Assessment of Knowledge, Attitudes, and Clinical Practices Regarding Dentine Hypersensitivity: A Cross-Sectional Study Among Dental Practitioners

Assessment of Knowledge, Attitudes, and Clinical Practices Regarding Dentine Hypersensitivity: A Cross-Sectional Study Among Dental Practitioners | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Knowledge, Attitudes, and Clinical Practices Regarding Dentine Hypersensitivity: A Cross-Sectional Study Among Dental Practitioners Basem H. AL-Huthaifi, Taghreed Ahmed Mohamad Al-kibsi, Baker M. Abdullah, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8206874/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background/aim: Dentin hypersensitivity (DH) is a common clinical condition characterized by a short, sharp pain that originates from exposed dentin. This study aimed to evaluate the knowledge, attitudes, and clinical practices regarding DH among dental practitioners. Methods A cross-sectional online survey was conducted among 401 dentists and specialists from July 2025 to August 2025. A validated questionnaire containing 30 questions was distributed to assess demographic variables, knowledge, attitudes, clinical practices, perceived barriers, and preventive practices in the diagnosis and management of DH. The data were analyzed using IBM SPSS Statistics (version 25.0), and p-value < 0.05 was considered statistically significant. Results The study gathered 401 (91.13% response rate) responses and revealed that the participants had moderate general knowledge about DH, with 28.1% demonstrating a “good” level of knowledge. Most participants were aware of the hydrodynamic theory (57.2%) and local factors, such as enamel erosion (78.1%), although some still had misconceptions, especially with regard to systemic factors (44.3%). Higher knowledge levels were significantly associated with being female and those with postgraduate qualifications (p < 0.05). Attitudes were generally positive, with 61.2% acknowledging DH’s impact on patients’ life quality. However, only 36.6% felt very confident in managing the DH cases. Diagnosis primarily relied on patient history (89.3%). The form of treatment most used was fluoride varnish (75.9%), and advanced modalities, such as lasers (13.4%), were infrequently used. Major barriers were diagnostic difficulties (67.2%) and noncompliance of patients (49.3%), with 83.6% of participants advocating for more education on DH. Conclusion Yemeni dental professionals have a moderate level of knowledge and a positive attitude toward DH but suffer great difficulties in implementing this knowledge in a confident evidence-based practice. The demonstrated knowledge-practice gap necessitates urgent attention for structured educational interventions in the form of context-based clinical guidelines and the provision of improved means of obtaining advanced therapeutic materials to enhance the quality of DH care in this resource-poor setting. Dentine hypersensitivity knowledge attitude clinical practice dental professionals Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Dentin hypersensitivity (DH) refers to a frequently unrecognized clinical condition characterized by sharp, transient pain when exposed dentin responds to various stimuli (thermal, mechanical, osmotic, or chemical) without any other dental issues present [ 1 , 2 ]. This phenomenon can be predominantly explained using Brännström’s hydrodynamic theory, which posits that such stimuli lead to fluid movement within dentinal tubules; this condition activates intradental nerve mechanoreceptors, which leads to the characteristic pain [ 3 , 4 ]. Global prevalence estimates of DH differ significantly (3.8% to 87%), depending on the diagnostic criteria, evaluation methods, and consideration of self-reported symptoms [ 5 – 7 ]. Importantly, about 50% of the dental patients with DH may not disclose it, thus contributing to underdiagnosis and undertreatment of DH [ 8 , 9 ]. The causative factors of DH are multifactorial, as they are caused by both local and systemic factors. Local factors of dentin exposure include gingival recession, enamel wear, periodontal disease, aggressive brushing, tooth bleaching, and pathological dental wear [ 1 , 10 ]. Systemic factors include conditions, such as gastroesophageal reflux (GER) and intake of acidic foods and beverages, which result in demineralization of enamel and dentin exposure [ 4 ]. The diagnosis of DH is complicated by the necessity of distinguishing it from other dental diseases that have similar symptoms, such as dental caries, fractured restorations, cracked tooth syndrome, and pulpitis [ 11 ]. This step requires a thorough patient history, clinical examination, and provocation testing. Discrepancies in diagnosis arise because some clinicians rely on self-reporting of symptoms, and others depend upon recognized examination methods [ 12 – 14 ]. Management of DH consists of a variety of approaches, which range from patient-directed home care using desensitizing toothpastes containing stannous fluoride, potassium nitrate, or bioactive glass, to professional options, such as high-concentration fluoride varnishes, dentin bonding agents, lasers, and restorative treatments [ 1 , 15 ]. Long-term management depends on correct diagnosis, correct selection of desensitizing agents used, and patient education regarding risk factor modifications, adherence to recommended therapies, and the importance of regular professional visits for ongoing treatment [ 12 ]. Globally, significant differences exist in the knowledge and management of DH between high-income countries (HICs) and low- and middle-income countries (LMICs). Studies conducted in HICs, such as the USA and UK, revealed greater practitioner knowledge and a consistent application of evidence-based diagnostic procedures, along with access to updated desensitization agents [ 16 , 17 ]. Conversely, studies conducted in LMICs, including regions in South Asia, Africa, and the Middle East, indicate considerable gaps in knowledge, inconsistent diagnostic practices, limited access to advanced treatments, and the absence of context-specific clinical guidelines [ 6 , 10 , 18 ]. Recent research showed substantial variations in the knowledge, diagnosis, and management philosophies among dentists [ 19 – 21 ] despite the availability of evidence-based management guidelines [ 22 ]. These differences are particularly pronounced in low-resource and Middle Eastern regions, which underscores the critical need for local situational analyses to inform focused interventions. DH is a prevalent issue that considerably affects clinical treatment, which highlights the need for dentists to be well-informed and implement evidence-based practices. In Yemen, a resource-limited setting, researches on dental practitioners’ awareness and management of DH are lacking. This lack of data obstructs the development of targeted educational programs and the establishment of clinical care standards. Thus, this current study aimed to evaluate the knowledge, attitudes, and practices of dentists in Sana’a, Yemen, regarding the diagnostic and treatment approaches for DH. Methodology Study Design and Ethical Approval A descriptive cross-sectional study was conducted using a self-administered, web-based questionnaire targeting actively practicing dentists in Sana’a City, Yemen, from July 2025 to August 2025. Ethical clearance was obtained from the University of Ibn Al-Nafis for Medical Sciences (r = 192 on 09 June 2025). This work was carried out in accordance with the ethical principles of the Declaration of Helsinki [23]. All respondents provided electronic informed consent before accessing the questionnaire. Participation was voluntary and anonymous, and each individual was permitted to submit only one entry through Google Forms to avoid duplication of entries. Sample Size Determination A prior sample size estimation was performed to assess the minimum number of dental practitioners required for this cross-sectional research. The study population was 6840 GDPs registered with the Yemen Dental Association. Sample calculations were carried out using Cochran’s formula for categorical data, at a 95% confidence interval (Z = 1.96), a 5% margin of error (e = 0.05), and a response distribution (p) of 50% (which is used when the true proportion in the population is unknown) [24]; a minimum required sample size of 440 participants was achieved. Ultimately, the study included 401 dental practitioners, which resulted in a response rate of 91.13%. This value surpassed the recommended 60%–70% and previous surveys, which reduced nonresponse bias. Posthoc power analysis was performed with G*Power software (version 3.1), targeting a medium effect size (Cohen’s w = 0.3) and a significance level of α = 0.05 (two-tailed), which resulted in a statistical power greater than 80%. This finding suggests that the sample size was sufficient to detect meaningful associations using the chi-square test. Participants Eligibility The study involved licensed dentists (general practitioners or specialists) who are actively engaging in clinical practice and working in private dental clinics, universities, or government hospitals in Sana’a, Yemen. In addition, in accordance with the inclusion criteria, all participants were required to complete the online questionnaire and give informed consent to participate. To reduce information and recall bias, we excluded nonpracticing dentists, dental interns without independent clinical responsibility, and any dental personnel who had prior exposure to other formal education or research related to DH in the 6 months before this study. In addition, participants who did not complete a survey (missing >15% of items) or had duplicate entries were excluded. Instrument Development, Validity, Reliability, and Pilot Testing A comprehensive self-administrated questionnaire was developed and modified from previously validated survey instruments in DH [5,25,26,27]. The initial version of the questionnaire was reviewed and evaluated by a multidisciplinary panel review, including three consultants from restorative, oral medicine, and endodontists, who have extensive clinical and research experience. Each reviewer independently rated each item for relevance, clarity, simplicity, and ambiguity using a 4-point Likert scale (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, and 4 = highly relevant). Content validity index was calculated at 0.89, which implies a good level of agreement and high level of content appropriateness. Members of the panel were invited to make qualitative comments, which resulted in minor linguistic and structural changes to improve questionnaire’ precision and readability. Internal consistency was assessed with Cronbach’s alpha (α = 0.88), which indicates good reliability. The refined version of the questionnaire was then pilot tested on a sample of 30 dentists to assess its readability, clarity, and mean completion time. Feedback from the pilot study was utilized to refine the questionnaire. Test–retest reliability was assessed through the administration of the questionnaire to a separate sample of 30 dentists with a one-month interval. The test demonstrated considerable agreement (Cohen’s κ = 0.84). Figure 1 summarizes the process used to develop the instrument. Questionnaire Parts The