Survey on patients’ attitude towards the nutritional counselling in the dental setting

The study addresses whether dental patients are receptive to receiving nutritional counselling within dental clinics and if a transdisciplinary approach involving both dentists and nutritionists is acceptable. The context is the recognized, multidirectional link between oral and systemic health and the shared modifiable risk factors, including diet, for non-communicable diseases such as diabetes and cardiovascular disease. WHO highlights the role of healthy diets in preventing chronic diseases, and professional bodies (e.g., ADA) encourage dental practitioners to engage in nutrition-related screening, counselling, and referrals. Despite the importance, patients’ perspectives on receiving dietary counselling in dental settings had not been explored. The primary aim was to evaluate patients’ attitudes toward receiving nutritional support in dental settings; the secondary aim was to assess differences among three dental settings: private practice, hospital public clinic, and private practice within the hospital (intra moenia).

Prior literature links dietary habits to dental diseases (caries risk with sugar frequency; erosion with dietary acids) and to periodontal risk via macro- and micronutrient imbalances. Recommendations for oral health practitioners include advice on fish oils, fiber, fruits, vegetables, and limiting refined sugars for oral and systemic health. Dental settings have been proposed for broader health screening (e.g., diabetes, obesity). Although dentists recognize nutrition’s importance, barriers such as limited training, time, and financial considerations hinder counselling. Dental and nutrition students often lack cross-disciplinary training. Evidence suggests dentists are open to referrals and that one-to-one dietary interventions in dental clinics can change behavior. However, before this study, patients’ attitudes toward receiving dietary counselling by a nutritionist in dental settings had not been reported.

Design: Cross-sectional survey conducted January–May 2023 in Lombardy, Italy (Milan and Lecco). Sampling and settings: Convenience sampling of adult patients (≥18 years) attending three dental settings: Group 1 private clinic in Lecco (Centro Odontostomatologico); Group 2 hospital dental clinic within the national health system in Milan (ASST Santi Paolo e Carlo); Group 3 intra-moenia private practice within the same hospital. Inclusion: age >18 years and willingness to participate. Exclusion: age <18 or refusal. Questionnaire: Semi-structured, including demographic data and six focused items on nutrition counselling attitudes. Self-administered anonymously after informed consent. Content validity and adaptation were reviewed by two experienced dieticians and four dentists. A pilot with 12 patients tested comprehension; the finalized questionnaire was used for data collection (pilot data excluded). BMI assessment: BMI = weight (kg)/height (m^2). WHO categories: underweight (<18.49; with subclasses), normal (18.50–24.99), overweight (25–29.99), obesity (≥30; classes I 30.00–34.99, II 35.00–40.00, III >40.00). Sample size: Calculated using Raosoft (general adult population of Milan and Lecco): recommended n=271 (margin of error 5%, confidence level 90%, response distribution 50%), with two-thirds from Milan and one-third from Lecco. Statistical analysis: Descriptive statistics with means (SD) for continuous variables and counts/percentages for categorical variables. Between-group comparisons: one-way ANOVA for continuous variables; chi-square or Fisher’s exact test for categorical variables. Subgroup analyses by sex and BMI explored potential modifiers. Significance set at p<0.05. Software: Excel and Stata 17.

• Participants: 313 patients (123 males, 190 females), mean age 53±17 years (range 18–87). Group 1: n=109, age 51±15, 24 males/85 females. Group 2: n=104, age 53±18, 50 males/54 females. Group 3: n=100, age 54±19, 49 males/51 females.
• Baseline differences (Table 1): Males more frequent in Groups 2 and 3 vs Group 1 (p<0.01). Weight and BMI higher in Groups 2 and 3 vs Group 1 (both p<0.01). Daily medications: mean 0.7±1.2 (Group 1), 1.8±2.2 (Group 2), 1.6±2.4 (Group 3); Group 2 had more patients taking ≥3 drugs/day (p<0.01).
• BMI distribution: Most patients were normal weight overall (p=0.02). Group 1 had more underweight (n=8). Groups 2 and 3 had more overweight/obese (n=50 and n=43, respectively).
• Prior dieting: ~half had followed a diet (Group 1 n=63, Group 2 n=57, Group 3 n=47; p=0.28). Diets were usually prescribed by a dietician/nutritionist/clinician; fewer were self-made (Group 1 n=10; Group 2 n=22; Group 3 n=23). Associations with BMI varied by group: e.g., in Group 2, prior-diet patients more often had BMI out of range (30/47; 63.8%) vs never-diet (22/57; 38.5%; p=0.02).
• Willingness to receive nutritional advice (general and for preventing oral diseases): Most patients (>80%) across all groups were willing (p=0.01); Group 2 had more “indifferent” responses.
• Preferred provider of advice: Majority in all groups preferred both dentist and nutritionist (p<0.01). Between-group differences: Group 2 favored nutritionist more; Group 3 emphasized dentist more (p=0.0002).
• Perceived utility of a nutritionist in dental clinics: Most patients agreed across groups; strongest in Group 2 (p=0.05).
• Interest in having an on-site nutritionist to provide general advice and personalized diet for systemic disease prevention: High overall and significantly higher in Group 2, with >80% positive responses (p<0.01; between-group p=0.003). Among those not interested, several had BMI out of range in each group.
• Value of regular nutritional follow-up: Most patients endorsed follow-up scheduling; >80% positive in Group 2 (p<0.01).

The findings directly address the research question by showing that dental patients are receptive to nutritional counselling within dental settings and favor a collaborative model where both dentists and nutritionists provide guidance. High willingness to receive advice, strong perceived utility of a nutritionist, and interest in personalized diet planning and follow-up support the feasibility and acceptance of integrating nutrition services into dental care. Given the shared risk factors between oral and systemic diseases, embedding nutrition counselling in dental clinics may enhance prevention, facilitate early identification of conditions such as overweight/obesity and metabolic syndrome, and strengthen the role of dentistry in holistic health promotion. Differences across settings suggest contextual factors (e.g., patient profiles in public hospital clinics) may influence interest and perceived utility, informing tailored implementation strategies.

Dental patients view dental clinics as appropriate venues for receiving nutritional advice from both dentists and nutritionists. Participants expressed willingness to obtain information and engage in nutritional programs aimed at preventing both oral and systemic diseases. A multidisciplinary model is recommended, with dental clinics supporting periodic screening and follow-up, and nutritionists integrated into the dental team to contribute to comprehensive patient management.

Cross-sectional design limits causal inference. Convenience sampling from a single Italian region (Lombardy) reduces generalizability. Data were self-reported using a pilot, non-validated questionnaire. Geographic restriction to northern Italy and differences among clinic populations may introduce selection bias.