Knowledge, attitudes, and referral behavior of pediatric dentists regarding the early diagnosis of orthodontic anomalies: a cross-sectional survey

Pediatric dentists are often the first clinicians to detect developing malocclusions and serve as gatekeepers for orthodontic referrals, yet their knowledge of early diagnosis, attitudes, and referral behavior have not been well characterized. This study assessed pediatric dentists’ knowledge, attitudes, and referral behavior regarding the early diagnosis of orthodontic anomalies and their associations with demographic and professional characteristics. This cross-sectional study used an anonymous 28-item online questionnaire distributed to pediatric dentists via social media and professional groups from January to February 2026. The questionnaire was developed de novo in Turkish, content-validated by an expert panel, and pilot-tested. Knowledge responses were summed into a descriptive score (0–11) and classified, using study-specific cut-offs, as poor, moderate, or good. Data were analyzed using descriptive statistics, the Mann-Whitney U and Kruskal-Wallis tests, chi-square tests with Monte Carlo simulation, and Spearman correlation, with Benjamini-Hochberg correction; significance was set at p < 0.05. A total of 120 pediatric dentists participated (83.3% female; 68.3% with 0–5 years of experience). The mean knowledge score was 8.68 ± 1.46 out of 11 (Kuder-Richardson 20 = 0.296); 62.5% had good, 32.5% moderate, and 5.0% poor knowledge. Correct-response rates were lowest for the anterior open-bite vignette (46.7%), the recommended age for the first orthodontic evaluation (61.7%), the timing of unilateral posterior crossbite treatment (61.7%), and the age of spontaneous closure of physiologic diastema (69.2%). Attitudes were highly positive (≥ 94% agreed that diagnostic knowledge, early referral, and communication with orthodontists are important), but only 37.5% considered undergraduate education adequate. The knowledge score did not differ by any demographic or professional characteristic, whereas the number of referrals was higher among respondents who routinely collaborated with an orthodontist (adjusted p = 0.041). The pediatric dentists participating in this survey answered most knowledge items correctly but showed specific gaps concerning the timing of early evaluation and intervention, alongside strongly positive attitudes. A gap between attitudes and preventive practice and a perception of inadequate undergraduate education were also evident. These findings from a convenience sample should be generalized with caution. Strengthening education and continuing professional development, and fostering pediatric dentist-orthodontist collaboration, appear warranted.