final version of questionnaire consisted of 30 questions and was divided into six sequential parts to assess systematically the dentists’ knowledge, attitudes, clinical practices, perceived barriers, and preventive practices in the diagnosis and management of DH. The first part consisted of nine questions on demographic information with: age (<25, 25–34, 35–44, 45–54, or 55+), sex (male or female), the number of years in clinical practice (20 years), professional qualification (intern, bachelor’s degree, master’s degree, doctorate (PhD) or fellowship/specialized training), specialty (general dentistry, orthodontics, oral/maxillofacial surgery, periodontics, conservative dentistry, or others), practice setting (private practice, public hospital, academic institution, or group practice ), practicing or clinic location (urban or rural), the number of patients seen per week (1–5, 6–10, 11–15, or 16–20), and whether the participant had previously undertaken any DH specific training. The second part was related to the assessment of knowledge, which included five multiple-choice questions, to evaluate the level of fundamental knowledge regarding DH definition, mechanism, etiological factors, criteria for diagnosis, and current treatment modalities. A binary scoring system was adopted (1 point for correct answers, 0 for incorrect or “don't know”), with a cumulative score categorized into poor (0–8), fair (9–13), or good (14–17) knowledge. The third part consisted of questions correlated to the assessment of attitude, which included a 5-item Likert scale (from 1 = strongly disagree to 5 = strongly agree) to determine the professional opinions on the prevalence of DH that dentists encountered, the effect on the quality of life of the patient, the dentist’s diagnostic certainty, and self-rated confidence levels during treatment. Although the fourth part consisted of seven questions related to clinical practices of participants, it examined how participants were diagnosed with DH, the other conditions they considered when performing a differential diagnosis, the most common forms of desensitizing treatments used, how often they recommended desensitizing toothpastes, and how often they performed follow up. The fifth part involved questions regarding the participants’ perceived barriers, which were sought to assess difficulty in the implementation of management strategies, through three items requiring description of first management barriers, expressed need for continued education, and perceptions of artificial intelligence and digital instruments in improved management of DH care. The last part was associated with questions of preventive practices seeking proactive management strategies, that is, through two items requiring documentation of strategies employed for patient education in respect to preventive lifestyle changes and of those preventive measures regularly employed. This logical sequence of foundations of knowledge through useful applicability to preventive strategies, along with previously validated scoring systems, provides overall well-rounded multidimensional assessment of factors that influence DH management techniques administered by the dental community within Yemen. Data Collection Procedures and Setting The survey was distributed through professional networks and social media platforms used by dental professionals in Yemen. It was facilitated by disseminating the advertisement primarily through WhatsApp and Facebook groups. The advertisement gave a brief overview of that study and a link to the questionnaire hosted on Google Forms. To ensure data integrity, we set the Google Form to disallow multiple submissions from the same account or device. Following the first survey distribution, two reminder notifications were sent at two weekly intervals. This method was viewed as a valid means of collection that normally yields high response rates [28,29]. The receipt of responses was automatically stored in a database accessible only to the researchers. Partly completed surveys were automatically excluded from the final database. Data Management and Statistical Analysis The data were double entered into Microsoft Excel and analyzed using statistical software (IBM SPSS Statistics, version 25.0 for Windows; IBM Corp., Armonk, NY, USA). Descriptive statistics (frequencies and percentages) were computed for all categorical data. Associations between levels of knowledge (poor, fair, and good) and demographic variables (gender, age, qualification, and years in practice) were assessed using chi-square (χ²) test. Data integrity and consistency were assured via independent verification of all entries and elimination of all incomplete replies before analysis. Results Participant Demographics Overall, 401 dental practitioners participated in the survey. Most respondents were male and within the 25–34 age range (56.7%). The majority of respondents were general dentists (72.4%), with more than half reporting they have less than five years of clinical experience (55.7%). Most respondents were urban practitioners (84.3%), and nearly 70% had previously conducted a continuing education workshop on DH. In addition, less than two-thirds (71.1%) reported treating one to five patients with DH in a week. Figure 2 shows additional participants’ demographic details. Knowledge of DH Overall knowledge on DH was moderate across the study participants. DH was correctly identified by most participants as the sharp pain induced by external stimuli, and the main mechanism can be explained by the hydrodynamic theory (72.9% and 57.2%, respectively). However, misconceptions remained, with 14.4% attributing DH to direct nerve stimulation. The most commonly recognized etiological factors were enamel erosion (78.1%) and gingival recession (73.4%). In addition, less than half of the participants (44.3%) identified systemic, factors such as gastric reflux (Fig. 3 ). Total knowledge scores of all participants indicate that approximately one third (34.8%) had poor knowledge, one third had fair knowledge (37.1%), and one quarter had good knowledge (28.1%) (Fig. 4 ). Significant associations were observed between knowledge level concerning DH and demographic variables (Table 1 ). Higher knowledge scores were associated with female gender, younger age (25–34 years), and postgraduate qualifications (p < 0.05). On the other hand, only minor associations, if any, were found in the variables of a practice setting and attendance at workshops prior to the survey. The results suggest that professional education and academic qualifications have a more marked effect on competence in this field than mere years of practice. Table 1 Distribution of Knowledge level by Demographic Characteristics (n = 401) Category Group Poor Fair Good Chi- square df P-value N % N % N % Gender Male 92 65.7 74 49.7 53 46.9 11.134 2 0.004* Female 48 34.3 75 50.3 60 53.1 Age < 25 43 30.7 40 26.8 32 28.3 25.001 8 0.002* 25–34 82 58.6 95 63.8 51 45.1 35–44 14 10.0 11 7.4 21 18.6 45–54 1 0.7 3 2.0 8 7.1 55+ 43 30.7 40 26.8 32 28.3 Specialty General dentistry 101 72.1 111 74.5 79 69.9 12.092 10 0.279 Orthodontics 15 10.7 14 9.4 12 10.6 Oral and Maxillofacial Surgery 7 5.0 16 10.7 8 7.1 Periodontics 10 7.1 2 1.3 6 5.3 Conservative Dentistry 2 1.4 4 2.7 3 2.7 Paedodontics, Prosthodontics and Oral Medicine 5 3.6 2 1.3 5 4.4 Highest level of education Intern 36 25.7 18 12.1 11 9.7 19.244 8 0.014* Bachelor’s degree 78 55.7 92 61.7 69 61.1 Master’s degree 21 15.0 35 23.5 29 25.7 Doctorate (PhD) 3 2.1 3 2.0 4 3.5 Fellowship/Specialized Training 2 1.4 1 0.7 0 0.0 Practice setting Private practice 69 49.3 87 58.4 65 57.5 4.359 6 0.628 Public hospital 32 22.9 25 16.8 20 17.7 Academic institution 30 21.4 32 21.5 23 20.4 Group practice 9 6.4 5 3.4 5 4.4 Number of years in practice 20 years 6 4.3 1 0.7 2 1.8 Practice location Urban 112 80.0 132 88.6 95 84.1 4.039 2 0.133 Rural 28 20.0 17 11.4 18 15.9 Attended DH Workshop Yes 98 70.0 107 71.8 75 66.4 0.912 2 0.634 No 42 30.0 42 28.2 38 33.6 DH Patients per Week 1–5 99 70.7 113 75.8 74 65.5 6.328 6 0.387 6–10 28 20.0 30 20.1 30 26.5 11–15 8 5.7 5 3.4 6 5.3 16–20 5 3.6 1 0.7 3 2.7 * Significant difference by chi-square test, p < 0.05 Attitudes and Self-Confidence in DH Management Attitudes toward DH were mostly positive. More than one half of the participants (53.3%) reported DH as moderately or very common in their practice. In addition, 61.2% identified its significant impact on patients’ quality of life. A majority (58.7%) of the participants assumed that DH is often misdiagnosed. Even with this awareness, only 36.6% felt very confident in DH management. Meanwhile, 46.3% had moderate confidence. This finding shows a gap between awareness and self-efficacy (Fig. 5 ). Clinical Practice and Treatment Strategies The majority of respondents relied on patient history (89.3%) as their primary source of information for diagnosis, followed by air-blast (61.2%) and cold stimulus (55.7%) tests. The most common differential diagnoses considered were cracked tooth syndrome (75.9%) and postoperative sensitivity (62.4%). Management strategies focused on the identification of risk factors (73.6%), fluoride application (66.2%), and patient education. The most common desensitizing agents used were fluoride varnish (75.9%) and potassium nitrate (37.6%), and the more advanced options, such as lasers (13.4%) and arginine-based products, were rarely used (13.2%). Almost half of the respondents routinely recommended desensitizing toothpaste (47.5%). However, only 38.3% indicated that they routinely scheduled follow-up visits (Table 2 ). Table 2 Clinical Practice and Management Strategies for DH (n = 401) Question Response Frequency Percentage How do you diagnose DH? Patient history 359 89.3 Air blast test 246 61.2 Cold stimulus test 224 55.7 Tactile sensitivity 132 32.8 Other 3 0.7 Other conditions to consider in DH diagnosis Cracked tooth syndrome 305 75.9 Fractured restoration 245 60.9 Dental caries 234 58.2 Periodontal condition 223 55.5 Postoperative sensitivity 251 62.4 Pulpitis 166 41.3 Marginal leakage 181 45.0 Bleaching sensitivity 230 57.2 Other 0 0.0 How do you manage DH? Identify risk factors 296 73.6 Oral hygiene counseling 242 60.2 Scaling & Polishing 107 26.6 Fluoride products 266 66.2 Home desensitizing agents 229 57.0 In-office desensitization 176 43.8 Dentine bonding agents 192 47.8 Sealants 168 41.8 Root canal therapy 71 17.7 Extractions 24 6.0 Periodontal surgery 66 16.4 Laser therapy 55 13.7 Bioactive materials 95 23.6 Diet counseling 118 29.4 Other 0 0.0 Desensitizing treatments you commonly use Potassium nitrate 151 37.6 Fluoride varnish 305 75.9 Arginine-based products 53 13.2 Glutaraldehyde 53 13.2 Bioactive materials 113 28.1 Lasers 54 13.4 Restorative approaches 136 33.8 Other 1 0.2 How often do you recommend desensitizing toothpastes? Always 191 47.5 Often 128 31.8 Sometimes 68 16.9 Rarely 10 2.5 Never 5 1.2 Do you schedule follow-up visits? Always 154 38.3 Often 116 28.9 Sometimes 79 19.7 Rarely 47 11.7 Never 6 1.5 Patient Education and Prevention More than 56.5% of participants mentioned that they routinely provided patients education on prevention strategies for DH. The most common recommendations were to avoid brushing their teeth aggressively (71.9%), address risk factors (69.4%), and reduce acidic dietary intake (63.7%). However, 13.2% of the practitioners did not provide any preventive advice, which suggests that variability exists in practice as well (Fig. 6 ). Barriers and Challenges in DH Management Diagnostic challenges were the most common barrier mentioned (67.2%), along with patient nonadherence (49.3%) and limitations of treatment effectiveness (40.0%). A majority of respondents (83.6%) indicated a need for further education about DH management. Interestingly, almost half the respondents (43.8%) viewed artificial intelligence (AI)-based diagnostic tools as potentially helpful, but many also noted challenges to their implementation (Fig. 7 ). Discussion This cross-sectional study represents the first comprehensive assessment of the knowledge, attitudes, and clinical practices regarding DH among dentists in Yemen. The results reveal moderate levels of knowledge and a considerable variation in evidence-based reports of clinical practices. They unveil major discrepancies between theoretical knowledge and considerable variability in the application of evidence-based clinical practices, which offer important implications for curricular development, continuing professional education, and health policy development in resource-poor situations. Participants’ Knowledge regarding DH The present data indicate that dental practitioners in Yemen have moderate knowledge of DH, with 28.1% demonstrating a “good” level. This prevalence is very similar to that observed in other studies undertaken in LMICs [ [ 10 , 30 ] but is markedly different from that in HICs, where the majority of practitioners demonstrate good or excellent knowledge [ 16 , 31 ]. This finding may reflect the differential availability of continuing professional development (CPD) opportunities, differential availability of standardized clinical guidelines, and differences in the emphasis of the undergraduate curriculum on DH management [ 17 , 26 ]. The majority of participants correctly provided the classical definition of DH (72.9%) and the hydrodynamics involved (57.2%). However, considerable misconceptions in regard to DH must be accounted for. In particular, incorrect attribution of DH occurred due to direct nerve stimulation in 14.4% of instances, which suggests that the widely acknowledged underlying pathophysiology has not been correctly grasped [ 3 , 32 ]. The same type of fundamental misconception has been documented in other studies, which demonstrated an urgent need for more emphasis on the neurophysiology of DH in dental training [ 5 ]. In terms of causation, local factors, such as enamel erosion (78.1%) and gingival recession (73.4%), were recognized by the respondents, with the exception of the systemic aetiologic factors, e.g., gastric reflux, which was recognized by less than half of the respondents (44.3%). The lack of understanding of these combinations indicates a very important clinical deficit in knowledge as intrinsic erosive conditions are present in a high percentage of DH cases [ 1 , 4 ]. The failure to recognize the systemic factors may result in an incomplete examination of the patient and failure to effectively treat the general condition as the treatment by definition is aimed at relieving only local symptoms. Significant associations were present between a high knowledge level and some of the demographic variables. Female practitioners and practitioners with postgraduate qualifications had significantly higher knowledge scores (p < 0.05). This finding corresponds closely with the findings of other investigators [ 18 , 31 ]. Notably, the years of clinical experience by themselves do not correlate with improved knowledge. This outcome indicates that years of experience in practice itself without any formal communication through the continued update system will not guarantee an up-to-date knowledge of DH. It also emphasizes the importance of evidence-based CPD Courses [ 33 , 34 ]. No significant relationship was observed between prior attendance at workshops and knowledge level, which indicates that current educational programs may lack the detailed components (interactive and case-based skills) that are necessary for effective development of knowledge skills and retention of learned material [ 35 ]. Attitudes and Self-Confidence in DH Management The attitudes toward DH were largely positive, as most of the participants perceived it as a frequently noted condition in their practice (53.3%), with a significant effect on the oral health-related quality of life of patients (61.2%). These results are in accordance with contemporary literature on the great effect of DH on diet and psychosocial well-being [ 36 , 37 ]. However, a significant awareness–confidence gap exists: although 58.7% thought that DH was commonly misdiagnosed, only 36.6% claimed high confidence in their treatment of this condition. This discrepancy between awareness and self-efficacy is in accordance with findings of international studies and represents a significant translational gap between cognitive knowledge and clinical ability [ 38 , 39 ]. This gap arises likely because of inadequate clinical experience with various desensitizing therapies and inadequate feedback regarding patient outcomes during training. Simulation-based and mentored clinical care experience would likely go a long way to solving this confidence gap [ 39 ]. Clinical Management Strategies and Treatment Approaches In terms of diagnostic strategies, conventional recommended protocols were followed closely. Diagnostic strategies were reliant mainly on patient history (89.3%), with the use of air-blast (61.2%) and cold stimulus (55.7%) tests as a second resort [ 40 ]. However, the limited use of standardized assessments of pain (e.g., Visual Analogue Scale) suggested a lack of objectivity in diagnosis, which may complicate treatment assessment and evaluation of efficacy [ 3 , 41 ]. Treatment approaches were predominantly based on conventional evidence-based interventions, such as fluoride varnish (75.9%) and potassium nitrate (37.6%). These agents work in different ways, tubule occlusion by fluoride and neural desensitization by potassium nitrate, but both have copious evidence supporting their clinical effectiveness [ 1 , 32 ]. Advanced modalities, such as laser therapy (13.4%) and arginine-based compounds (13.2%), were severely under used in this study, despite providing encouraging evidence of effectiveness [ 4 , 32 ]. The limited application of these agents reflects multifold barriers as found in LMICs, including cost, availability/accessibility, lack of training, and lack of insurance coverage of therapy [ 42 ]. A cause for concern was the low routine follow-up appointment scheduling (38.3%). Notably, systematic evaluation of treatment response is necessary, and thus, compliance to therapy can be assessed and protocols be modified accordingly [ 8 , 40 ]. Longitudinal practice leads to infrequent follow-ups in the current study, which is also a contributing factor to less than optimal long-term clinical practice outcome and reduced patient satisfaction. Patient Education and Prevention Although 56.5% of respondents indicated routinely providing preventive counseling, its content appeared to be variable at 13.2%, which offered no preventive counseling. This finding indicates a significant clinical gap given that patient counseling and behavior modification are key factors in DH control in the long term [ 8 , 19 – 20 , 22 ]. The necessary components of appropriate patient education is globally accepted to be comprehensive, patient-centered patient education using health-literacy sensitive communication methods that provide the following: etiology description, preventive oral hygiene practice education, dietary counseling, product use education, and preventive advice [ 3 , 37 ]. Barriers and Challenges in DH Management The most frequent barriers reported comprised diagnostic uncertainty (67.2%), followed by patients’ noncompliance (49.3%) and perceived limitations in the efficacy of treatment modalities (40.0%). These barriers are well-documented worldwide and highlight the inherent difficulties in the management of a condition with subjective characterization and no objective markers [ 11 , 40 ]. Encouragingly, the vast majority of the participants (83.6%) felt a need for further education, which indicated professional awareness and receptivity to CPD. Furthermore, a considerable proportion (43.8%) expressed an interest in AI-based diagnostic modalities, which means that proper education in this area, together with the relevant infrastructure in place, may create an avenue for the possible introduction of further technology-based medical aids [ 16 , 43 ]. Recommendations for Policy, Practice, and future research This study highlights the need for a tri-part intervention to improve the management of DH in low-resource settings. In terms of clinical practice, the development and dissemination of standardized, evidence-based guidelines will be essential to rectify diagnostic variability in DH and encourage a stepped-care model, in which practitioners systematically use lower-cost, more effective options, such as fluoride varnishes and preventive counseling. Moreover, mandatory continuing education should address this need; moving away from passive learning to interactive, case-based workshops would promote the translation of knowledge-bases education into improved clinical behavior and diagnostic confidence. At the policy level, national health agencies and dental councils need to recognize the importance of embedding these protocols into undergraduate dental education and actively promote easier access to desensitizing agents through public health campaigns and initiatives. For future research, longitudinal studies should be conducted to comprehend the long-term effects of these educational interventions on clinicians’ clinical behavior and patient outcomes. Implementation research can also investigate how best to assist with the adoption of evidence-based guidelines in low-resource settings. Further exploration of affordable digital diagnostic aids may help combat the barriers associated with subjective diagnosis. Figure 8 summarizes the recommended policies to improve DH management. Strengths and limitations To our knowledge, this work is the first comprehensive assessment of Yemeni dental practitioners’ knowledge, attitudes, and practice related to dental health, which provides important baseline information for future interventions. With the validated use of the instrument, a representative sample, and appropriate reliability testing (Cronbach’s α = 0.88; Cohen’s κ = 0.84), the credibility of the results was further enhanced. However, limitations included a cross-sectional design, which prevents any causal inference and reliance on self or investigator and report that may introduce recall and social desirability bias. In addition, although the present study is limited to Sana’a City, regional differences may exist in practice, and these should be investigated in future studies. Conclusion Dental professionals in Yemen exhibit a moderate understanding and favorable attitude toward DH and its impact on quality of life but experience significant diagnostic and practical challenges in managing the condition. The study showed a global knowledge-practice gap in this area and