Knowledge, Compliance, and Associated Factors of Radiation Protection Adherence Among Dental Students, Interns, and Dentists: A Cross-Sectional Study

Dental radiography is essential for diagnosis and treatment planning, but exposure to ionizing radiation requires strict adherence to radiation protection principles. This study evaluated radiation protection knowledge, self-reported compliance, and their associated factors among dental students, interns, and dentists. A cross-sectional study included 136 participants (86.1% response rate). A content-reviewed bilingual questionnaire assessed 7 knowledge items (6 scored in the composite knowledge score) and 12 self-reported compliance items. Pilot testing, translation, content validity (scale-level average content validity index [S-CVI/Ave] = 0.91), and internal consistency (α = 0.78; Kuder–Richardson Formula 20 [KR-20] = 0.70) were evaluated. Multivariable ordinary least squares regression examined factors associated with compliance using SPSS 27 and Python software. The composite knowledge score was 0.804; the pediatric radiation protection item had a correct-response rate of 54.4% (single-item assessment). Mean compliance was 3.09/4. Composite knowledge score was independently associated with self-reported compliance (B = 1.092, 95% confidence interval: 0.817–1.366, p < 0.001). Compliance was significantly lower among Year 5 students and interns than among Year 3 students (p = 0.037 and p = 0.005, respectively), whereas gender and the remaining training-level contrasts were not significant (R 2 = 0.360). Knowledge showed a moderate-to-strong positive correlation with compliance (rₛ= 0.528, p < 0.001). Exploratory analyses indicated a stronger knowledge–compliance association among more advanced trainees (Year 5, interns, and dentists/faculty) than among earlier-year students. The largest compliance gaps involved X-ray image repetition frequency, use of protective shielding devices, and motion-restraining tools. Composite knowledge score was independently associated with self-reported compliance, and adjusted compliance was lower among Year 5 students and interns than among Year 3 students. However, the cross-sectional design and reliance on self-reported data preclude causal interpretation. Lower compliance was observed for X-ray image repetition frequency, protective shielding devices, and motion-restraining tools. These findings support competency-based training and curriculum review, but recommendations remain exploratory and require confirmation in larger multi-institutional prospective studies.