert content validation, and pilot testing. Responses were recorded on five-point Likert scales, and composite scores across the four domains were standardized to a 0–100 scale. A score of 70 or above was predefined as indicating good environmental health literacy.

The headline result is deceptively simple: overall literacy was moderate, and statistically indistinguishable between the two groups. Dentists averaged 70.5 points, non-dentists 73.4, a difference that fell short of significance (p = 0.090). Roughly half of all participants — 48.1 percent of dentists and 57.9 percent of non-dentists — cleared the good-literacy threshold. In other words, in a profession whose daily work involves hazardous chemicals, sharps, radiation, and high water and energy consumption, about half of the workforce fell below the study’s own bar for adequate environmental health understanding.

Beneath that aggregate parity, however, lay a striking asymmetry. When the researchers broke the scores into domains, non-dentists significantly outperformed dentists on knowledge, scoring 19.02 versus 17.93 on the knowledge subscale, with 64.3 percent achieving good knowledge levels compared with just 51.6 percent of dentists. No significant differences emerged in attitudes, confidence, or practices. The pattern is counterintuitive: the clinicians with the most formal training knew less about environmental health than the assistants and allied staff working alongside them.

The authors offer a plausible explanation. Academicians and allied professionals may have greater exposure to interdisciplinary public health and sustainability initiatives, while practicing dentists are consumed by clinical and administrative demands that leave little room for environmental education. Compounding this, environmental health and sustainability concepts remain thinly integrated into traditional dental curricula — a gap documented in prior work. A 2025 study cited in the paper found that dental students showed greater environmental awareness than practicing dentists, and separate research on Swedish dental and nursing professionals found both groups felt inadequately prepared to discuss climate change and sustainability with patients.

The study’s correlation analysis adds an encouraging note. Across both groups, all four literacy domains were positively and moderately-to-strongly correlated with one another (all p < 0.010). Knowledge tracked with attitude, attitude with practice, practice with confidence — coefficients ranged from 0.70 to 0.83. This interlocking structure supports the multidimensional model of health literacy, in which understanding forms the foundation for favorable beliefs, self-efficacy, and ultimately behavior. It also hints that interventions targeting knowledge could ripple outward into practice, though the cross-sectional design forbids any causal claim.

What actually predicted good literacy? For dentists, regression analysis pointed to three modifiable factors. Those aged 30–49 had roughly three times the odds of good literacy compared with dentists under 30 (adjusted odds ratio 3.01), and those aged 50–65 had more than four times the odds (aOR 4.28). Attendance at environmental health conferences or scientific events was the strongest single predictor, nearly quadrupling the odds (aOR 4.02), and prior formal environmental health training more than doubled them (aOR 2.35). Among non-dentists, the conference effect was even more dramatic: attendees had over twelve times the odds of good literacy (aOR 12.25), though the wide confidence interval and small subgroup sizes warrant caution.

The age gradient among dentists is intriguing. Older practitioners may have accumulated environmental and occupational health information over longer careers, or benefited from more continuing professional development. But the authors are careful to note that the cross-sectional design cannot distinguish whether education builds literacy or whether environmentally minded individuals simply seek out more education. Either way, the practical implication is the same: structured exposure — conferences, formal training, targeted curricula — is the variable most tightly linked to adequate literacy, and prior intervention studies, including a virtual phthalate-literacy program for professionals, have shown measurable gains from exactly such efforts.

The study has honest limitations. Convenience sampling means environmentally engaged professionals were likely overrepresented, so the true literacy of the broader workforce may be even lower than reported. The questionnaire, while piloted and expert-reviewed, was not assessed for internal-consistency reliability or construct validity. The non-dentist group also lumped together academicians, assistants, and allied professionals, so the knowledge advantage may not be uniform across those roles. And the 70 percent threshold was investigator-defined. Still, the core message stands: environmental health literacy among oral healthcare professionals is moderate at best, knowledge gaps favor the non-dentists, and educational exposure is the clearest lever for improvement. As healthcare systems worldwide confront their own carbon footprints — dentistry’s single-use plastics, amalgam separators, and sterilization energy loads among them — the findings argue that sustainability belongs in dental school curricula and continuing education alike, not as an elective afterthought but as core professional competence.

Subject of Research: Environmental health literacy among dentists and non-dentist oral healthcare professionals in Saudi Arabia

Article Title: Environmental health literacy among oral healthcare professionals—a comparison across professional groups

Article References: Al-Kattan, R. (2026). Environmental health literacy among oral healthcare professionals—a comparison across professional groups. Frontiers in Public Health, 14, Article 1933350. https://doi.org/10.3389/fpubh.2026.1933350

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1933350

Keywords: environmental health literacy, dentistry, oral healthcare professionals, Saudi Arabia, sustainable healthcare, dental education, public health, cross-sectional study, knowledge attitudes practices, continuing professional development, Environmental, health