highlights the need for targeted education, clinical guidelines, and improved access to modern materials to facilitate a transition from recognition to effective treatment for implementing evidence-based treatment options in Yemen and comparable resource-limited environments. Declarations Acknowledgments Not applicable. Authorship contribution statement Basem H. AL-Huthaifi, Taghreed Ahmed Mohamad Al-kibsi, Baker M. Abdullah and Mohammed M Al Moaleem: Conceived and designed experiments; Performed the experiments; Analyzed and interpreted data; Contributed reagents, materials, analysis tools, or data; Wrote the paper. Basem H. AL-Huthaifi, Taghreed Ahmed Mohamad Al-kibsi, Baker M. Abdullah, Mohammed M Al Moaleem and Rashed Mohammed Aishan: Conceived and designed experiments; Wrote the paper. Salim A. Algarni, Khalid Aldhorae and Emad Mohamed Shaif Shaamala: Contributed reagents, materials, analysis tools, or data. Abrar A. Al-aswani, Haya H. Al kumaim, Lena F. Alsairi, Reeman A. Zayed, Wejdan T. Al-olofi, Areej A. Alrifaie: Analyzed and interpreted data. Funding No funding was received. Availability of data and materials The datasets created and/or analyzed during the current study are not publicly available due to confidentiality, but can be made available by the authors upon reasonable request. Ethics approval and consent to participate Ethical approval for the study was obtained from the Research Committee of the Faculty of Dentistry, University of Ibn Al-Nafis for Medical Sciences, Sann, Yemen (r = 192 on 09 June 2025). All participants provided written informed consent after being fully informed about the study’s purpose, procedures, and potential risks, and were informed that they could discontinue the questionnaire at any point without providing an explanation. Clinical trial number Not applicable Consent for publication Not applicable. Declaration of competing interest The authors state that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper. References Ramos FSES, Briso ALF, Albertinazzi L, Marchetti VM, Souza MT, Fagundes TC. Efficacy of different in-office treatments for dentin hypersensitivity: randomized and parallel clinical trial. Braz Dent J. 2024 Jun 24;35:e245487. doi: 10.1590/0103-6440202405487. PMID: 38922247; PMCID: PMC11196028. Liu XX, Tenenbaum HC, Wilder RS, Quock R, Hewlett ER, Ren YF. 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Evidence-based recommendations for diagnosing and managing dentine hypersensitivity in clinical practice: insights from the Middle East and Africa. Front Oral Health. 2025;6:1663984. https://doi.org/10.3389/froh.2025.1663984 Parums DV. Editorial: The 2024 Revision of the Declaration of Helsinki and its Continued Role as a Code of Ethics to Guide Medical Research. Med Sci Monit. 2024 Dec 1;30:e947428. doi: 10.12659/MSM.947428. PMID: 39616449; PMCID: PMC11619173. Cochran, W G. Sampling techniques. 3rd editionJohn Wiley & Sons. Inc. New York. pp (1977). Exarchou C, Betsani I, Sakellari D, Chatzopoulou D, Gillam D. A Survey of Dentists in the Management of Dentine Hypersensitivity: A Questionnaire-based Study. Eur J Dent. 2019 Jul;13(3):383-390. doi: 10.1055/s-0039-1694306. Epub 2019 Sep 19. PMID: 31537018; PMCID: PMC6890503. Gillam D. The impact of dentine hypersensitivity on the quality of life: an overview. 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DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20253286 Additional Declarations No competing interests reported. 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16:43:45","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":179026,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/209e1ca7132930210b510bda.html"},{"id":98072788,"identity":"cb61725e-5216-4ec8-ba7c-2d9f948d5fd3","added_by":"auto","created_at":"2025-12-12 13:20:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":107592,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of instrument development\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/41b26f30c55babf8b2a91f69.png"},{"id":98072787,"identity":"3343b6fd-809a-4a57-960f-b773d53ce261","added_by":"auto","created_at":"2025-12-12 13:20:16","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":417475,"visible":true,"origin":"","legend":"\u003cp\u003eSociodemographic characteristics of the participants (n=401)\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/8e308f105328f7f793542f21.jpeg"},{"id":98429229,"identity":"609f8e77-d379-4d08-849c-54d5e4c1b73e","added_by":"auto","created_at":"2025-12-17 16:43:00","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":315497,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant’s knowledge about DH (n=401)\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/a4f5e3637eb1581d4ab159b6.jpeg"},{"id":98428980,"identity":"e0e3c160-efc3-4d1a-a1e0-be07eeeb6f26","added_by":"auto","created_at":"2025-12-17 16:42:38","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":89480,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Participants by Knowledge Score Categories (n=401)\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/9d00e4a14ccf3d3b046cad3a.jpeg"},{"id":98072793,"identity":"4d4aef82-2411-4155-8259-ae9a79c2c6ef","added_by":"auto","created_at":"2025-12-12 13:20:16","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":217381,"visible":true,"origin":"","legend":"\u003cp\u003eParticipants’ Attitudes and Self-reported Confidence in DH Management (n=401)\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/5bebca79e670c63b3208944a.jpeg"},{"id":98429613,"identity":"3d40aacf-3270-4aa6-9c12-ff8e836841b2","added_by":"auto","created_at":"2025-12-17 16:43:52","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":187061,"visible":true,"origin":"","legend":"\u003cp\u003ePreventive Measures and Patient Education (n=401)\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/b123245ffa1c31095c66262a.jpeg"},{"id":98426633,"identity":"b7607023-a7ff-46b7-a6eb-7f9cf3453eca","added_by":"auto","created_at":"2025-12-17 16:37:53","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":225013,"visible":true,"origin":"","legend":"\u003cp\u003eBarriers and Challenges in DH Management (n=401)\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/b1cdeaeb43692d602c627e60.jpeg"},{"id":98072796,"identity":"95360e48-91e2-4a2e-96c9-232547faf3a5","added_by":"auto","created_at":"2025-12-12 13:20:16","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":160588,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of Recommendations for Policy, Practice, and Future Research\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/e74f651321e44119a290d2ce.jpeg"},{"id":98622183,"identity":"b456cf59-0bfd-480b-86d3-29e749123257","added_by":"auto","created_at":"2025-12-19 16:48:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2984342,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8206874/v1/e0c99ae9-9fce-4a30-b686-5ed9c082974e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of Knowledge, Attitudes, and Clinical Practices Regarding Dentine Hypersensitivity: A Cross-Sectional Study Among Dental Practitioners\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDentin hypersensitivity (DH) refers to a frequently unrecognized clinical condition characterized by sharp, transient pain when exposed dentin responds to various stimuli (thermal, mechanical, osmotic, or chemical) without any other dental issues present [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This phenomenon can be predominantly explained using Br\u0026auml;nnstr\u0026ouml;m\u0026rsquo;s hydrodynamic theory, which posits that such stimuli lead to fluid movement within dentinal tubules; this condition activates intradental nerve mechanoreceptors, which leads to the characteristic pain [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobal prevalence estimates of DH differ significantly (3.8% to 87%), depending on the diagnostic criteria, evaluation methods, and consideration of self-reported symptoms [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Importantly, about 50% of the dental patients with DH may not disclose it, thus contributing to underdiagnosis and undertreatment of DH [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The causative factors of DH are multifactorial, as they are caused by both local and systemic factors. Local factors of dentin exposure include gingival recession, enamel wear, periodontal disease, aggressive brushing, tooth bleaching, and pathological dental wear [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Systemic factors include conditions, such as gastroesophageal reflux (GER) and intake of acidic foods and beverages, which result in demineralization of enamel and dentin exposure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe diagnosis of DH is complicated by the necessity of distinguishing it from other dental diseases that have similar symptoms, such as dental caries, fractured restorations, cracked tooth syndrome, and pulpitis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This step requires a thorough patient history, clinical examination, and provocation testing. Discrepancies in diagnosis arise because some clinicians rely on self-reporting of symptoms, and others depend upon recognized examination methods [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eManagement of DH consists of a variety of approaches, which range from patient-directed home care using desensitizing toothpastes containing stannous fluoride, potassium nitrate, or bioactive glass, to professional options, such as high-concentration fluoride varnishes, dentin bonding agents, lasers, and restorative treatments [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Long-term management depends on correct diagnosis, correct selection of desensitizing agents used, and patient education regarding risk factor modifications, adherence to recommended therapies, and the importance of regular professional visits for ongoing treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobally, significant differences exist in the knowledge and management of DH between high-income countries (HICs) and low- and middle-income countries (LMICs). Studies conducted in HICs, such as the USA and UK, revealed greater practitioner knowledge and a consistent application of evidence-based diagnostic procedures, along with access to updated desensitization agents [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Conversely, studies conducted in LMICs, including regions in South Asia, Africa, and the Middle East, indicate considerable gaps in knowledge, inconsistent diagnostic practices, limited access to advanced treatments, and the absence of context-specific clinical guidelines [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent research showed substantial variations in the knowledge, diagnosis, and management philosophies among dentists [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] despite the availability of evidence-based management guidelines [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These differences are particularly pronounced in low-resource and Middle Eastern regions, which underscores the critical need for local situational analyses to inform focused interventions.