Search Results (267)

Objective: This study aims to provide a global landscape of research into oral hygiene products with antimicrobial or microbiome-modulating activity through a comprehensive bibliometric analysis to identify trends and hotspots that may influence future research frontiers. Methods: A structured bibliographic search was conducted within the Web of Science Core Collection database from 2006 to 2025. Manual screening was performed to exclude duplicate records, studies that did not align with the core topic, and those failing to meet the predefined inclusion criteria. Bibliometric and visual analyses were performed using VOSviewer, CiteSpace, and the R package ‘bibliometrix’ to evaluate production metrics, citation networks, and multi-level collaboration patterns. Results: The analysis included 1007 publications. Sreenivasan PK was the most productive author, and Lundberg JO was the most cited. The United States, followed by India, Brazil, and China, led global research volume, while the United Kingdom and the Netherlands led in total citations. The International Journal of Dental Hygiene was the most productive journal (n = 48), and the Journal of Dentistry was the most cited (n = 1356). Burgeoning research hotspots include the impact of mouthwashes on the oral microbiome and systemic disorders, the controlled clinical use of chlorhexidine, and alternative formulations incorporating probiotics, herbal extracts, or hyaluronic acid. Conclusions: This study underscores a global shift in dental research priorities from traditional bacterial elimination toward preserving oral microbiota eubiosis. While chlorhexidine remains a subject of research due to its widespread use for therapeutic benefits, bibliometric research highlights its potential systemic consequences as a hotspot. Therefore, future research should focus on innovative antimicrobial formulations for mouthwashes and toothpastes that maintain oral health without causing dysbiosis. Full article

To assess the prevalence of molar–incisor hypomineralization (MIH) and identify the associated factors in Brazilian schoolchildren, a representative cross-sectional study was conducted Diamantina, Brazil, with a random sample of 316 (80.8% response rate) children aged 7 to 10 from public and private schools. The presence of MIH was assessed according to the criteria of the European Academy of Pediatric Dentistry (EAPD). Sociodemographic data and data related to the prenatal, perinatal, and postnatal periods, as well as child health, were obtained through a questionnaire sent to caregivers. Descriptive analyses and adjusted and unadjusted Poisson regression were performed, accounting for the sample weights, using Stata software (version 16.1). The prevalence of MIH was 21.2%. The adjusted model showed that children admitted to the neonatal intensive care unit (NICU) were 2.28 times more likely to have MIH (95% CI: 1.34–3.90). The present study identified a high prevalence of MIH among children aged 7 to 10 years in Brazilian schoolchildren. Children who were admitted to the NICU had a higher prevalence of MIH than those who did not. Given the cross-sectional design, study sample and regional context, these findings should be interpreted as associations rather than evidence of causal relationships. Full article

Background/Objectives: Dental trauma is recognized as a global public health problem due to its prevalence and psychosocial consequences. This study aimed to verify the prevalence of traumatic dental injuries in practitioners of combat sports and whether they were associated with sociodemographic and sports variables in a capital city in southeastern Brazil. Methods: This cross-sectional observational study included 284 athletes over 18 years of age from 17 academies that offered combat sports. Data collection was performed by a single examiner through individual interviews and a questionnaire addressing sociodemographic profile, access to oral health services, sport modality, experience with dental trauma during combat sports, mouthguard use, and guidance on dental injuries. Descriptive analyses, frequency tables, the Chi-square test (p < 0.05), and Odds Ratio were used. Results: Most participants were male (n = 203; 71.48%), aged up to 25 years (n = 75; 26.41%). The most practiced sports were Jiu-Jitsu (n = 79; 27.82%) and Kickboxing (n = 77; 27.11%). Among participants who suffered dental trauma (n = 19; 6.69%), single episodes predominated (n = 9; 47.37%), enamel fractures were most frequent (n = 7; 36.84%), and anterior teeth were the most affected (n = 9; 47.36%). Most were not using a mouthguard at the time of trauma (n = 15; 78.95%), although they considered mouthguard use important (n = 229; 80.63%), and most had not received guidance on dental trauma (n = 237; 83.45%). Age group was significantly associated with dental trauma (p = 0.016; OR = 3.33; 95% CI: 1.167–9.524). Conclusions: The prevalence of dental trauma among fighters was low. Mouthguard adherence was inconsistent, post-trauma management was inadequate, and most respondents had never received guidance on dental trauma. Public health policies should strengthen awareness and prevention of dental injuries in sports. Full article

