749 2024 Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 1 Assessment of Oral Histology Knowledge and Its Application in Clinical Orthodontics, Operative Dentistry, Oral Medicine, and Oral Surgery Selma Merza Hasan1, Zainab A. Almashhadi 2, Amjed F. Hussein3, Heider Hemeed Abbas 4 1College of Dentistry, University of Kufa, College of Dentistry, Ahl Al Bayt University, Iraq. Email: Drsmerza@gmail.com, Orcid: https://orcid.org/0009-0002-6442-5254 2College of Dentistry, Ahl Al Bayt University, Iraq. Email:almashhadizainabaj@gmail.com, Orcid: https://orcid.org/0009-0004-5819-6170 3College of Dentistry, Ahl Al Bayt University, Iraq. Email:Dr.amjedfouad88@gmail.com, Orcid: https://orcid.org/0009-0008-5846-9975 4College of Dentistry, Babylon University, Iraq. Email: dent.heider.hemeed@uobabylon.edu.iq, Orcid: hQps://orcid.org/0000-0003-1691-2728 Abstract Objec:ve: This study aims to assess the knowledge of oral histology among fi6h-year dental students in Iraq and evaluate its relevance to various clinical dental disciplines, including orthodon>cs, opera>ve den>stry, oral medicine, and oral surgery. Methods: A cross-sec>onal survey was conducted from February to May 2024 among dental students from both public and private ins>tu>ons in Iraq. Par>cipants were recruited through targeted online adver>sements on plaHorms such as Telegram, WhatsApp, and Facebook. Results: The results compare clinical and basic knowledge between younger and older dental students. Younger students scored higher in understanding basic concepts like structural changes in the periodontal ligament, bone remodeling, tooth erup>on enamel structure, cavity design and surgical interven>ons. However, older students excelled in clinical areas such as maxillofacial development, orthodon>c appliances, and developmental anomalies. Conclusion: This study provides insights into the perceived value of oral histology educa>on among dental students and its applica>on in clinical prac>ce. The findings may be encouraging early clinical involvement while reinforcing basic science concepts can lead to a more well-rounded and confident dental workforce. Keywords: Oral Histology, Orthodon>cs, Opera>ve Den>stry, Oral Medicine, Maxillofacial Surgery, Student Ques>onnaire. Cita%on: Hasan SM, et al. (2024) Assessment of oral histology knowledge and its applica%on in clinical orthodon%cs, opera%ve den%stry, oral medicine, and oral surgery. Den%stry 3000. 1:a001 doi:10.5195/d3000.2024.749 Received: October 5, 2024 Accepted: October 21, 2024 Published: November 27, 2024 Copyright: ©2024 Hasan SM, et al. This is an open access ar%cle licensed under a Crea%ve Commons ASribu%on Work 4.0 United States License. Email:Drsmerza@gmail.com Introduction Oral histology is a fundamental discipline in dentistry, providing a microscopic understanding of oral tissues. It serves as a cornerstone for various specialties, including orthodontics, operative dentistry, oral medicine, and oral surgery. A comprehensive grasp of oral histology is essential for diagnosing, treating, and preventing oral diseases [1,2]. Understanding oral histology is crucial for dental students to comprehend the pathophysiology of oral diseases [3]. Instead of rote memorization, theoretical lectures and clinical application help students to understand histologic specimens. Then, knowledge of oral histology can help dental practitioners to manage patients with oral diseases in the clinic [4,5]. Dental Education program has provided valuable suggestions and strategies for the integration of histology in the dental curriculum and for teaching the subject in a way that better integrates preclinical education in the clinical years [6]. Some available studies have reported strong correlations between histology students' performance in clinical discipline learning [1]. The competence of dental students in their professional tasks after graduation depends on the acquisition of Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 2 knowledge and clinical skills needed to deliver evidence-based dental treatment [7]. Preclinical basic medical information is important for dental students to become qualified dentists [8]. Oral histology is integral to various dental specialties, providing essential insights into tissue structure and function that directly impact clinical practice [9]. In orthodontics, tooth movement relies on the remodeling of alveolar bone and the periodontal ligament, with histological changes in these tissues playing a key role in understanding the effects of orthodontic forces, managing root resorption, and predicting soft tissue responses [10,11]. In operative dentistry, understanding the histology of enamel, dentin, pulp, and cementum is vital for designing effective cavity preparations, selecting appropriate restorative materials, and predicting tissue response and healing [12]. Histological analysis of caries- affected tissues informs the extent of decay and guides intervention strategies [13], while the compatibility of restorative materials with dental tissues ensures long-term success [14]. Oral surgery heavily depends on histological knowledge for understanding wound healing processes, the interaction between bone and soft tissues during procedures like extractions and implants [15], and diagnosing pathological conditions requiring surgical