\u003c/p\u003e\u003cp\u003eDH is a prevalent issue that considerably affects clinical treatment, which highlights the need for dentists to be well-informed and implement evidence-based practices. In Yemen, a resource-limited setting, researches on dental practitioners\u0026rsquo; awareness and management of DH are lacking. This lack of data obstructs the development of targeted educational programs and the establishment of clinical care standards. Thus, this current study aimed to evaluate the knowledge, attitudes, and practices of dentists in Sana\u0026rsquo;a, Yemen, regarding the diagnostic and treatment approaches for DH.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Ethical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive cross-sectional study was conducted using a self-administered, web-based questionnaire targeting actively practicing dentists in Sana\u0026rsquo;a City, Yemen, from July 2025 to August 2025. Ethical clearance was obtained from the University of Ibn Al-Nafis for Medical Sciences\u0026nbsp;(r = 192 on 09 June 2025). This work was carried out in accordance with the ethical principles of the Declaration of Helsinki [23]. All respondents provided electronic informed consent before accessing the questionnaire. Participation was voluntary and anonymous, and each individual was permitted to submit only one entry through Google Forms to avoid duplication of entries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prior sample size estimation was performed to assess the minimum number of dental practitioners required for this cross-sectional research. The study population was 6840 GDPs registered with the Yemen Dental Association. Sample calculations were carried out using Cochran\u0026rsquo;s formula for categorical data, at a 95% confidence interval (Z = 1.96), a 5% margin of error (e = 0.05), and a response distribution (p) of 50% (which is used when the true proportion in the population is unknown) [24]; a minimum required sample size of 440 participants was achieved. Ultimately, the study included 401 dental practitioners, which resulted in a response rate of 91.13%. This value surpassed the recommended 60%\u0026ndash;70% and previous surveys, which reduced nonresponse bias. Posthoc power analysis was performed with G*Power software (version 3.1), targeting a medium effect size (Cohen\u0026rsquo;s w = 0.3) and a significance level of \u0026alpha; = 0.05 (two-tailed), which resulted in a statistical power greater than 80%. This finding suggests that the sample size was sufficient to detect meaningful associations using the chi-square test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants Eligibility\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study involved licensed dentists (general practitioners or specialists) who are actively engaging in clinical practice and working in private dental clinics, universities, or government hospitals in Sana\u0026rsquo;a, Yemen. In addition, in accordance with the inclusion criteria, all participants were required to complete the online questionnaire and give informed consent to participate. To reduce information and recall bias, we excluded nonpracticing dentists, dental interns without independent clinical responsibility, and any dental personnel who had prior exposure to other formal education or research related to DH in the 6 months before this study. In addition, participants who did not complete a survey (missing \u0026gt;15% of items) or had duplicate entries were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrument Development, Validity, Reliability, and Pilot Testing\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive self-administrated questionnaire was developed and modified from previously validated survey instruments in DH [5,25,26,27]. The initial version of the questionnaire was reviewed and evaluated by a multidisciplinary panel review, including three consultants from restorative, oral medicine, and endodontists, who have extensive clinical and research experience. Each reviewer independently rated each item for relevance, clarity, simplicity, and ambiguity using a 4-point Likert scale (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, and 4 = highly relevant).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eContent validity index was calculated at 0.89, which implies a good level of agreement and high level of content appropriateness. Members of the panel were invited to make qualitative comments, which resulted in minor linguistic and structural changes to improve questionnaire\u0026rsquo; precision and readability. Internal consistency was assessed with Cronbach\u0026rsquo;s alpha (\u0026alpha; = 0.88), which indicates good reliability. The refined version of the questionnaire was then pilot tested on a sample of 30 dentists to assess its readability, clarity, and mean completion time. Feedback from the pilot study was utilized to refine the questionnaire. Test\u0026ndash;retest reliability was assessed through the administration of the questionnaire to a separate sample of 30 dentists with a one-month interval. The test demonstrated considerable agreement (Cohen\u0026rsquo;s \u0026kappa; = 0.84). Figure 1 summarizes the process used to develop the instrument.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire Parts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final version of questionnaire consisted of 30 questions and was divided into six sequential parts to assess systematically the dentists\u0026rsquo; knowledge, attitudes, clinical practices, perceived barriers, and preventive practices in the diagnosis and management of DH. The first part consisted of nine questions on demographic information with: age (\u0026lt;25, 25\u0026ndash;34, 35\u0026ndash;44, 45\u0026ndash;54, or 55+), sex (male or female), the number of years in clinical practice (\u0026lt;5, 5\u0026ndash;10, 11\u0026ndash;20, or \u0026gt;20 years), professional qualification (intern, bachelor\u0026rsquo;s degree, master\u0026rsquo;s degree, doctorate (PhD) or fellowship/specialized training), specialty (general dentistry, orthodontics, oral/maxillofacial surgery, periodontics, conservative dentistry, or others), practice setting (private practice, public hospital, academic institution, or group practice ), practicing or clinic location (urban\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eor\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003erural), the number of patients seen per week (1\u0026ndash;5, 6\u0026ndash;10, 11\u0026ndash;15, or 16\u0026ndash;20), and whether the participant had previously undertaken any DH specific training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe second part was related to the assessment of knowledge, which included five multiple-choice questions, to evaluate the level of fundamental knowledge regarding DH definition, mechanism, etiological factors, criteria for diagnosis, and current treatment modalities. A binary scoring system was adopted (1 point for correct answers, 0 for incorrect or \u0026ldquo;don\u0026apos;t know\u0026rdquo;), with a cumulative score categorized into poor (0\u0026ndash;8), fair (9\u0026ndash;13), or good (14\u0026ndash;17) knowledge.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe third part consisted of questions correlated to the assessment of attitude, which included a 5-item Likert scale (from 1 = strongly disagree to 5 = strongly agree) to determine the professional opinions on the prevalence of DH that dentists encountered, the effect on the quality of life of the patient, the dentist\u0026rsquo;s diagnostic certainty, and self-rated confidence levels during treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough the fourth part consisted of seven questions related to clinical practices of participants, it examined how participants were diagnosed with DH, the other conditions they considered when performing a differential diagnosis, the most common forms of desensitizing treatments used, how often they recommended desensitizing toothpastes, and how often they performed follow up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe fifth part involved questions regarding the participants\u0026rsquo; perceived barriers, which were sought to assess difficulty in the implementation of management strategies, through three items requiring description of first management barriers, expressed need for continued education, and perceptions of artificial intelligence and digital instruments in improved management of DH care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe last part was associated with questions of preventive practices seeking proactive management strategies, that is, through two items requiring documentation of strategies employed for patient education in respect to preventive lifestyle changes and of those preventive measures regularly employed. This logical sequence of foundations of knowledge through useful applicability to preventive strategies, along with previously validated scoring systems, provides overall well-rounded multidimensional assessment of factors that influence DH management techniques administered by the dental community within Yemen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedures and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey was distributed through professional networks and social media platforms used by dental professionals in Yemen. It was facilitated by disseminating the advertisement primarily through WhatsApp and Facebook groups. The advertisement gave a brief overview of that study and a link to the questionnaire hosted on Google Forms. To ensure data integrity, we set the Google Form to disallow multiple submissions from the same account or device. Following the first survey distribution, two reminder notifications were sent at two weekly intervals. This method was viewed as a valid means of collection that normally yields high response rates [28,29]. The receipt of responses was automatically stored in a database accessible only to the researchers. Partly completed surveys were automatically excluded from the final database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Management and Statistical Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were double entered into Microsoft Excel and analyzed using statistical software (IBM SPSS Statistics, version 25.0 for Windows; IBM Corp., Armonk, NY, USA). Descriptive statistics (frequencies and percentages) were computed for all categorical data. Associations between levels of knowledge (poor, fair, and good) and demographic variables (gender, age, qualification, and years in practice) were assessed using chi-square (\u0026chi;\u0026sup2;) test. Data integrity and consistency were assured via independent verification of all entries and elimination of all incomplete replies before analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eParticipant Demographics\u003c/h2\u003e\u003cp\u003eOverall, 401 dental practitioners participated in the survey. Most respondents were male and within the 25\u0026ndash;34 age range (56.7%). The majority of respondents were general dentists (72.4%), with more than half reporting they have less than five years of clinical experience (55.7%). Most respondents were urban practitioners (84.3%), and nearly 70% had previously conducted a continuing education workshop on DH. In addition, less than two-thirds (71.1%) reported treating one to five patients with DH in a week. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows additional participants\u0026rsquo; demographic details.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge of DH\u003c/h2\u003e\u003cp\u003eOverall knowledge on DH was moderate across the study participants. DH was correctly identified by most participants as the sharp pain induced by external stimuli, and the main mechanism can be explained by the hydrodynamic theory (72.9% and 57.2%, respectively). However, misconceptions remained, with 14.4% attributing DH to direct nerve stimulation. The most commonly recognized etiological factors were enamel erosion (78.1%) and gingival recession (73.4%). In addition, less than half of the participants (44.3%) identified systemic, factors such as gastric reflux (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTotal knowledge scores of all participants indicate that approximately one third (34.8%) had poor knowledge, one third had fair knowledge (37.1%), and one quarter had good knowledge (28.1%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSignificant associations were observed between knowledge level concerning DH and demographic variables (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Higher knowledge scores were associated with female gender, younger age (25\u0026ndash;34 years), and postgraduate qualifications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). On the other hand, only minor associations, if any, were found in the variables of a practice setting and attendance at workshops prior to the survey. The results suggest that professional education and academic qualifications have a more marked effect on competence in this field than mere years of practice.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Knowledge level by Demographic Characteristics (n\u0026thinsp;=\u0026thinsp;401)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eFair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi- square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e49.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e11.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.004*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e53.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e25.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e45.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e18.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eSpecialty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral dentistry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e69.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e12.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.279\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthodontics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral and Maxillofacial Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriodontics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConservative Dentistry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePaedodontics, Prosthodontics and Oral Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eHighest level of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e19.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.014*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e61.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e25.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctorate (PhD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFellowship/Specialized Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePractice setting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e4.359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.628\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcademic institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNumber of years in practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e55.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e10.926\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e38.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePractice location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e88.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e84.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAttended DH Workshop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eDH Patients per Week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e65.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e6.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.387\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e* Significant difference by chi-square test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAttitudes and Self-Confidence in DH Management\u003c/h2\u003e\u003cp\u003eAttitudes toward DH were mostly positive. More than one half of the participants (53.3%) reported DH as moderately or very common in their practice. In addition, 61.2% identified its significant impact on patients\u0026rsquo; quality of life. A majority (58.7%) of the participants assumed that DH is often misdiagnosed. Even with this awareness, only 36.6% felt very confident in DH management. Meanwhile, 46.3% had moderate confidence. This finding shows a gap between awareness and self-efficacy (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eClinical Practice and Treatment Strategies\u003c/h2\u003e\u003cp\u003eThe majority of respondents relied on patient history (89.3%) as their primary source of information for diagnosis, followed by air-blast (61.2%) and cold stimulus (55.7%) tests. The most common differential diagnoses considered were cracked tooth syndrome (75.9%) and postoperative sensitivity (62.4%). Management strategies focused on the identification of risk factors (73.6%), fluoride application (66.2%), and patient education. The most common desensitizing agents used were fluoride varnish (75.9%) and potassium nitrate (37.6%), and the more advanced options, such as lasers (13.4%) and arginine-based products, were rarely used (13.2%). Almost half of the respondents routinely recommended desensitizing toothpaste (47.5%). However, only 38.3% indicated that they routinely scheduled follow-up visits (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical Practice and Management Strategies for DH (n\u0026thinsp;=\u0026thinsp;401)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eHow do you diagnose DH?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAir blast test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCold stimulus test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTactile sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003eOther conditions to consider in DH diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCracked tooth syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFractured restoration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDental caries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriodontal condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostoperative sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePulpitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarginal leakage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBleaching sensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e\u003cp\u003eHow do you manage DH?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIdentify risk factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral hygiene counseling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScaling \u0026amp; Polishing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFluoride products\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome desensitizing agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-office desensitization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDentine bonding agents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSealants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRoot canal therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtractions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriodontal surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLaser therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBioactive materials\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiet counseling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eDesensitizing treatments you commonly use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePotassium nitrate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFluoride varnish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArginine-based products\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGlutaraldehyde\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBioactive materials\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLasers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRestorative approaches\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eHow often do you recommend desensitizing toothpastes?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOften\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eDo you schedule follow-up visits?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOften\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePatient Education and Prevention\u003c/h2\u003e\u003cp\u003eMore than 56.5% of participants mentioned that they routinely provided patients education on prevention strategies for DH. The most common recommendations were to avoid brushing their teeth aggressively (71.9%), address risk factors (69.4%), and reduce acidic dietary intake (63.7%). However, 13.2% of the practitioners did not provide any preventive advice, which suggests that variability exists in practice as well (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eBarriers and Challenges in DH Management\u003c/h2\u003e\u003cp\u003eDiagnostic challenges were the most common barrier mentioned (67.2%), along with patient nonadherence (49.3%) and limitations of treatment effectiveness (40.0%). A majority of respondents (83.6%) indicated a need for further education about DH management. Interestingly, almost half the respondents (43.8%) viewed artificial intelligence (AI)-based diagnostic tools as potentially helpful, but many also noted challenges to their implementation (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study represents the first comprehensive assessment of the knowledge, attitudes, and clinical practices regarding DH among dentists in Yemen. The results reveal moderate levels of knowledge and a considerable variation in evidence-based reports of clinical practices. They unveil major discrepancies between theoretical knowledge and considerable variability in the application of evidence-based clinical practices, which offer important implications for curricular development, continuing professional education, and health policy development in resource-poor situations.