Occlusal Reduction for Post-Endodontic Pain: Awareness and Practice Across Levels of Dental Training in Saudi Arabia

Background/Objectives: Randomized evidence on occlusal reduction for post-endodontic pain remains inconsistent. In the absence of a clear directive from trials, the decision to reduce the occlusal surface is made at the chairside on the basis of training, experience, and perceived benefit. Yet no study has characterized awareness and practice of occlusal reduction, quantified how much and which cusps are reduced, or identified the characteristics that predict its use. This study assessed the awareness, perceptions, and self-reported practices of dental students, interns, and dentists in Saudi Arabia. Methods: An expert-reviewed, closed-ended online questionnaire of 22 items administered in English was completed by 297 dental students, interns, general practitioners, and endodontic residents or specialists. Three a priori outcomes were analyzed by multivariable binary logistic (familiarity), ordinal (frequency of use), and Firth penalized logistic regression (perceived effectiveness). Because both binary outcomes were highly prevalent, adjusted prevalence ratios (aPRs) from modified Poisson regression with robust variance are reported as the primary effect measure, with odds ratios retained for comparability, and Wilson 95% confidence intervals (CIs) are given for the principal proportions. Exploratory comparisons were adjusted by the Benjamini-Hochberg procedure. Results: Familiarity was reported by 251/297 participants (84.5%; 95% CI 80.0–88.2), and 231/297 (77.8%; 95% CI 72.7–82.1) performed the technique at least occasionally, although only 13.8% used it in more than half of cases. Among users, 68.0% reduced 0.5–1 mm and 93.1% (95% CI 89.0–95.7) perceived it to be effective, most often in symptomatic irreversible pulpitis. Professional level was the only characteristic significantly associated with the outcomes in the multivariable models: relative to undergraduate students, endodontic residents and endodontists were more likely to be familiar with the technique (aPR 1.35, 95% CI 1.10–1.66) and to perform it (aPR 1.90, 95% CI 1.38–2.61); neither sex nor age showed a statistically significant association with any outcome, although estimates for age were imprecise. Conclusions: Familiarity and frequency of use increased with professional level after adjustment for age and sex, whereas routine application remained limited. These findings reflect perceptions and self-reported practices and are not evidence of clinical effectiveness. Continuing education should target evidence-based case selection and technical adequacy of the reduction.