Background/Objectives: One of the most common oral surgery procedures performed in dentistry is the removal of third molar teeth (3M). Complications of both retention and removal of third molars are associated with potentially preventable hospitalisations (PPH). This study aims to systematically review the published literature to identify demographics, aetiology, incidence, associated factors, length of hospital stay (LOS) and variables influencing the outcomes of PPH arising from 3M. Methods: An electronic literature search was performed using Medline and Embase via Ovid in May 2024, and relevant studies were analysed for demographics, aetiology, incidence, related factors and LOS associated with PPH resulting from 3M. Results: Nineteen publications with sample sizes ranging from 37 to 3549 patients per study were identified. Two studies reported 101 patients described PPH specifically related to 3M. The remaining 17 studies described 6153 oral health-related PPH, predominantly arising from broader odontogenic infection cohorts, of which 1654 (26.9%) PPH were associated with 3M. The mandibular 3M was implicated in 98.5% of 3M-related PPH. Pericoronitis and postoperative infections following 3M removal were reported as the leading causes of hospitalisation, whereas data on dental caries were not reported. Similarly, most studies did not report detailed information on demographics, aetiology, or outcomes specific to third molars. Conclusions: Available indirect data shows that 3M-related dental infections, including post operative infections, contribute to oral health-related PPH. There are significant evidence gaps in third molar-specific PPH data. Further studies with standardised reporting focusing on third molar-related hospitalisations are required to identify factors influencing clinical outcomes and to inform evidence-based clinical decision-making regarding the removal or retention of third molars. Full article

Background: Oral cancer remains a major global health concern, with increasing incidence and mortality, especially in developing countries. Public awareness is crucial for early detection and improved outcomes. Objective: To assess oral cancer awareness, recognition of risk factors and early signs, screening behavior, and care-seeking preferences among patients attending a university dental hospital in Türkiye. Methods: This cross-sectional, facility-based survey included 1360 volunteer patients who attended the Faculty of Dentistry between January and December 2025. Consecutive sampling was used to include all eligible and consenting individuals. A structured questionnaire assessed participants’ sociodemographic characteristics, oral cancer awareness, knowledge of symptoms and risk factors, screening history, and lifestyle habits. Data were analyzed using IBM SPSS Statistics 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed. Statistical significance was set at p < 0.05. Main outcomes and measures: The primary outcome was oral cancer awareness (measured by the question “Have you ever heard of oral cancer?”). Secondary outcomes included knowledge of risk factors and early clinical signs, screening history, preferred healthcare contact for suspected oral cancer, and lifestyle factors (tobacco and alcohol). Associations between sociodemographic variables and oral cancer awareness were also evaluated. Results: The sample consisted of 1360 participants (56.4% female; mean age: 33.44 ± 14.60 years; range: 18–70). Of the 1377 questionnaires collected, 1360 were complete and included in the final analysis (questionnaire completion rate: 98.8%). Breast cancer was the most recognized cancer (96.9%), whereas only 50.8% of participants had heard of oral cancer. Dentists (39.4%) were the primary source of information. Tobacco use (92.2%) and alcohol consumption (80.3%) were the most frequently identified risk factors, whereas only 58.3% recognized human papillomavirus as a risk factor for oral cancer. In univariate analyses, oral cancer awareness was significantly associated with age, marital status, education level, monthly income, occupation, alcohol use, and the timing of the most recent dental visit (p < 0.05). In multivariable logistic regression, undergraduate education (OR = 2.008, 95% CI: 1.135–3.553), higher monthly income (>100,000 TRY vs. <25,000 TRY, OR = 2.398, 95% CI: 1.571–3.658), alcohol use (OR = 1.521, 95% CI: 1.082–2.139), and a dental visit within the previous year (OR = 4.130, 95% CI: 1.590–10.730) remained independently associated with oral cancer awareness. Conclusions: Oral cancer awareness in this study population was limited. The findings suggest that targeted educational strategies may be beneficial for improving oral cancer awareness. Strengthening dentists’ preventive role and promoting education through social media may help improve oral cancer awareness and facilitate earlier detection. Full article