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u0026rsquo; Knowledge regarding DH\u003c/h2\u003e\u003cp\u003eThe present data indicate that dental practitioners in Yemen have moderate knowledge of DH, with 28.1% demonstrating a \u0026ldquo;good\u0026rdquo; level. This prevalence is very similar to that observed in other studies undertaken in LMICs [ [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] but is markedly different from that in HICs, where the majority of practitioners demonstrate good or excellent knowledge [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This finding may reflect the differential availability of continuing professional development (CPD) opportunities, differential availability of standardized clinical guidelines, and differences in the emphasis of the undergraduate curriculum on DH management [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe majority of participants correctly provided the classical definition of DH (72.9%) and the hydrodynamics involved (57.2%). However, considerable misconceptions in regard to DH must be accounted for. In particular, incorrect attribution of DH occurred due to direct nerve stimulation in 14.4% of instances, which suggests that the widely acknowledged underlying pathophysiology has not been correctly grasped [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The same type of fundamental misconception has been documented in other studies, which demonstrated an urgent need for more emphasis on the neurophysiology of DH in dental training [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn terms of causation, local factors, such as enamel erosion (78.1%) and gingival recession (73.4%), were recognized by the respondents, with the exception of the systemic aetiologic factors, e.g., gastric reflux, which was recognized by less than half of the respondents (44.3%). The lack of understanding of these combinations indicates a very important clinical deficit in knowledge as intrinsic erosive conditions are present in a high percentage of DH cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The failure to recognize the systemic factors may result in an incomplete examination of the patient and failure to effectively treat the general condition as the treatment by definition is aimed at relieving only local symptoms.\u003c/p\u003e\u003cp\u003eSignificant associations were present between a high knowledge level and some of the demographic variables. Female practitioners and practitioners with postgraduate qualifications had significantly higher knowledge scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This finding corresponds closely with the findings of other investigators [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Notably, the years of clinical experience by themselves do not correlate with improved knowledge. This outcome indicates that years of experience in practice itself without any formal communication through the continued update system will not guarantee an up-to-date knowledge of DH. It also emphasizes the importance of evidence-based CPD Courses [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. No significant relationship was observed between prior attendance at workshops and knowledge level, which indicates that current educational programs may lack the detailed components (interactive and case-based skills) that are necessary for effective development of knowledge skills and retention of learned material [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eAttitudes and Self-Confidence in DH Management\u003c/h2\u003e\u003cp\u003eThe attitudes toward DH were largely positive, as most of the participants perceived it as a frequently noted condition in their practice (53.3%), with a significant effect on the oral health-related quality of life of patients (61.2%). These results are in accordance with contemporary literature on the great effect of DH on diet and psychosocial well-being [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, a significant awareness\u0026ndash;confidence gap exists: although 58.7% thought that DH was commonly misdiagnosed, only 36.6% claimed high confidence in their treatment of this condition. This discrepancy between awareness and self-efficacy is in accordance with findings of international studies and represents a significant translational gap between cognitive knowledge and clinical ability [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This gap arises likely because of inadequate clinical experience with various desensitizing therapies and inadequate feedback regarding patient outcomes during training. Simulation-based and mentored clinical care experience would likely go a long way to solving this confidence gap [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eClinical Management Strategies and Treatment Approaches\u003c/h2\u003e\u003cp\u003eIn terms of diagnostic strategies, conventional recommended protocols were followed closely. Diagnostic strategies were reliant mainly on patient history (89.3%), with the use of air-blast (61.2%) and cold stimulus (55.7%) tests as a second resort [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, the limited use of standardized assessments of pain (e.g., Visual Analogue Scale) suggested a lack of objectivity in diagnosis, which may complicate treatment assessment and evaluation of efficacy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTreatment approaches were predominantly based on conventional evidence-based interventions, such as fluoride varnish (75.9%) and potassium nitrate (37.6%). These agents work in different ways, tubule occlusion by fluoride and neural desensitization by potassium nitrate, but both have copious evidence supporting their clinical effectiveness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Advanced modalities, such as laser therapy (13.4%) and arginine-based compounds (13.2%), were severely under used in this study, despite providing encouraging evidence of effectiveness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The limited application of these agents reflects multifold barriers as found in LMICs, including cost, availability/accessibility, lack of training, and lack of insurance coverage of therapy [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA cause for concern was the low routine follow-up appointment scheduling (38.3%). Notably, systematic evaluation of treatment response is necessary, and thus, compliance to therapy can be assessed and protocols be modified accordingly [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Longitudinal practice leads to infrequent follow-ups in the current study, which is also a contributing factor to less than optimal long-term clinical practice outcome and reduced patient satisfaction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003ePatient Education and Prevention\u003c/h2\u003e\u003cp\u003eAlthough 56.5% of respondents indicated routinely providing preventive counseling, its content appeared to be variable at 13.2%, which offered no preventive counseling. This finding indicates a significant clinical gap given that patient counseling and behavior modification are key factors in DH control in the long term [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The necessary components of appropriate patient education is globally accepted to be comprehensive, patient-centered patient education using health-literacy sensitive communication methods that provide the following: etiology description, preventive oral hygiene practice education, dietary counseling, product use education, and preventive advice [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eBarriers and Challenges in DH Management\u003c/h2\u003e\u003cp\u003eThe most frequent barriers reported comprised diagnostic uncertainty (67.2%), followed by patients\u0026rsquo; noncompliance (49.3%) and perceived limitations in the efficacy of treatment modalities (40.0%). These barriers are well-documented worldwide and highlight the inherent difficulties in the management of a condition with subjective characterization and no objective markers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Encouragingly, the vast majority of the participants (83.6%) felt a need for further education, which indicated professional awareness and receptivity to CPD. Furthermore, a considerable proportion (43.8%) expressed an interest in AI-based diagnostic modalities, which means that proper education in this area, together with the relevant infrastructure in place, may create an avenue for the possible introduction of further technology-based medical aids [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eRecommendations for Policy, Practice, and future research\u003c/h2\u003e\u003cp\u003eThis study highlights the need for a tri-part intervention to improve the management of DH in low-resource settings. In terms of clinical practice, the development and dissemination of standardized, evidence-based guidelines will be essential to rectify diagnostic variability in DH and encourage a stepped-care model, in which practitioners systematically use lower-cost, more effective options, such as fluoride varnishes and preventive counseling. Moreover, mandatory continuing education should address this need; moving away from passive learning to interactive, case-based workshops would promote the translation of knowledge-bases education into improved clinical behavior and diagnostic confidence. At the policy level, national health agencies and dental councils need to recognize the importance of embedding these protocols into undergraduate dental education and actively promote easier access to desensitizing agents through public health campaigns and initiatives. For future research, longitudinal studies should be conducted to comprehend the long-term effects of these educational interventions on clinicians\u0026rsquo; clinical behavior and patient outcomes. Implementation research can also investigate how best to assist with the adoption of evidence-based guidelines in low-resource settings. Further exploration of affordable digital diagnostic aids may help combat the barriers associated with subjective diagnosis. Figure\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e summarizes the recommended policies to improve DH management.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eTo our knowledge, this work is the first comprehensive assessment of Yemeni dental practitioners\u0026rsquo; knowledge, attitudes, and practice related to dental health, which provides important baseline information for future interventions. With the validated use of the instrument, a representative sample, and appropriate reliability testing (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.88; Cohen\u0026rsquo;s κ\u0026thinsp;=\u0026thinsp;0.84), the credibility of the results was further enhanced. However, limitations included a cross-sectional design, which prevents any causal inference and reliance on self or investigator and report that may introduce recall and social desirability bias. In addition, although the present study is limited to Sana\u0026rsquo;a City, regional differences may exist in practice, and these should be investigated in future studies.