intervention, oral histology is crucial for diagnosing oral lesions, differentiating between various types of pathological conditions [16], understanding oral manifestation of systemic disease manifestations in the oral cavity, and assessing the impact of medications on oral tissues, all of which contribute to informed clinical decision-making and patient care [17]. This study will help in recognizing dental education deficiencies and providing insight that may benefit and improve dental students' performance and education. It appears that no previous study has been conducted in Iraq examining the proficiency of dental students in oral histology, which is a considerable current deficiency in our academic dental counseling. Therefore, our research study will target the fifth year of dental students from specific age groups. The importance of the study arose for measuring dentists' orofacial histological expertise, which has not previously been published, and for assessing the impact of the teaching process in academic dental institutions students for basic science and undergraduate clinical education. Material and Methods Study Method A cross-sectional survey was conducted from February to May 2024 among dental students in Iraq. Participants were recruited through targeted advertisements online by different social media especially telegram, WhatsApp and Facebook groups, focusing on individuals within the specified age range, different genders and geographic locations. Survey design At the beginning of the survey, as part of the demographic data, respondents were asked about their gender in addition to their age, which was divided into two groups. The first group ranged from 22 to 24 years old, considered the fresh group, representing the typical age for graduation. The second group ranged from 25 to 28 years old, considered the old group. This questionnaire was designed for fifth-year dental students in Iraq, including both Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 3 governmental and private educational institutions. The survey contains 40 items addressing key questions that connect oral histology to various clinical dental branches, aiming to evaluate how much students benefit from studying oral histology as a basic science and its application in clinical dentistry. Consultation was made with the heads of relevant departments and teaching staff involved in the research to identify the questions they deemed important for the fifth-year stage, which should be addressed before starting the practical component. Improving reliability of online surveys is crucial for precise data gathering. The validity of the content was evaluated by professionals in orthodontics, operative dentistry, oral surgery, oral medicine, and oral histology. Data collection The validity of the content was evaluated, obscurity was ensured throughout the data collection process. The fifth-year representatives in both public and private universities have been contacted to ensure that the questionnaire reaches the largest number of students. The responses designated as: Extensive Knowledge (Score 4), Limited Knowledge (Score 3), Moderate Knowledge (Score 2) and Knowledge Unimportant (Score 1). Statistical analysis The data analysis was conducted using Jeffreys’s Amazing Statistics Program (JASP), version 0.19.0. The methods applied included descriptive statistics, such as the mean and standard deviation, along with the independent samples t-test to compare the two categories under study Results The sample consisted of approximately 1,265 students from Iraqi public and private universities. The number of students aged 22-24 was around 731, representing about 57.7% of the sample, while students aged 25-28 numbered around 534, making up about 53.3%. The female students in the overall responses were approximately 735, representing about 58%, while the male students were around 530, accounting for 41.7%. Students’ knowledge in Orthodontics The older students consistently demonstrated a higher level of knowledge in clinical areas (Table 1), while fresh students, however, displayed a stronger understanding of basic knowledge areas like tooth eruption. The Independent Samples T-Test results show significant differences between Fresh and Older Students across various orthodontic knowledge areas. As shown in Table 2. Table 1. Scores of responses regarding the students’ knowledge in orthodontics. Question Group Valid Mean Standard Deviation To what extent do you know about the structural changes in the periodontal ligament during orthodontic movement? Fresh Students 731 2.412 0.856 Older Students 534 2.011 0.893 To what extent do you know about the cells involved in bone remodeling during orthodontic treatment? Fresh Students 731 2.31 0.848 Older Students 534 2.11 0.979 To what extent do you know about maxillofacial development? Fresh Students 731 2.238 0.818 Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 4 Older Students 534 2.521 0.976 To what extent do you know about orthodontic appliances? Fresh Students 731 2.022 0.747 Older Students 534 2.264 0.943 To what extent do you know about tooth eruption and shedding sequences? Fresh Students 731 2.23 0.810 Older Students 534 1.83 0.996 To what extent do you know about developmental anomalies that need orthodontic intervention? Fresh