Background: In Romania, data regarding the oral health of infants and toddlers is scarce. This study aimed to analyze the reasons for the first dental visit among children aged 3 or under and to assess their oral health status and the therapeutic methods applied. Methods: A retrospective cross-sectional study was conducted on 602 children (339 boys and 263 girls), aged ≤ 3 years, who were referred for their first dental visit to the Pediatric Dentistry Department, Faculty of Dentistry, Carol Davila University, Bucharest, Romania. Results: The main reasons for referral were routine check-up (28.23%), asymptomatic carious lesions (21.92%), abscess or swelling (18.43%), and dental trauma (14.78%). Caries was diagnosed in 344 children; 23 (6.68%) had only non-cavitated lesions, 157 (45.64%) had uncomplicated cavitated lesions, and 174 (50.58%) already had complicated caries. Mean values of caries experience indices were significantly higher in rural children (dmf-t = 4.33 ± 4.13; dmf-s = 9.16 ± 11.34) than in urban children (dmf-t = 2.67 ± 3.61; dmf-s = 5.62 ± 8.86) (p = 0.000). The most frequent treatments were routine check-up with oral hygiene and dietary instructions (55.31%), pulp treatments (19.91%), and restorative procedures (15.1%). Conclusions: Many infants and toddlers were referred later than the recommended age and required therapeutic rather than preventive care. More than half had carious lesions, and many of those were already complicated. Significant disparities were observed between rural and urban children from this study group. Targeted public health initiatives are needed to improve early access to dental care. Full article

Pediatric dental diseases, notably dental caries, malocclusion, and dental trauma, remain a significant public health challenge in China, exerting considerable impact on children’s oral and general health. Despite growing societal demand for pediatric dental care, China faces a critical shortage and uneven geographic distribution of pediatric dentists, alongside persistent urban–rural disparities in access to oral health services. These challenges underscore the urgent need for educational reforms, workforce policy adjustments, and assessment of the strengths and limitations of recent training initiatives to enhance pediatric dental service delivery. This narrative review aims to: (I) describe the current structure of pediatric dental education in China and recent reforms, notably the integration of degree education with standardized residency training; (II) summarize the epidemiological burden of dental diseases among Chinese children, together with contributing social and geographic factors; (III) outline national policy initiatives targeting children’s oral health and existing gaps in implementation; and (IV) discuss innovations in dental education, including student-centered pedagogies and humanities integration. This review provides a comprehensive overview of pediatric dentistry in China and offers strategic recommendations to strengthen workforce training, expand service access, and reduce the burden of pediatric oral diseases. Full article

The era of highly effective pre-exposure prophylaxis (PrEP) has transformed HIV prevention, yet global HIV incidence remains unacceptably high, particularly in sub-Saharan Africa. While antiretroviral-based prevention is critical, persistent structural barriers to access and adherence highlight the urgent need for a complementary preventive HIV vaccine. In this narrative review and perspective, we argue that scientific progress toward an HIV vaccine must be matched by equally ambitious preparedness investments across three domains: manufacturing and supply chains, clinical trial and regulatory infrastructure, and delivery systems and community engagement. Drawing on lessons from the global rollout of PrEP, post-exposure prophylaxis (PEP), and the COVID-19 pandemic response, we outline a five-pillar strategic roadmap. This roadmap focuses on ensuring that a future HIV vaccine reaches the people who need it most from the moment of regulatory authorization, calling for co-investment in diverse platforms, binding advance market commitments, logistical simulation, and proactive planning for post-licensure effectiveness trials. Preparedness is not secondary to science; it is its essential partner. Full article