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDental professionals in Yemen exhibit a moderate understanding and favorable attitude toward DH and its impact on quality of life but experience significant diagnostic and practical challenges in managing the condition. The study showed a global knowledge-practice gap in this area and highlights the need for targeted education, clinical guidelines, and improved access to modern materials to facilitate a transition from recognition to effective treatment for implementing evidence-based treatment options in Yemen and comparable resource-limited environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship contribution statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBasem H. AL-Huthaifi, Taghreed Ahmed Mohamad Al-kibsi, Baker M. Abdullah and Mohammed M Al Moaleem: Conceived and designed experiments; Performed the experiments; Analyzed and interpreted data; Contributed reagents, materials, analysis tools, or data; Wrote the paper. Basem H. AL-Huthaifi, Taghreed Ahmed Mohamad Al-kibsi, Baker M. Abdullah, Mohammed M Al Moaleem and Rashed Mohammed Aishan: Conceived and designed experiments; Wrote the paper. Salim A. Algarni, Khalid Aldhorae and Emad Mohamed Shaif Shaamala: Contributed reagents, materials, analysis tools, or data. Abrar A. Al-aswani, Haya H. Al kumaim, Lena F. Alsairi, Reeman A. Zayed,\u0026nbsp;Wejdan T. Al-olofi, Areej A. Alrifaie:\u0026nbsp;Analyzed and interpreted data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets created and/or analyzed during the current study are not publicly available due to confidentiality, but can be made available by the authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was obtained from the Research Committee of the Faculty of Dentistry, University of Ibn Al-Nafis for Medical Sciences, Sann, Yemen (r = 192 on 09 June 2025). All participants provided written informed consent after being fully informed about the study\u0026rsquo;s purpose, procedures, and potential risks, and were informed that they could discontinue the questionnaire at any point without providing an explanation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors state that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRamos FSES, Briso ALF, Albertinazzi L, Marchetti VM, Souza MT, Fagundes TC. 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PMID: 40003401; PMCID: PMC11855150.\u003c/li\u003e\n\u003cli\u003eAlahmari NM, A K Al-Haboob M, Gadah TS, Albar NH, Al Moaleem MM, Sayed ME, Alhumaidi AM, Al-Amri TMAS, Diaban SSA, A H S Tajedin A. Knowledge and practice of dental professionals regarding vertical teeth preparation techniques. BMC Med Educ. 2024 Dec 18;24(1):1482. doi: 10.1186/s12909-024-06520-w. PMID: 39696324; PMCID: PMC11653934.\u003c/li\u003e\n\u003cli\u003eAl-Huthaifi BH, Al Moaleem MM, Alwadai GS, Abou Nassar J, Sahli AAA, Khawaji AH, Juraybi AK, Alsheri YA, Aldhorae K, Yaqoub AA, Aljabali SA, Dobashi AM, Al-Qubati SW. High Prevalence of Musculoskeletal Disorders Among Dental Professionals: A Study on Ergonomics and Workload in Yemen. Med Sci Monit. 2023 Dec 20;29:e942294. doi: 10.12659/MSM.942294. PMID: 38115571; PMCID: PMC10790725.\u003c/li\u003e\n\u003cli\u003ePereira R, Gillam DG, Bapatla S, Satyamurthy P. (2018) Awareness of Dentine Hypersensitivity among General Dental Practitioners in Mumbai, India. J Odontol. 2018; 2: 103-9. https://www.longdom.org/open-access-pdfs/awareness-of-dentine-hypersensitivity-among-general-dental-practitioners-in-mumbai-india.pdf \u003c/li\u003e\n\u003cli\u003eHatton J, KumarH, Gillam DG. Knowledge of UK dental undergraduates and dentists in treating dentine hypersensitivity. Dent Oral Biol Craniofacial Res. 2020;1-9. doi: 10.31487/j.DOBCR.2020.03.01\u003c/li\u003e\n\u003cli\u003eDionysopoulos D, Gerasimidou O, Beltes C. Dentin hypersensitivity: etiology, diagnosis and contemporary therapeutic approaches\u0026mdash;a review in literature. Appl Sci. 2023; 13.21 (2023): 11632. https:// doi.org/10.3390/app132111632\u003c/li\u003e\n\u003cli\u003eAl-Omary H, Soltani A, Stewart D, Nazar Z. Implementing learning into practice from continuous professional development activities: a scoping review of health professionals\u0026apos; views and experiences. BMC Med Educ. 2024 Sep 20;24(1):1031. doi: 10.1186/s12909-024-06016-7. PMID: 39304841; PMCID: PMC11414194.\u003c/li\u003e\n\u003cli\u003eWallace S, May SA. Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice. Vet Rec. 2016 Nov 19;179(20):515-520. doi: 10.1136/vr.103862. PMID: 27856985; PMCID: PMC5256232.\u003c/li\u003e\n\u003cli\u003eHattar S, AlHadidi A, Sawair FA, Alraheam IA, El-Ma\u0026apos;aita A, Wahab FK. Impact of COVID-19 pandemic on dental education: online experience and practice expectations among dental students at the University of Jordan. BMC Med Educ. 2021 Mar 8;21(1):151. doi: 10.1186/s12909-021-02584-0. PMID: 33685451; PMCID: PMC7938292.\u003c/li\u003e\n\u003cli\u003eGillam DG. The Impact of Dentine Hypersensitivity on Oral Health-Related Quality of Life. Dentine Hypersensitivity: Advances in Diagnosis, Management, and Treatment. Cham: Springer Nature Switzerland, 2025. 29-40. https://doi.org/10.1007/978-3-031-74321-4\u003c/li\u003e\n\u003cli\u003eGibson B, Boiko OV, Baker S, Robinson PG, Barlow A, Player T, Locker D. The everyday impact of dentine sensitivity: personal and functional aspects. Dentine hypersensitivity. Academic Press. 2015. 89-107.\u003c/li\u003e\n\u003cli\u003eAmarasena N, Spencer J, Ou Y, Brennan D. Dentine hypersensitivity - Australian dentists\u0026apos; perspective. Aust Dent J. 2010 Jun;55(2):181-7. doi: 10.1111/j.1834-7819.2010.01223.x. PMID: 20604761.\u003c/li\u003e\n\u003cli\u003eAli K, Slade A, Kay E, Zahra D, Tredwin C. Preparedness of undergraduate dental students in the United Kingdom: a national study. Br Dent J. 2017 Mar 24;222(6):472-477. doi: 10.1038/sj.bdj.2017.272. PMID: 28337012.\u003c/li\u003e\n\u003cli\u003eCanadian Advisory Board on Dentin Hypersensitivity. Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. J Can Dent Assoc. 2003 Apr;69(4):221-6. PMID: 12662460.\u003c/li\u003e\n\u003cli\u003eWang G, Miao C, Li H, Zhao G, Li C. Survey methods contributing to the difference of dentin hypersensitivity prevalence among publications between 1998 and 2022: a research-on-research study. BMC Oral Health. 2025 Jun 3;25(1):889. doi: 10.1186/s12903-025-06143-7. PMID: 40462051; PMCID: PMC12135246.\u003c/li\u003e\n\u003cli\u003eZeola LF, Teixeira DNR, Galv\u0026atilde;o ADM, Souza PG, Soares PV. Brazilian dentists\u0026apos; perception of dentin hypersensitivity management. Braz Oral Res. 2020 Jan 10;33:e115. doi: 10.1590/1807-3107bor-2019.vol33.0115. PMID: 31939497.\u003c/li\u003e\n\u003cli\u003eNehete S, Prabhudesai S, Satpathy A, Grewal M, Tyagi A. Beyond the surface: understanding dentine hypersensitivity through literature and expert opinion. Int J Community Med Public Health2025;12:4790-9. DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20253286\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dentine hypersensitivity, knowledge, attitude, clinical practice, dental professionals","lastPublishedDoi":"10.21203/rs.3.rs-8206874/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8206874/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground/aim:\u003c/h2\u003e\u003cp\u003eDentin hypersensitivity (DH) is a common clinical condition characterized by a short, sharp pain that originates from exposed dentin. This study aimed to evaluate the knowledge, attitudes, and clinical practices regarding DH among dental practitioners.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional online survey was conducted among 401 dentists and specialists from July 2025 to August 2025. A validated questionnaire containing 30 questions was distributed to assess demographic variables, knowledge, attitudes, clinical practices, perceived barriers, and preventive practices in the diagnosis and management of DH. The data were analyzed using IBM SPSS Statistics (version 25.0), and p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study gathered 401 (91.13% response rate) responses and revealed that the participants had moderate general knowledge about DH, with 28.1% demonstrating a \u0026ldquo;good\u0026rdquo; level of knowledge. Most participants were aware of the hydrodynamic theory (57.2%) and local factors, such as enamel erosion (78.1%), although some still had misconceptions, especially with regard to systemic factors (44.3%). Higher knowledge levels were significantly associated with being female and those with postgraduate qualifications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Attitudes were generally positive, with 61.2% acknowledging DH\u0026rsquo;s impact on patients\u0026rsquo; life quality. However, only 36.6% felt very confident in managing the DH cases. Diagnosis primarily relied on patient history (89.3%). The form of treatment most used was fluoride varnish (75.9%), and advanced modalities, such as lasers (13.4%), were infrequently used. Major barriers were diagnostic difficulties (67.2%) and noncompliance of patients (49.3%), with 83.6% of participants advocating for more education on DH.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eYemeni dental professionals have a moderate level of knowledge and a positive attitude toward DH but suffer great difficulties in implementing this knowledge in a confident evidence-based practice. The demonstrated knowledge-practice gap necessitates urgent attention for structured educational interventions in the form of context-based clinical guidelines and the provision of improved means of obtaining advanced therapeutic materials to enhance the quality of DH care in this resource-poor setting.\u003c/p\u003e","manuscriptTitle":"Assessment of Knowledge, Attitudes, and Clinical Practices Regarding Dentine Hypersensitivity: A Cross-Sectional Study Among Dental Practitioners","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-12 13:20:08","doi":"10.21203/rs.3.rs-8206874/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-15T12:17:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T17:07:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79086297806168787923546280168726485124","date":"2025-12-09T16:45:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T07:38:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T00:56:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15793606163667179884921808759976206948","date":"2025-12-07T12:25:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121255664301537149507703487364060734070","date":"2025-12-06T20:44:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50492168947150006814619050444446215082","date":"2025-12-06T19:55:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-06T19:33:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325407499735303616976379441712330482054","date":"2025-12-06T19:23:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173004864549915318108417992111717297213","date":"2025-12-06T18:58:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26392148354197763821453442583868327421","date":"2025-12-06T18:57:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-06T18:56:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-01T17:05:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-28T11:40:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-28T11:37:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-11-25T21:54:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0810d7c5-002e-42ee-a48f-28fb5c40fd1f","owner":[],"postedDate":"December 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-22T20:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-12 13:20:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8206874","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8206874","identity":"rs-8206874","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}