Search Results (58)

Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth–pulp–periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic–periodontal concepts upstream to include caries initiation and restorative modulation. Full article

Objectives: Commercial artificial teeth (AT) and three-dimensional printed teeth (3DPT) have been increasingly used in preclinical endodontic education; however, limitations regarding anatomical realism, tactile sensation, and procedural simulation continued to be reported. This study assessed students’ and evaluators’ perceptions regarding AT and PolyJet™ 3DPT fabricated with RGD525™, compared with natural teeth (NT), together with the quality of endodontic procedures performed using both artificial models. Methods: Undergraduate dental students with no previous experience using AT or 3DPT performed standardized endodontic procedures on both artificial models. Students and evaluators completed questionnaires regarding anatomical realism, tactile sensation, radiographic characteristics, educational applicability, and model preference. Procedural quality and errors were independently assessed radiographically by evaluators. Results: AT received more favorable perceptions regarding external anatomy, whereas 3DPT were more positively evaluated for internal anatomy, radiopacity, resistance of root canal walls and tactile sensation during instrumentation (p ≤ 0.002). NT remained the preferred training model, followed by 3DPT, while AT received the lowest preference ratings (p < 0.001). Evaluators consistently perceived 3DPT as more similar to NT than AT. Regarding treatment outcomes, 3DPT showed significantly higher scores for endodontic preparation, verifier fitting, and root canal filling (p < 0.05), while presenting significantly fewer procedural errors than AT (p < 0.001). Conclusions: PolyJet™ 3DPT fabricated with RGD525™ demonstrated promising applicability for preclinical endodontic training, combining favorable perceptions, fewer procedural errors, and potential for low-cost large-scale in-house production. Nevertheless, improvements in material realism and tactile simulation are still required. Full article

Background: Full pulpotomy has gained increasing attention as a conservative treatment option for managing complicated crown fractures and pulp exposures in mature permanent teeth. However, little is known about how undergraduate dental students perceive this treatment approach and which factors influence their willingness to adopt it in clinical practice. Objective: This study aimed to evaluate undergraduate dental students’ knowledge, attitudes, and preferences regarding full pulpotomy and to identify factors associated with willingness to use full pulpotomy as a definitive treatment option. Materials and Methods: A cross-sectional questionnaire-based study was conducted among fourth- and fifth-year dental students. The questionnaire evaluated participants’ treatment preferences, perceived procedural difficulties, preferred pulp capping materials, attitudes toward rubber dam use, perceived barriers to full pulpotomy adoption, and willingness to use full pulpotomy as a definitive treatment. Associations between variables were assessed using chi-square tests and multivariable binary logistic regression analysis. Results: In total, 255 undergraduate dental students participated in the study. Spontaneous pain (69.4%), prolonged pain to heat (50.6%), percussion sensitivity (46.7%), and radiographic findings (43.9%) were the most frequently reported diagnostic criteria for symptomatic irreversible pulpitis. In the standardized clinical scenario, a pulpotomy-based approach was the most preferred treatment strategy (45.1%), followed by single-visit pulpectomy with obturation (28.6%) and pulpectomy with calcium hydroxide dressing (24.7%). MTA was the most preferred pulp capping material (57.3%), followed by Biodentin (12.9%) and calcium hydroxide (8.2%). Overall, 55.7% of participants reported willingness to use full pulpotomy as a definitive treatment option. Clinical year, previous exposure to pulpotomy cases, and confidence in bleeding control were independently associated with willingness to use full pulpotomy. Previous performance of pulpotomy procedures and attitude toward mandatory rubber dam use were independently associated with greater willingness to use full pulpotomy, whereas perceived barriers and uncertainty regarding implementation were negatively associated. Conclusions: In this single-center, questionnaire-based study, undergraduate dental students generally showed a positive attitude toward full pulpotomy; however, acceptance was strongly influenced by practical experience, confidence in procedural protocols, and perceived implementation barriers. These findings may help inform future educational strategies aimed at improving confidence and supporting evidence-based adoption of conservative pulp-preserving approaches. Full article