Students 731 2.093 0.891 Older Students 534 2.300 1.014 To what extent do you know about the importance of mixed dentition in orthodontic treatment? Fresh Students 731 2.083 0.769 Older Students 534 2.272 0.883 To what extent do you know about tooth development and teeth anomalies? Fresh Students 731 1.973 0.769 Older Students 534 2.124 0.837 To what extent do you know about procedures to accelerate tooth movement? Fresh Students 731 2.226 0.826 Older Students 534 2.331 0.864 To what extent do you know about the effect of age on orthodontic treatment? Fresh Students 731 1.921 0.832 Older Students 534 1.963 0.883 Table 2. Comparison of orthodontic responses between two age groups. Questions t Degrees of freedom p To what extent do you know about the structural changes in the periodontal ligament during orthodontic movement? -4.786 1263 < .001 To what extent do you know about maxillofacial development? -5.590 1263 < .001 To what extent do you know about the cells involved in bone remodeling during orthodontic treatment? -4.126 1263 < .001 To what extent do you know about orthodontic appliances? -5.092 1263 < .001 To what extent do you know about the effect of age on orthodontic treatment? -0.862 1263 0.389 To what extent do you know about developmental anomalies that need orthodontic intervention? -3.841 1263 < .001 To what extent do you know about procedures to accelerate tooth movement? -2.205 1263 0.028 To what extent do you know about tooth development and teeth anomalies? -3.321 1263 < .001 To what extent do you know about tooth eruption and shedding sequences? -4.305 1263 < .001 To what extent do you know about the importance of mixed dentition in orthodontic treatment? -4.033 1263 < .001 Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 5 Students’ knowledge in Operative As shown in Table 3, fresh students generally demonstrate higher knowledge in basic concepts such as enamel structure, cavity design while older students tend to have better understanding in more advanced clinical. The independent samples t-test reveals that fresh students have significantly higher knowledge in basic areas such as enamel structure and cavity design compared to older students. In contrast, older students show significantly better understanding of the pulpal response to caries progression and root canal as shown in Table 4. Table 3. Scores of responses regarding the operative knowledge. Question Group Valid Mean Standard Deviation To which extent do you know about the structure of enamel and its significance in cavity preparation? Fresh Students 731 2.323 0.990 Older Students 534 1.981 0.777 To what extent do you know about cavity design? Fresh Students 731 2.361 1.046 Older Students 534 2.021 0.847 To what extent do you know about the structure of carious dentin? Fresh Students 731 2.264 0.749 Older Students 534 2.154 0.786 To what extent do you know about the pulpal response to caries progression? Fresh Students 731 2.114 0.888 Older Students 534 2.416 0.808 To what extent do you know about root canal configuration? Fresh Students 731 2.397 0.867 Older Students 534 2.599 0.943 To what extent do you know how to read radiographic films in operative procedures? Fresh Students 731 2.273 0.773 Older Students 534 2.289 0.777 To what extent do you know about advancements in adhesives? Fresh Students 731 2.405 0.764 Older Students 534 2.483 0.774 To what extent do you know about the materials used in crown and bridge? Fresh Students 731 2.441 0.889 Older Students 534 2.549 0.849 To what extent do you know about the treatment of discolored teeth? Fresh Students 731 2.040 0.782 Older Students 534 2.139 0.868 To what extent do you know about the interaction of restorative materials with the pulp-dentin complex? Fresh Students 731 2.218 0.780 Older Students 534 2.290 0.849 Table 4. Comparison the scores of responses of operative knowledge between two age groups. Questions t Degrees of freedom p To which extent do you know about the structure of enamel and its significance in cavity preparation? 6.620 1263 < .001 To what extent do you know about cavity design? 6.185 1263 < .001 To what extent do you know about the structure of carious dentin? 2.536 1263 0.011 Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 6 To what extent do you know about the interaction of restorative materials with the pulp- dentin complex? - 1.578 1263 0.115 To what extent do you know about advancements in adhesives? - 1.789 1263 0.074 To what extent do you know about the treatment of discolored teeth? - 2.121 1263 0.034 To what extent do you know about the materials used in crown and bridge? 0.178 1263 0.859 To what extent do you know about the pulpal response to caries progression? - 6.209 1263 < .001 To what extent do you know how to read radiographic films in operative procedures? 