Background: Periodontal diseases continue to be highly prevalent worldwide, and their early detection represents a clinical challenge, especially when based on non-standardized intraoral photographs. The present study develops an artificial intelligence-based prototype for the automatic classification of periodontal health, gingivitis, and periodontitis using Red, Green, Blue (RGB) images obtained in real conditions. Methods: A dataset comprising 1552 (306 healthy, 1019 with gingivitis, and 227 with periodontitis) was constructed by integrating proprietary clinical photographs with a public repository. A patient-level stratified split was enforced to prevent data leakage, ensuring that all images from the same patient remained within a single partition. This proposal uses EfficientNet-B2, which includes two-phase training, balanced focal loss, weighted sampling, CutMix/MixUp augmentation, and centered anatomical cropping to improve generalization across varied images. Results: The final model achieved an accuracy of 0.833, a macro F1-score (F1) of 0.832 [95% CI: 0.789–0.874], and a macro Area Under the Curve (AUC) of 0.962 [95% CI: 0.946–0.976] on an independent test set. A seven-configuration ablation study showed that each training component contributes to improved performance, and a baseline comparison with ResNet-50 demonstrated the superiority of EfficientNet-B2. Five-fold cross-validation with patient-level grouping yielded consistent results (F1 = 0.832 ± 0.016, AUC = 0.950 ± 0.005). Conclusions: These results demonstrate that EfficientNet-B2 is useful for assessing periodontal health using readily available RGB photographs, with potential for early detection, clinical triage, and remote assessment in modern dentistry. Full article

Background/Objectives: Large language models have created new pathways for patients to access health information, yet little is known about how the general population uses these conversational artificial intelligence (AI) tools for oral health concerns. This study investigated patterns of AI use as a source of oral health information, the nature of data shared with these systems, users’ perceptions, and the impact on dental care-seeking behavior. Methods: A cross-sectional study was conducted among adults from Bihor County, Romania, using a structured 16-item online questionnaire distributed via social media, with eligibility restricted to individuals who had previously used conversational AI for oral health information. The final sample comprised 393 valid responses from this self-selected group of users. Fisher’s exact test and Z-tests with Bonferroni correction were applied (α = 0.05). Results: Most participants were female (68.2%), university-educated (52.9%), and lived in an urban setting (88.3%). Significant differences in patterns of AI use for oral health information were identified according to age, sex, and living environment (p < 0.001). Younger participants used AI more frequently, while older individuals perceived the information as less clear. The vast majority used AI for informational or preliminary guidance purposes, with very few treating it as a substitute for professional opinion. A relevant subset shared visual data (intraoral photographs or radiographs) with AI systems, raising data privacy concerns. Rural participants more frequently delayed dental visits and less often discussed AI-derived information with their dentist compared to urban participants. Conclusions: When used by the public as a source of oral health information, AI is increasingly adopted, with adoption shaped by age, sex, and socioeconomic context. These findings concern only this informational use and do not extend to other applications of AI in dentistry, such as diagnostic support, image analysis, or clinical decision-making. Dental professionals should proactively engage patients about their use of AI for oral health information to ensure that digitally obtained content is appropriately contextualized. Full article