Introduction: Large language models (LLMs) are increasingly applied in healthcare, yet their diagnostic accuracy in endodontics remains underexplored. This study evaluated the performance of four chatbots—OpenAI GPT-4o, Microsoft Copilot, Google Gemini, and Gemini Advanced (GeminiA)—on endodontic case vignettes. Methods: Seven clinical cases from the American Association of Endodontists newsletter were presented to each chatbot at two time points (June–July 2024). Fifty-six responses were collected and independently scored by two board-certified endodontists. Diagnostic accuracy (pulpal, apical, and overall) was recorded as a binary outcome. Response quality was assessed using a modified Global Quality Score (mGQS, 5-point), reasoning accuracy (6-point), and completeness (3-point). Secondary outcomes included readability (Flesch–Kincaid grade level) and word count. Mixed-effects models evaluated differences among chatbots. Results: Overall diagnostic accuracy was 69.6% (39/56), with significant differences across chatbots (p = 0.006). GeminiA achieved the highest scores across all qualitative measures (mGQS 4.93 ± 0.27; reasoning 5.93 ± 0.27; completeness 3.0 ± 0.00). GPT-4o also demonstrated high performance (mGQS 4.71 ± 0.47; reasoning 5.64 ± 0.50; completeness 2.79 ± 0.43). Copilot consistently underperformed. Readability exceeded college level across chatbots, and word counts varied, with Copilot having the shortest and Gemini having the longest responses. Conclusions: In this exploratory study, advanced LLMs, particularly GeminiA and GPT-4o, outperformed Copilot and Gemini in endodontic diagnosis and reasoning quality. However, these findings should be interpreted with caution, given the limited number of cases and use of publicly available datasets that may have been included in model training. Further validation using larger, de novo case sets is warranted before these tools can be recommended as adjuncts for education or clinical decision support. Clinical significance: Large language model chatbots show promise as adjunctive tools for endodontic diagnosis. Understanding their strengths and limitations may help clinicians and students critically interpret AI-generated recommendations and support clinical decision-making. Full article

Objectives: Oral healthcare and regular dental follow-up are important during pregnancy, as maternal oral health may have important implications for both maternal and fetal well-being. However, dental attendance remains low. Therefore, this cross-sectional e-survey aimed to explore pregnant women’s dental pain management strategies, their perceptions of endodontic treatment, and avoidance of specific endodontic procedures during pregnancy. Methods: An 18-item online questionnaire was administered to 130 pregnant women. Data were collected on dental attendance, experiences of toothache, use of analgesics or antibiotics, and perceptions of the safety of dental anesthesia and radiographic procedures during pregnancy. Statistical analyses were conducted using Chi-square or Fisher’s exact tests and multivariate logistic regression (p < 0.05). Results: The mean age of participants was 32 years. Only 26.15% reported attending regular dental visits during pregnancy. Among participants who experienced toothache, 51.52% used analgesics and 1.54% used antibiotics. Although 92.31% believed dental infections should be treated during pregnancy, concerns regarding dental procedures were common; 76.92% considered dental radiography unsafe and only 50% considered local anesthesia safe. Multivariate analysis showed that the number of pregnancies was associated with dental visits during pregnancy (p = 0.048), age with analgesic use (p = 0.018), and education level with perception of dental radiography safety (p = 0.013). Conclusions: Despite awareness of the importance of treating dental infections, pregnant women may delay endodontic care during pregnancy, highlighting a need for improved patient education and clearer clinical guidance. Full article

