Unseen challenges: a cross-sectional survey of orthodontists’ perspectives on oral mucosal lesions

Background Oral mucosal lesions (OMLs) are common conditions that require early recognition for proper management and prevention of complications. Orthodontists frequently encounter the oral mucosa during routine treatment procedures, making their awareness and clinical approach to OMLs highly relevant. However, limited information is available regarding their knowledge, attitudes, and clinical practices related to these lesions. Methods A cross-sectional online questionnaire was administered between May 28, 2024, and October 1,2024, to members of the Turkish Orthodontic Society via email. An 18-item questionnaire assessed participants' demographics, diagnostic practices, and management strategies regarding OMLs. Categorical variables were summarized using frequencies and percentages. Associations between categorical variables were assessed using Pearson’s chi-squared test or Fisher’s exact test. Results Of 2,290 invited members, 317 responded to the survey (13.8%); after data screening, 282 questionnaires were included in the final analysis (12.3% of those invited). Among the 282 participants, 95.0% reported encountering OMLs, 0.7% had performed a biopsy, and 51.8% documented lesions in patient records. Oral aphthous ulcers and traumatic lesions were most frequently observed. Self-reported diagnostic and treatment confidence varied significantly by age and years of professional experience, while treatment confidence also differed by institutional affiliation; weekly patient volume was associated with selected diagnostic perceptions. Younger orthodontists generally reported lower confidence for selected outcomes, while university-affiliated orthodontists reported lower treatment confidence for stomatitis. Conclusion Orthodontists are uniquely positioned to detect OMLs due to the specific nature of orthodontic treatment, including long-term follow-up and frequent visits. However, gaps in self-reported diagnostic confidence, documentation, and engagement with continuing education were identified. These findings support the value of OML-focused education and more standardized approaches to documentation and referral within orthodontic practice.