Background: Tooth enamel is the hardest and most highly mineralized tissue in the human body. It serves as a protective barrier against chemical, mechanical, and microbial challenges. Despite its durability, enamel remains vulnerable to developmental and posteruptive defects such as fluorosis, hypomineralization, and amelogenesis imperfecta (AI). For oral health professionals, a clear understanding of the biological and molecular mechanisms underlying enamel formation is essential for advancing preventive and therapeutic strategies in clinical practice. This review synthesizes current knowledge on enamel formation, with emphasis on its cellular, molecular, and structural determinants, and discusses clinically relevant disruptions as well as emerging biomimetic approaches. Methods: This scoping review was conducted according to the PRISMA-ScR guidelines. A systematic literature search of the mechanisms of enamel formation was performed via Embase and Medline. Titles and abstracts were screened independently by three authors. Studies that primarily addressed enamel defects were excluded from the systematic synthesis; however, these studies were retained for narrative discussion. Following the screening process, 92 publications met the inclusion criteria and were incorporated into the thematic synthesis. Results: Enamel formation is a complex, multistage process involving epithelial–mesenchymal interactions and the sequential activity of ameloblasts during presecretory, secretory, transition, and maturation stages. Key mechanisms include the secretion of enamel matrix proteins (e.g., amelogenin, ameloblastin, and enamelin), proteolytic processing by enzymes such as MMP20 and KLK4, and controlled ion transport, leading to hydroxyapatite crystal growth and organization into rod and interrod structures. The structural arrangement endows enamel with exceptional mechanical resistance. Narrative sections address “What can go wrong?”, summarizing genetic, epigenetic, and environmental causes of fluorosis, hypomineralization, and amelogenesis imperfecta, and other developmental defects, whereas “What can we learn from nature?” highlights biomimetic strategies. Conclusions: Human enamel formation is a highly coordinated biomineralization process regulated at the cellular, structural, and molecular levels. Disruptions in these processes underlie major enamel pathologies. Integrating mechanistic insights from natural enamel development with emerging biomimetic technologies offers promising avenues for prevention, diagnosis, and treatment in dentistry. This review provides oral health professionals with a biologically grounded framework to guide evidence-based management of enamel-related conditions. Full article

Background/Objectives: Private dental markets operating under fee-for-service arrangements lack the structural accountability mechanisms that typically drive quality governance adoption in publicly funded systems. In Romania, where no private dental office currently holds formal accreditation, accreditation-seeking reflects a genuine behavioral choice rather than a regulatory compliance. This study examined whether financing structure and Professional Governance behavior operate as distinct determinants of accreditation-seeking intention among private dental practitioners and which pathway offers a more tractable entry point for quality policy intervention. Methods: A cross-sectional survey was conducted among 98 licensed private dental practitioners in Romania (November 2025–January 2026). Three domain composites were derived from a 31-item de novo instrument anchored in JCI, ANMCS, and EN ISO 9001:2015 standards: Professional Governance, Patient Rights and Ethics, and Patient Safety Behaviors. The financing profile was operationalized as engagement with the national public insurance system (CNAS). Binary logistic regression modeled high accreditation-seeking intention (Q31 ≥ 4) against standardized domain scores and financing engagement, with bootstrap confidence intervals from 2000 replicates. Results: Two predictors independently and significantly predicted high accreditation-seeking intention. CNAS engagement showed the strongest association (OR = 5.05, 95% bootstrap CI [1.87–17.91], and p = 0.003), while the Professional Governance score remained independently associated (OR = 2.68, 95% bootstrap CI [1.63–5.63], and p = 0.003). The Patient Rights and Ethics score was not significant. Practitioners actively exploring CNAS contracting showed the highest accreditation-seeking intention (exceeding that of established contractors), suggesting a possible transitional accountability dynamic during financing transition, though this interpretation requires prospective longitudinal validation. Model performance was good (AUC = 0.788; Nagelkerke R² = 0.339). Conclusions: Both financing engagement and governance behavior predicted accreditation-seeking intention after mutual adjustment, representing distinct pathways to voluntary quality adoption in private dental practice. Policy interventions aligned with entry into public contracting and with practice-level governance development are more likely to support accreditation uptake than normative appeals to professional ethics alone. Full article

