Saudi dental students’ perceptions on sustainable development goals and sustainable dental practice

Climate change and ecological concerns have heightened global attention to sustainability, shifting emphasis from development alone to reducing environmental footprint and promoting sustainable development. Dentistry, under pressure from rising costs, demand, and environmental impacts, generates substantial waste (e.g., sterilisation pouches, barriers, covers, gloves, masks, suction tips) and consumes large amounts of water and energy, alongside hazardous outputs (e.g., lead foils, X-ray fixer, mercury). The UN’s 17 Sustainable Development Goals (SDGs) provide a framework linking poverty reduction, hunger, gender equality, infrastructure/innovation, and sustainable cities to oral health outcomes. Conversely, preventive care, health promotion, and recyclable materials in dentistry can support SDG 12 (responsible consumption and production) among others. Sustainable dental practices (SDP)—often termed green or eco-friendly dentistry—seek to replace harmful practices with environmentally sustainable alternatives; while transition may require time and investment, it is feasible and occurring globally. Professional bodies (e.g., FDI) advocate integrating sustainability into oral health care and education. Dental students, as future professionals, need sufficient knowledge and positive perceptions to bridge SDGs with oral health and to regulate their practices sustainably. There is a paucity of country-level data on oral health–SDG interconnections, and no prior study on Saudi dental students’ perceptions of SDGs and SDP. Therefore, this study assesses Saudi dental students’ self-perceived knowledge and awareness of SDGs and SDP, and examines associations with sociodemographic factors.

Prior work documents significant environmental burdens from dental care including high volumes of disposable materials, water use, and hazardous wastes (lead, fixer, mercury). Eco-friendly dentistry, introduced in 2007, proposes replacing conventional practices with sustainable alternatives. Reviews and surveys indicate increasing global efforts to embed sustainability into dental routines and curricula, with professional calls (e.g., FDI) for sustainable techniques to safeguard care and foster a green economy. Studies show variable levels of awareness: some report favorable attitudes among students toward environmental sustainability, yet gaps in knowledge and implementation persist. International surveys (Spain, Indonesia) reveal many university students are unfamiliar with SDGs and often learn about them online rather than through formal education. Scoping and cross-national studies also identify barriers such as lack of knowledge/training and costs as impediments to adopting SDP in practice.

Design: Cross-sectional online survey. Ethics: Approved by Prince Sultan University Institutional Review Board (PRB-2022-10-0130). Electronic informed consent obtained via a participation statement. Setting and sampling: Undergraduate dental students enrolled in public and private dental colleges across Saudi Arabia were targeted, with support from the Ministry of Education. Each college designated a student representative to distribute reminders and the survey link. Data collection: Google Forms, with mandatory responses per item and single-response restriction. Distribution and collection occurred from 16 Nov 2022 to 15 Nov 2023. Approximately 1300 students were enrolled nationally during the period; 841 responses were obtained (response rate 64.7%). Eligible participants were adults aged 18–35 years of any gender. Instrument: Adapted (contextualized) from two previously validated surveys (references 18, 19), piloted with no comments. The questionnaire had 34 items across seven sections: (1) demographics (3 items); (2) source of information about SDGs (1); (3) self-reported knowledge of SDGs (3, 5-point Likert); (4) learning level of SDGs (11, multiple choice); (5) awareness of SDGs (7, 5-point Likert); (6) awareness of SDP (8, 5-point Likert); (7) barriers to implementing SDP (1, closed-ended). Measures: Likert anchors: not at all, slightly, moderately, quite, extremely. Closed-ended items covered demographics, information sources, learning level, and SDP barriers. Analysis: Data were summarized after anonymous submission. Analytic steps included: (1) preliminary analysis and psychometric properties; (2) descriptive statistics for knowledge/awareness of SDGs and SDP and subscales; (3) independent samples t-tests for associations with gender, age, and level of education (pre-clinical vs clinical). SPSS v29 used; significance at p < 0.05.

