Self-Reported Prebiotics and Probiotics Recognition and Recommendation Practices Among Dentists in Sibiu County, Romania: A Cross-Sectional Questionnaire Survey.

Abstract

Background/Objectives: Probiotics and prebiotics are being investigated as adjuncts for the management of oral dysbiosis, but little is known about how dentists understand and recommend them. We describe self-reported recognition of oral microbiome concepts, identification of the definitions of prebiotics and probiotics, and recommendation practices among dentists in Sibiu County, Romania. Methods: A cross-sectional online questionnaire survey (comprising eight closed items; delivered using Google Forms) was distributed through the county professional association WhatsApp messaging channel and to personal contacts between 20 February 2026 and 9 March 2026. Of a target of 630 dentists, 107 completed the questionnaire (response rate: 17.0%), forming a voluntary local sample. Three pre-specified hypotheses (definition accuracy × recommendation; general recommendation × adjunct recommended during antibiotic therapy; and years of experience × definition accuracy and recommendation) were tested with exact tests, odds ratios (ORs), and 95% confidence intervals (CIs) with Holm adjustment; other item associations were exploratory and adjusted within families. Results: A microbial role was recognized for periodontal disease by 98.1% of respondents, for dental caries by 92.5%, for focal infection by 73.8%, and for bone infection of dental origin by 64.5%. Diet, antibiotics, oral hygiene, and smoking were recognized as microbial influencing factors by 78-84%, probiotics by 58.9%, and prebiotics by 52.3%. Definitions of the adjuncts were correctly identified by 83.2% (prebiotics) and 80.4% (probiotics). Prebiotics were recommended by 50.5% and probiotics by 86.0% of respondents. Correct definitions were not associated with recommendation (prebiotics: OR 1.76, 95% CI 0.62-4.95; probiotics: OR 1.60, 95% CI 0.46-5.65). During antibiotic therapy, dentists who recommended prebiotics were more likely to select a prebiotic-probiotic combination than those who did not (57.4% versus 3.8%; exact p < 0.001). No outcome differed by years of experience. Conclusions: In this self-selected sample, biotics were recognized as microbiome-influencing factors less often than classical factors, and knowing the definitions was not associated with recommending the products. The reasons behind recommendation habits were not measured and require dedicated study.