Oral health in chronic obstructive pulmonary disease: are physicians prepared to integrate it into routine care?

Poor oral health has been associated with adverse outcomes in chronic obstructive pulmonary disease (COPD), yet its integration into routine COPD care remains poorly understood. This study evaluated physicians' attitudes, confidence, clinical practices, perceived barriers, and factors associated with routine oral health assessment.

A national cross-sectional survey was conducted among general practitioners, pulmonologists, and critical care physicians practising in Saudi Arabia between October 2025 and April 2026. The questionnaire assessed physicians' attitudes, confidence, oral health practices, and perceived barriers related to oral health in COPD. Composite attitude and confidence scores were calculated by averaging responses across the corresponding Likert-scale items. Univariable and multivariable logistic regression analyses were performed to identify factors associated with routine oral health assessment.

A total of 1,095 physicians completed the survey. Routine oral health assessment was infrequent, with only 24.7% reporting that they often or always assessed oral health during COPD care, despite generally neutral to moderately favourable attitudes towards oral health in COPD. Among physicians who assessed oral health at least sometimes, documentation of oral health findings was the most common management strategy (45.2%). The principal barriers were lack of formal training (38.5%), insufficient time (28.1%), uncertainty regarding professional responsibility (24.1%), and the absence of workplace protocols (22.6%). In the multivariable analysis, pulmonologists were more likely than General Practitioners to routinely assess oral health (adjusted OR 1.65, 95% CI 1.11-2.45; P = 0.013). Higher attitude (adjusted OR 1.31, 95% CI 1.04-1.64; P = 0.022) and confidence scores (adjusted OR 3.00, 95% CI 2.26-3.99; P < 0.001) were independently associated with routine oral health assessment.

Despite generally positive attitudes towards oral health in COPD, routine oral health assessment remains infrequently incorporated into clinical practice. The identified associations highlight potential areas for improving the integration of oral health into COPD care; however, the cross-sectional design does not permit causal inference.