Background: Haptic virtual simulators are increasingly incorporated into dental education, yet it remains unclear whether the sequence of simulation-based and natural-tooth training influences early endodontic skill acquisition. Objective: The objective of this study was to compare the effect of two training sequences—haptic simulation followed by natural-teeth practice, versus natural-teeth practice followed by haptic simulation—on performance in endodontic access cavity preparation among undergraduate dental students. Methods: Thirty-eight third-year dental students were randomly assigned to two groups. All participants completed three consecutive attempts on a haptic simulator (Simodont^®) and one access cavity preparation on extracted mandibular incisors. Simulator metrics included progress, precision, target volume removed, and excess volume removed. Natural-tooth preparations were scored by two blinded endodontists (ICC range = 0.75–0.88). Data were analyzed using Mann–Whitney U tests with Holm correction, Wilcoxon signed-rank tests, and a linear mixed-effects model to characterize learning trajectories. Results: No significant between-group differences were found in any simulator metric (Holm-adjusted p = 0.47–0.62; effect sizes r = 0.12–0.20, 95% CI −0.14 to 0.43) or in natural-tooth performance (all Bonferroni-adjusted p = 1.00). Students demonstrated significant improvement between the first and second simulator attempts (p < 0.05), with a clear learning plateau thereafter. Mixed-effects modelling confirmed significant overall improvement across attempts (p < 0.001), with no effect of training sequence or attempt × group interaction. Conclusions: Training sequence did not influence learning outcomes or final clinical-quality access preparations. Early performance gains suggest a rapid familiarization effect, and both modalities provide complementary—but non-hierarchical—learning affordances. Haptic simulation can therefore be integrated flexibly within preclinical endodontic curricula without compromising educational effectiveness. Full article

The OHI demonstrated moderate internal consistency and consistent associations with oral health-related quality of life and cardiovascular risk indicators. Objective: The primary objective was to propose and internally assess an Oral Health Index (OHI) which integrates multiple clinically assessed oral health variables. The secondary objective was to investigate its association with oral health-related quality of life (OHRQoL) and common clinical cardiovascular risk (CVR) factors. Material and Methods: This observational study included 191 participants. Seven parameters (tooth loss, periodontal disease, endodontic involvement, residual roots, extractions due to periodontitis, inflammatory oral mucosal diseases, and dental maintenance and rehabilitation status) were combined using Z-scores to compute the OHI, with higher scores indicating poorer oral health. CVR factors included age/sex thresholds, education level, BMI, smoking status, diabetes, hypertension, pulse pressure, and lung function. OHRQoL was assessed using the Oral Health Impact Profile. Results: Higher OHI scores were associated with poor oral health-related quality of life. Participants with cardiovascular risk factors had significantly higher OHI scores. The analysis demonstrated that the OHI was directly associated with worse oral health-related quality of life and a greater cardiovascular risk burden, independent of age, sex, and comorbidities. Conclusions: This study proposed and internally assessed the Oral Health Index, designed to integrate multiple clinical parameters into a single standardized measure of oral health. The OHI demonstrated moderate internal consistency and showed consistent associations with poorer oral health conditions, reduced oral health-related quality of life, and a greater cardiovascular risk burden. Full article

Objective. To evaluate the prevalence, risk factors, aetiology, and management of traumatic dental injuries (TDIs) among children aged 1–18 years attending the Department of Pediatric Dentistry, Damascus University, Syria, during 2023–2024, and to illustrate representative clinical cases with documented outcomes. Methods. This retrospective cross-sectional study reviewed 2716 patient records (2023–2024) and identified 301 children with TDIs. Demographic, clinical, and behavioural variables were extracted and analysed using χ², t tests, ANOVA, and binary logistic regression (IBM SPSS v26). Results. The overall TDI prevalence was 11.08%. Males were over twice as likely as females to experience TDIs (OR = 2.30; 95% CI = 1.76–3.01; p < 0.001). Older age acted as a protective factor (OR = 0.56; 95% CI = 0.43–0.74; p < 0.001). Falls were the most common cause (63.7%), and injuries most often occurred at home (48.9%). The maxillary central incisors were most frequently affected (68.5% of cases). Children with special healthcare needs had significantly more traumatised teeth (mean = 2.61 ± 1.13) than healthy children (1.66 ± 0.92; p < 0.001). Nearly half of the patients (45.3%) presented > one month after injury, and asymptomatic apical periodontitis and reversible pulpitis were the most frequent diagnoses. Representative case presentations demonstrated multidisciplinary management using restorative, endodontic, and orthodontic approaches with favourable follow-up outcomes. Conclusions. TDIs affected about one in nine children in this Syrian cohort. Male gender, younger age, and previous trauma were key risk factors. The predominance of delayed presentation underscores the need for community education, early referral systems, and targeted preventive programs within school and home environments. Full article