Sample and demographics: N=841; age 18–35; females 70.6% (n=594), males 29.4% (n=247). Age groups: 18–25 years 69.3% (n=583); 26–35 years 30.7% (n=258). Education: pre-clinical (1st–2nd years) 38.8% (n=326); clinical (3rd–5th years) 61.2% (n=515). Sources of SDG information: Internet 59.9% (n=504); no knowledge 25.8% (n=217); school/college/university 10.2% (n=86); specific training/events/workshops 4.1% (n=34). Self-reported knowledge and awareness levels (Table 3): - Self-reported knowledge of SDGs: Mean 6.76 (SD 2.60), 95% CI [6.58, 6.93], range 3–12 (moderate). - Awareness of SDGs: Mean 21.53 (SD 6.61), 95% CI [21.08, 21.97], range 7–34 (moderate). - Awareness of SDP: Mean 29.68 (SD 10.49), 95% CI [28.96, 30.39], range 8–40 (high). Learning level of SDGs (correct responses; Table 1): 1) Meaning of SDGs: 784 (93.2%). 2) Number of SDGs: 623 (74.1%). 3) Number of SDG targets: 347 (41.3%). 4) Organization launching SDGs: 579 (68.8%). 5) Year launched: 643 (76.5%). 6) End year: 764 (90.8%). 7) NOT among 5Ps: 284 (33.8%). 8) NOT among three pillars: 661 (78.6%). 9) NOT a 2030 SDG goal: 587 (69.8%). 10) SDG for good health and wellbeing: 592 (70.4%). 11) SDG for gender equality: 424 (50.4%). Total N=841. Group comparisons (Independent samples t-tests; Table 4): - Gender: Females scored higher than males across all outcomes. • Knowledge of SDGs: Male M=4.72 (SD 2.32) vs Female M=7.61 (SD 2.20); t(839)=-17.01; p<0.001. • Awareness of SDGs: Male M=16.01 (SD 8.05) vs Female M=23.82 (SD 4.13); t(839)=-18.50; p<0.001. • Awareness of SDP: Male M=19.62 (SD 11.42) vs Female M=33.86 (SD 6.49); t(839)=-22.79; p<0.001. - Age: No significant differences. • Knowledge of SDGs: 18–25 M=6.74 (SD 2.52) vs 26–35 M=6.79 (SD 2.76); t=-0.21; p=0.82. • Awareness of SDGs: 18–25 M=21.50 (SD 6.16) vs 26–35 M=21.59 (SD 7.54); t=-0.17; p=0.86. • Awareness of SDP: 18–25 M=29.90 (SD 10.30) vs 26–35 M=29.18 (SD 10.93); t=0.91; p=0.36. - Level of education: No differences for SDG knowledge or awareness; significant for SDP awareness. • Knowledge of SDGs: Pre-clinical M=6.84 (SD 2.60) vs Clinical M=6.70 (SD 2.60); t=0.76; p=0.44. • Awareness of SDGs: Pre-clinical M=21.98 (SD 6.58) vs Clinical M=21.24 (SD 6.62); t=1.57; p=0.11. • Awareness of SDP: Pre-clinical M=28.68 (SD 10.29) vs Clinical M=30.30 (SD 10.58); t=-2.18; p=0.02. Barriers to implementing SDP (Fig. 2): Lack of information/training 69.1%; cost 11.4%; availability of materials 7.6%; patients’ cooperation 3.6%; human resources 1.4%; operationalisation 0.7%.

The study shows Saudi dental students have moderate self-reported knowledge and awareness of SDGs, but relatively high awareness of sustainable dental practices, indicating a readiness to engage with sustainability in clinical contexts despite broader SDG knowledge gaps. Educational institutions appear underutilized as SDG information sources, with most students learning online and a quarter reporting no SDG knowledge, underscoring the need to embed SDG content within dental curricula at multiple levels. Gender differences were pronounced: female students demonstrated higher knowledge and awareness of SDGs and SDP, consistent with literature describing an eco gender gap wherein women more often adopt pro-environmental values and behaviors. Clinical students showed higher awareness of SDP than pre-clinical students, potentially due to direct exposure to clinical environments where waste generation and resource use are apparent; further research should examine specific domains of clinical sustainability knowledge (equipment/materials selection, energy use, waste disposal, biodiversity) and compare public versus private institutions. Comparisons with prior studies reveal variability: while US students have reported favorable attitudes toward environmental sustainability, a recent Saudi survey found limited awareness among students and faculty; the present findings suggest increased awareness of SDP among Saudi students but persistent knowledge gaps on SDGs. Across contexts, lack of knowledge/training and costs frequently emerge as barriers, echoed here by the predominance of information/training deficits, followed by financial and material availability concerns. Collectively, findings support integrating sustainability and SDG-aligned learning outcomes into dental education, advancing professional development (continuing education, mentoring), and fostering industry and policy support for sustainable materials and practices. Such steps align with broader SDG advancement through oral health promotion and preventive care, emphasizing responsible consumption, waste reduction, and patient safety.

This first nationwide study of Saudi dental students indicates moderate self-reported knowledge and awareness of SDGs and a higher level of awareness of sustainable dental practices. Female students exhibited greater knowledge and awareness of both SDGs and SDP than males, and clinical students showed higher awareness of SDP than pre-clinical students. To advance sustainability competence, stakeholders should integrate SDG and SDP principles into dental curricula, promote preventive care and resource minimization without compromising patient safety, and support development and adoption of sustainable materials and technologies. Policymakers should incentivize environmentally sustainable practices, and professionals should engage in policy processes. Educating patients about the environmental implications of treatment choices can further promote sustainability. Coordinated actions across the oral health ecosystem can align dental practice with SDGs and strengthen sustainable dental practice. Future research could examine specific domains of clinical sustainability awareness and compare outcomes between public and private institutions.

Use of an online, convenience-style distribution can limit representativeness and introduce self-selection bias; accurately characterizing the target population is challenging, and respondent bias may affect findings. Knowledge and awareness were self-reported, which may not reflect objective competence. The study did not analyze differences between public and private colleges, which could influence generalizability. Cross-sectional design precludes causal inferences.