0.221 1263 0.825 To what extent do you know about root canal configuration? - 3.953 1263 < .001 Students’ knowledge in Oral Medicine The responses indicate that fresh students seem to perform better in foundational areas, such as recognizing challenges in reading pathological slides and distinguishing between cysts and tumors. In contrast, older students exhibit a stronger understanding of clinical aspects, particularly in areas like TMJ disorder knowledge, as shown in Table 5. The comparison of scores through Independent Samples t-test (Table 6), fresh students demonstrated a significantly higher difficulty in reading pathological slides, while older students outperformed in understanding TMJ disorders. Table 5. Scores of responses regarding the students’ knowledge in oral medicine. Questions Group Valid Mean Standard Deviation To what extent do you know about the anatomy and histology of the Temporomandibular Joint (TMJ)? Older Students 729 2.044 0.841 Fresh Students 534 2.086 0.911 To what extent do you know about differentiating between cysts and tumors in the oral cavity? Fresh Students 729 2.303 0.734 Older Students 534 2.243 0.761 To what extent do you know about the anatomy, histology, and abnormalities of the salivary glands? Fresh Students 731 2.212 0.697 Older Students 534 2.155 0.671 To what extent do you know about oral mucosal abnormalities (growths, ulcers, infections, allergies, immune-mediated and autoimmune disorders)? Fresh Students 731 2.238 0.735 Older Students 534 2.193 0.716 To what extent do you know about apththous ulceration? Older Students 731 2.274 0.850 Fresh Students 534 2.193 0.823 To what extent do you know about TMJ disorder? Older Students 731 2.460 0.737 Fresh Students 534 2.296 0.724 To what extent do you know about differences between benign and malignant lesions? Older Students 731 2.408 0.766 Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 7 Fresh Students 534 2.446 0.748 To what extent do you know about oral manifestation of systemic diseases? Fresh Students 731 2.230 0.763 Older Students 534 2.238 0.759 To what extent do you observe difficulties in reading pathological slides? Older Students 714 2.444 0.791 Fresh Students 502 2.654 0.855 Based on your previous academic year, to what extent do you have knowledge about common premalignant lesions? Fresh Students 727 2.329 0.789 Older Students 532 2.333 0.866 To what extent do you know about gingival tissues in healthy individuals versus those with gingivitis or periodontitis? Fresh Students 731 2.285 0.786 Older Students 534 2.365 0.777 Table 6. Comparison the scores of responses of oral medicine knowledge between two age groups. Questions t Degrees of freedom p To what extent do you know about the anatomy and histology of the Temporomandibular Joint (TMJ)? 0.248 1261 0.805 To what extent do you know about differentiating between cysts and tumors in the oral cavity? 1.407 1261 0.160 To what extent do you know about differences benign and malignant lesion? 1.811 1263 0.03 To what extent do you know about the anatomy, histology, and abnormalities of the salivary glands? 1.450 1263 0.147 To what extent do you know about apththous ulcers? 1.091 1263 0.276 to which extent you observed difficulties in reading pathological slides? 2.305 1214 0.021 Based on your previous academic year, to what extent do you have knowledge about common premalignant lesions? 0.084 1257 0.933 To what extent do you know about TMJ disorder? 1.691 1263 0.044 to what extent do you know about oral manifestation of systemic diseases? 0.185 1263 0.853 To what extent do you know about oral mucosal abnormalities? 1.535 1263 0.125 Students’ knowledge in Oral and Maxillofacial surgery The result reveals that fresh students performed better in foundational areas such as knowledge of the histological concept of dental implants, the mechanism of bone remodeling after extraction as shown in Table 7. In contrast, older students demonstrated stronger knowledge in areas, including suturing techniques as demonstrated in Table 8. Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 8 Table 7. Scores of responses regarding the students’ knowledge in Oral and Maxillofacial Surgery. Questions Group Valid Mean Standard Deviation To what extent do you know the regional anatomy of the oral cavity? Fresh Students 731 1.914 0.804 Older Students 533 1.961 0.908 To what extent do you know about developmental anomalies that need surgical intervention? Fresh Students 731 1.885 0.945 Older Students 534 2.028 1.091 To what extent do you know about the mechanism of bone remodeling after extraction? Fresh Students 729 2.23 0.792 Older Students 534 2.092 0.875 To what extent do you know about grafting materials? Fresh Students 731 1.828 0.844 Older Students 533 1.816 0.813 To what extent do you know about histopathological correlation with clinical presentation in oral cysts? Fresh Students 731 2.34 0.681 Older Students 534 2.12 0.747 To what extent do you know about the number and distribution of roots before extraction? Fresh Students 730 2.136 0.767 Older Students 534 2.12 0.829 To what extent do you know about complications and delayed healing after extraction? Fresh Students 731 1.949 0.820 Older Students 534 2.131 0.852 To what extent do you know about suturing techniques and types of sutures? Fresh Students 730 2.036 0.773 Older Students 534 2.369 1.011 To what extent do you know about the histological concept of dental implants? Fresh Students 731 2.35 0.795 Older Students 534 2.067 0.810 To what extent do you know about the stages of healing following a surgical incision in the oral cavity? Fresh Students 731 2.314 0.756 Older Students 533 1.681 0.978 Table 8. Comparison the scores of responses of Oral and Maxillofacial Surgery. Questions t Degrees of freedom p To what extent do you know the regional anatomy of the oral cavity? -0.967 1262 0.334 To what extent do you know about developmental anomaly needed surgical intervention? -2.489 1263 0.013 To which extent do you know about grafting materials? 