Background/Objectives: Endodontic treatment quality can be graded from A to D according to international standards. This study aimed to evaluate radiographic treatment success of high-standard endodontic treatments (Grade A). A secondary aim was to assess the students’ self-perceived assessment of case difficulty. Methods: A retrospective analysis was conducted on root canal treatments (RCTs) performed by undergraduate students at the University of Bergen between January 2012 and December 2014. Data related to endodontic treatments graded as A, along with a postoperative self-perceived assessment of case difficulty, were extracted from patient records. Statistical analysis was performed with a significance level set at p ≤ 0.05. Results: Out of 1149 RCTs, 462 (40.2%) were classified as Grade A. Among these, 350 teeth had at least one recall after one year. Out of the 350 teeth, 312 were successful (89.2%), 6 (1.7%) were failures and 32 (9.1%) were extracted due to factors unrelated to endodontic infection. After exclusion or inclusion of extracted teeth, the success rate was 98.1% and tooth survival 90.9%. Patients under 56 years of age, and teeth with indirect coronal restorations, had significantly better tooth survival. Students significantly underestimated case difficulty (p < 0.01). Conclusions: High-standard endodontic treatments can achieve a high success rate. Self-assessment of endodontic treatment and accurate assessment of case difficulty using relevant tools serves as an important educational aid, potentially contributing to enhanced knowledge and improved clinical decision-making. Full article

Background/Objectives: The objective of this study was to investigate current endodontic practice patterns and the adoption of newer technologies among dentists, endodontic specialists, and postgraduate students in Spain and Latin America. Methods: A cross-sectional survey was conducted using a structured 30-item questionnaire covering demographics, training, technology adoption (NiTi instrumentation, magnification, CBCT, irrigation adjuncts, bioceramic sealers), obturation techniques, irrigant selection, and clinical procedures. The survey was distributed through a professional Instagram account and WhatsApp groups of dentists, specialists, and postgraduate students. Participation was voluntary, anonymous, and restricted to qualified professionals. Data were collected via Google Forms, cleaned, and grouped into Spain, Mexico, Venezuela, Colombia, Southern Cone & Andes (Argentina, Chile, Peru, Ecuador, Bolivia), and other countries. Descriptive statistics were calculated, and intergroup comparisons were performed using Chi-square or Fisher’s exact tests with Bonferroni correction (p < 0.05). Multiple regression analyses were performed. Results: A total of 1358 valid responses were analyzed, distributed as follows: Spain (219), Mexico (353), Venezuela (162), Colombia (108), Southern Cone & Andes (260), and other countries (256). Most respondents (62.8%) had ≤10 years of experience, and 61.2% reported postgraduate training. Loupes (55.4%) were the most frequent magnification system, followed by microscopes (18.6%). Sodium hypochlorite (98.3%) was the irrigant of choice, commonly used with EDTA (83.5%) and, to a lesser extent, chlorhexidine (33.4%). Sonic (83.2%) and ultrasonic (52.9%) activation were frequent. Bioceramic sealers were used by 18.9%, while calcium hydroxide medication was applied by 37.4%. Specialists and master-level clinicians showed greater use of rotary NiTi systems, CBCT, magnification, and bioceramic sealers, whereas general practitioners relied more on manual instrumentation and single-cone obturation. Success was mainly verified by combined clinical and radiographic evaluation (86.7%). Spain demonstrated higher adoption of microscopes, warm vertical compaction, and CBCT. Conclusions: Core practices such as sodium hypochlorite irrigation and rubber dam use were widespread, while advanced technologies and irrigant protocols varied with training level and region. Continuous education remains essential to promote evidence-based practice and reduce disparities in endodontic innovation. Full article