0.243 1262 0.808 To what extent do you know about the mechanism of bone remodeling after extraction? -0.288 1261 0.774 Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 9 To which extent do you know about the histological concept of dental implant? -10.023 1262 < .001 To what extent do you know about the stages of healing following a surgical incision in the oral cavity? -3.271 1263 0.001 " To what extent do you know about suturing techniques and types of sutures? -6.644 1262 < .001 To which extent do you know about Histopathological correlation with clinical presentation in oral cysts? -3.871 1263 < .001 To what extent do you know about the complications and delayed healing after extraction? -3.828 1263 < .001 To which extent do you know about number and distributions of toot before extraction? -4.494 1262 < .001 Discussion Students from various Iraqi colleges participated in this survey, which focused on their professional experience and the role of oral histology in clinical dentistry. These students had completed preclinical training and were actively engaged in clinical practice. Clinical-based education is a complex process where students apply the theoretical knowledge acquired during their preclinical studies to real patient cases. Since dentistry plays a crucial role in healthcare, improving the quality of clinical dental education is vital for enhancing overall oral and dental health in the population. Oral histology forms the basis for clinical dental science including main branches like: orthodontics, operative, oral medicine and oral and maxillofacial branch moreover other dental branches, the histology plays a crucial role in oral diagnosis and treatment planning. However, students often find oral histology challenging and perceive it as less significant for their future dental careers. Similar findings were observed by Johnson et al. (2015) [18] who compared the learning approaches of dental and medical students. The results of this study declares that in comparing the clinical and basic knowledge between two groups, younger scored higher in understanding structural changes in different studied branches such as the periodontal ligament, bone remodeling during orthodontic treatment and tooth eruption and shedding, enamel structure and cavity design in operative, distinguishing between tumors and cysts, reading pathological tissue slides, and understanding the anatomy and histology of the temporomandibular joint (TMJ) in oral medicine, while in oral and maxillofacial branch their responses indicated understanding of surgical interventions such as tooth extractions and dental implants. They also consistently recall histological, anatomical, and physiological fundamentals, linking clinical signs to the cysts and tumors that are seen in the maxillofacial surgery clinic at the college. This is finding supported by a previous study Naruishi et al. (2022) [19], when showed younger students often come into dental school with strong basic knowledge due to recent educational experiences. However, they may struggle to apply this knowledge effectively in clinical settings, which can affect their confidence and patient interactions. This foundational knowledge can be advantageous in theoretical assessments and initial learning phases. However, as they transition into clinical training, they may face challenges in applying this knowledge effectively in real- world scenarios. The lack of clinical experience can lead to reduced Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 10 cooperation and confidence when interacting with patients and performing procedures. Younger learners may not yet fully appreciate the clinical relevance of histological details, such as the importance of knowing the vascularization of the periosteum or how bone tissue reacts to extractions or implants. This may lead to a gap in their ability to relate histological knowledge directly to oral surgery. This finding is supported by a previous study [20], that reported that the unprepared for the hands-on aspects of surgical procedures, which can lead to anxiety and decreased self-confidence among young dental student. However, older students demonstrated superior knowledge in areas related to clinical requirement, in orthodontics they showed good understanding of maxillofacial development, orthodontic appliances developmental anomalies requiring orthodontic intervention and mixed dentition. Statistical analysis revealed significant differences, indicating that older students generally have stronger clinical knowledge, while younger students excel in certain basic concepts. The analysis of operative question scores shows that older, employed students exhibit a more advanced grasp of complex clinical issues like treating discolored teeth, pulpal responses to caries, and root canal anatomy. On other hand the results showed that there were significant differences in responses scores for distinguishing between tumors and cysts, reading pathological tissue slides, and understanding the anatomy and histology of the temporomandibular joint (TMJ) while the older student reported significant differences related to TMJ disorder. Students working in the healthcare sector excel in the clinical aspects of any surgical intervention in surgical department, as they often perform these procedures in their jobs, which grants them strong clinical skills. Older students likely benefit from more clinical exposure, allowing them to observe a wider range of cases, especially those related to maxillofacial development. Older students’ extensive clinical exposure helps them grasp the relationship between facial growth, dental development, and orthodontic outcomes. While younger students may excel in basic sciences, older students benefit from their additional clinical experience. This emphasizes the importance of integrating both theoretical knowledge and clinical practice in dental education to ensure a well- rounded learning experience. In Iraq, the laws and regulations allow individuals over the age of 18 to enroll in Iraqi dental colleges, provided they meet the high academic standards and mental qualifications required for admission, whether the institutions are governmental or private. Additionally, the regulations permit individuals up to the age of 28 to join these colleges, often those who are already employed in governmental or private positions. Such individuals are generally motivated by a passion for the profession. These roles offer them valuable hands-on experience in clinical procedures, patient care, and the operation of dental equipment. Supporting this, Agrawal’s et al. (2015) study [21] found that older students accumulate more clinical experience as they progress, which is crucial for applying orthodontic principles effectively. According to previous studies [22,23], most errors in root canal treatments were related to the obturation process. The study showed that Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 11 dental students were less skilled in performing root canal treatments, with many mistakes being made in contrast to cases managed by more experienced students at higher educational levels. Once more, various studies revealed that the change from preclinical to clinical dentistry education can be emotionally upsetting and stressful, which can result in less- than-optimal learning outcomes [24], diminished stimulus for learning [25] and, in the worst case, signs of anxiety and depression [26]. Building and maintaining motivation seems to be essential to averting poor outcomes, the older age students can overcome these situations due to large mentality and easier communication with seniors and patients [27,28]. The result determined that fifth-year students' lack of clinical proficiency was particularly noticeable in the clinical procedures; these issues are currently being resolved. The older group highly engagement with professors and experts tend to have greater interactions with professors and experts in the field, which enhances their understanding and knowledge in addition to clinical experience. In addition to that they may work in some institution that related to health care where they are often immersed in clinical practice and developing their skills in other branches that support the services of the Iraqi Ministry of Health and private clinics. Conclusion The results of this investigation demonstrate the various degrees of knowledge and clinical skills between younger and older dental students across various disciplines. Younger students tend to excel in basic concepts, in contrast, older students and those with clinical experience demonstrate a deeper understanding of complex clinical scenarios. Younger students often possess a strong foundation in oral histology and basic sciences, they may struggle to translate this knowledge into clinical practice, as seen in the challenges faced in operative and surgical procedures. To bridge this gap, dental education programs should aim to integrate both theoretical knowledge and clinical exposure throughout the curriculum. By doing so, students can develop a more comprehensive understanding of how oral histology informs clinical decision- making, which is critical for achieving proficiency in various dental specialties. Encouraging early clinical involvement while reinforcing basic science concepts can lead to a more well-rounded and confident dental workforce. A deficiency in the clinical competence of fifth-year students was particularly noted in the clinical procedures. Conflicts of Interest The authors state that there are no conflicts of interest. Financial Support None. Authors’ Contributions In this study, Salma Merza Hasan developed the questionnaire sections in partnership with the heads of different branches and distributed it to the majority of fifth-year representatives. Concurrently, Zainab A. Almashhadi gathered the data and performed the statistical analysis, and both contributed to writing the introduction, materials, and methods sections. Amjed F. Hussein and Heider Hemeed Abbas were responsible for drafting the results and discussion all the results of research . All participants consented to all aspects of the research. Assessment of Oral Histology Knowledge and Its Applica8on in Clinical Orthodon8cs, Opera8ve Den8stry, Oral Medicine, and Oral Surgery Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.749 12 References 1. Nanci, A. 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