Background: This ambispective study evaluated the prognostic factors for long-term survival and success of endodontically treated teeth (ETT) in patients treated at an educational hospital. Methods: Patients who received root canal treatment (RCT) at Princess Nourah bint Abdulrahman University (2018–2023) were included if the following criteria were met: follow-up time of a minimum of 12 months was available, and clear pre- and post-treatment periapical radiographs. Two calibrated examiners assessed RCT quality along with pre-treatment and follow-up periapical index (PAI) scores. Coronal restorations were evaluated for quality, type, and timing. Data on oral hygiene, smoking, systemic health, periodontal status, and occlusal factors were collected. Tooth survival was defined as a functional, asymptomatic tooth, while success required a clinically asymptomatic tooth with a PAI score ≤ 2. Multivariate regression analysis was performed to assess the influence of the collected variables on tooth survival and success. Statistical significance was set at p < 0.05. Results: A total of 461 ETT from 242 patients were analyzed. The survival rate was 89%, while 81% met the treatment success criteria. Most patients were female (65%), and only 8.9% had a healthy periodontium. Multivariate analysis identified preoperative PAI score, obturation density, and coronal restoration quality as significant predictors of survival and success (Nagelkerke R² = 0.338). Conclusions: ETT demonstrated high survival and success rates. Preoperative PAI score, obturation density, and coronal restoration quality were key predictors of long-term treatment outcomes, highlighting the importance of comprehensive pre-treatment assessment and high-quality endodontic and restorative procedures. Full article

Background: Timely dental care is essential to prevent complications and preserve natural teeth, yet inefficient referral practices, low reimbursement rates and systemic barriers continue to disproportionately affect Medicaid-enrolled children. This study assessed the appropriateness of root canal therapy (RCT) referrals to a University-based Advanced Education in General Dentistry (AEGD) program and examined diagnostic and treatment characteristics of referred cases. Methods: A retrospective review was conducted of pediatric patients aged 6–17 years who were referred by external dental providers to two AEGD clinics in Nevada, United States, between February and August 2024 for endodontic evaluation of carious permanent teeth. Demographic, tooth-type, pulp-status, and treatment outcome data were analyzed using descriptive statistics, chi-square tests, Kruskal–Wallis comparisons, and multivariable logistic regression models. Results: Among 154 referred patients, 96.8% (n = 149) were Medicaid beneficiaries. A total of 247 teeth were evaluated; 74.1% were molars. Pulp testing showed that 41.3% had healthy pulps and 16.6% had reversible pulpitis, while only 37.2% of teeth required RCT. Age differed significantly across pulp diagnoses (p = 0.0012), and older age independently predicted appropriate referral (adjusted OR = 1.18, 95% CI 1.07–1.31). Gender was not associated with follow-up compliance (p = 0.47). By November 2024, 53.4% of referred teeth had completed treatment, and 9.3% had no follow-up. Conclusions: More than half of the referral teeth did not require RCT, indicating a high rate of potentially avoidable referrals and highlighting gaps in diagnostic confidence and decision-making at the primary care level. Practical Implications: Enhancing diagnostic training and decision support for general dentists, particularly in vital pulp therapy for young permanent teeth, along with improving Medicaid reimbursement and standardizing referral protocols, may reduce inappropriate specialty referrals. In combination with broader policy reforms, these measures can improve system efficiency and expand access to timely, equitable pediatric dental care. Full article

Background/Objectives: Artificial intelligence (AI) is entering dental curricula, yet its educational value in endodontics remains unclear. This review synthesized student-based evidence on AI in endodontics, primarily comparing AI vs. students on diagnostic tasks as an educational endpoint and secondarily considering assessment tasks relevant to training. Methods: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched in July 2025. Eligible studies involved dental students using AI in endodontic tasks or applied AI to student-generated outputs. For diagnostic comparisons we performed random-effects meta-analysis and a complementary Bayesian random-effects model with weakly informative priors. Risk of bias used QUADAS-2; certainty used GRADE. Results: Five studies met inclusion. Two provided complete mean–SD data for the primary meta-analysis and one contributed to a sensitivity model after SD imputation; two were summarized narratively (AUC/F1 only). Pooled effects favored AI: Hedges g = 1.48 (95% CI 0.60–2.36; I² ≈ 84%); sensitivity (k = 3) g = 1.45 (95% CI 0.77–2.14; I² ≈ 77%). Across the two LLM studies with analyzable means/SDs, the pooled mean difference in accuracy was approximately +20 percentage points (AI − students). Bayesian analyses yielded posterior means near 1.5 with 95% credible intervals excluding 0 and P (μ > 0) ≈ 1.00. Educational outcomes were sparsely and non-standardly reported. Conclusions: Student-based evidence indicates that AI likely outperforms dental students on endodontic diagnostic tasks, supporting its use as an adjunct for formative tutoring, objective feedback, and more consistent assessment. Full article

Objectives: The aim of this study was to compare the responses of large language models (LLMs)—DeepSeek V3, GPT 5, and Gemini 2.5 Flash—to patients’ frequently asked questions (FAQs) regarding root canal treatment in terms of accuracy and comprehensiveness, and to assess the potential roles of these models in patient education and health literacy. Methods: A total of 37 open-ended FAQs, compiled from American Association of Endodontists (AAE) patient education materials and online resources, were presented to three LLMs. Responses were evaluated by expert clinicians on a 5-point Likert scale for accuracy and comprehensiveness. Inter-rater and test–retest reliability were assessed using intraclass correlation coefficients (ICCs). Differences among models were analyzed with the Kruskal–Wallis H test, followed by pairwise Mann–Whitney U tests with effect sizes (Cliff’s delta, δ). A p-value < 0.05 was considered statistically significant. Results: Inter-rater agreement was excellent, with ICCs of 0.92 for accuracy and 0.91 for comprehensiveness. Test–retest reliability also demonstrated high consistency (ICCs of 0.90 for accuracy and 0.89 for comprehensiveness). DeepSeek V3 achieved the highest scores, with a mean accuracy of 4.81 ± 0.39 and a mean comprehensiveness of 4.78 ± 0.41, demonstrating statistically superior performance compared to GPT 5 (accuracy 4.0 ± 0.0; comprehensiveness 4.05 ± 0.4; p < 0.05, δ = 0.81 for accuracy, δ = 0.69 for comprehensiveness) and Gemini 2.5 Flash (accuracy 3.83 ± 0.68; comprehensiveness 3.81 ± 0.7; p < 0.05, δ = 0.71 for accuracy, δ = 0.70 for comprehensiveness). No significant difference was observed between GPT 5 and Gemini 2.5 Flash for either accuracy (p = 0.109, δ = 0.16) or comprehensiveness (p = 0.058, δ = 0.21). Conclusions: LLMs, such as DeepSeek V3, which can provide satisfactory responses to FAQs may serve as valuable supportive tools in patient education and health literacy; however, expert clinician oversight remains essential in clinical decision-making and treatment planning. When used appropriately, LLMs can enhance patient awareness and support satisfaction throughout the root canal treatment. Full article

Background/Objectives: Dental neglect represents a preventable form of child maltreatment that may lead to significant oral and systemic health complications. This study primarily aimed to investigate the main oral manifestations and determinants of dental neglect in a pediatric population from Bihor County, Romania. Additionally, it assessed the association between systemic factors, such as nutritional status and psychological conditions, and the severity of oro-dental lesions, with the goal of informing future preventive strategies and public health interventions. Methods: A retrospective analysis was conducted on 333 pediatric patients diagnosed with dental neglect. Clinical data were collected from two centers between 2020 and 2024. Oral health status, socio-demographic characteristics, and psychological conditions were evaluated. Statistical analyses included Fisher’s Exact Test, Mann–Whitney U Test, and Bonferroni-adjusted Z-tests, with significance set at p ≤ 0.05. Results: Among the 333 participants, 52.9% were male, with a mean age of 8.75 ± 3.29 years. Most children (81.7%) resided in rural areas, and 55.6% were first-born. Carious lesions were identified in 100% of cases, with 54.7% showing complications such as endodontic pathology. Poor oral hygiene was reported in 99.1% of children, while 58.6% presented signs of periodontal disease and 37.2% reported spontaneous gingival bleeding. Acute pain was experienced by 40.2% of participants. Nutritional issues were prevalent, with 24.3% classified as obese and 21.6% as malnourished. Significant associations were found between lesion severity and both psychological disorders (p < 0.001) and malnutrition (p < 0.001). Conclusions: This study identifies untreated carious lesions, poor oral hygiene, acute dental pain, and oro-dental trauma as key clinical indicators of pediatric dental neglect, with rural residency and limited education as significant socio-demographic risk factors. The findings highlight the urgent need for integrated, community-based strategies, including school-based screenings, parental education, and referral pathways, to improve early detection and prevention in Romania. Full article