Background/Objectives: Health system socio-economic inequities in dental care are a long-standing problem in Europe. The issue gained increased relevance during the recent pandemic due to service disruption and socio-economic inequities that become even more pronounced under such circumstances. However, while preventive dental programs are considered key elements of public health, little is known about their role in addressing equity in accessing dental care among different countries and over time between them. This research aims at investigating the relationship between preventive dental policy, socio-economic factors, and the inability to get appropriate dental care within EU member states. Methods: A longitudinal panel dataset at the country level, consisting of data collected during 2020 through 2024, was assembled using open sources of statistics from Europe and other international statistical databases. The dependent variable used in the study was the percentage of the population that had unmet dental care need because of cost. Independent variables were the presence or absence of preventive policies related to dentistry, educational attainment, gross domestic product per capita, unemployment rate, number of dentists, and out-of-pocket expenses. Balanced panel datasets and regressions with robust standard errors in random-effects models were estimated. Interaction terms were created to test the moderating effect of education level on the relationship between policies and access to care. Results: Cross-country variations in terms of the prevention policy environment, socio-economic status, and unmet dental care need were found from descriptive analysis. The higher level of out-of-pocket payment was always related to the higher unmet dental care need, while the lower GDP countries displayed poorer access. Using the balanced panel random-effects model, preventive dental policies and the interaction between preventive policies and educational level were insignificant factors predicting the unmet dental care need. On the other hand, higher out-of-pocket payments, education, and dentists per million population had nearly significant positive relationships. In the sensitivity analysis, GDP per capita showed a negative association, whereas dentists per million population remained positively associated with unmet dental care need. Conclusions: The findings suggest that inequalities in access to dental care during and after the COVID-19 period were shaped primarily by financial and structural determinants rather than by the presence of preventive policies alone. While preventive programs remain an important component of long-term oral health strategies, reducing direct household payment burden and strengthening health system capacity may represent more immediate mechanisms for maintaining equitable access to dental services during periods of system disruption. Full article

Background/Aim: Cardiovascular disease (CVD) represents a relevant global public health challenge with dyslipidemia as a major modifiable cardiovascular risk factor (CVRF). Recent advances have introduced injectable lipid-lowering therapies (LLT). Their clinical effectiveness in real-world practice seems to depend not only on pharmacological efficacy but also on patients’ acceptance, adherence, and persistence, influenced directly by perceived barriers and facilitators. The main objective of this scoping review is to map the barriers and facilitators related to the use of novel injectable LLTs among adult patients with dyslipidemia or CVD. Methods: This review was conducted in accordance with JBI methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for scoping reviews (PRISMA-ScR); pre-registration on Open Science Framework (OSF) was performed. A search was conducted in MEDLINE from PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) from EBSCOhost, and Google Scholar up to June 2025. Eligible studies included qualitative, quantitative, mixed-methods, and review papers involving adult patients with dyslipidemia who reported experiences, perceptions or challenges related to the use of injectable LLT in any healthcare or community setting worldwide. Two reviewers independently screened studies, selected and extracted data. Results: Out of 665 records identified, 7 studies met the inclusion criteria. Patients’ adherence to injectable LLTs is shaped by psychological fears, prior negative experiences, and perceived efficacy. Satisfaction increases when patients feel supported and informed. Convenience, self-administration, and motivational meaning facilitate persistence. Organizational support and economic accessibility further influence uptake, highlighting that adherence depends on both patient experience and structural factors. Conclusions: Patient acceptance and persistence with injectable LLT depends on a complex interplay of emotional, clinical, organizational and economic factors, beyond pharmacological efficacy alone. Fear of injections, previous statin-related experiences, administrative complexity, and high costs remain major barriers, while shared decision-making, trust in healthcare providers, perceived efficacy, regimen convenience, and supportive structures act as strong facilitators. Addressing these challenges requires multidimensional and multidisciplinary strategies for policy makers and clinical managers. Full article

Background/Objectives: Dental caries is one of the most prevalent chronic diseases in childhood, disproportionately affecting socially vulnerable populations. This scoping review aimed to analyze the clinical effects of selected minimally invasive materials and approaches, specifically mouthrinses, fluoride varnishes, silver diamine fluoride, and glass ionomer-based interventions, for the prevention and management of dental caries in pediatric patients, with emphasis on public health and community-based settings. Methods: This scoping review followed the Population, Concept, and Context (PCC) framework. Electronic searches were conducted up to 23 January 2026, using tailored strategies for mouthrinses, fluoride varnishes, silver diamine fluoride (SDF), and glass ionomer cements (GICs). Randomized clinical trials (RCTs) were included. Data extraction and qualitative synthesis focused on clinical outcomes and applicability in public health contexts. Results: Fifty-five RCTs were included. Fluoride- or chlorhexidine-based mouthrinses showed potential in controlling cariogenic biofilm, with evidence primarily based on microbiological outcomes. Fluoride varnishes were associated with enamel remineralization and control of early white spot lesions, particularly in supervised programs. SDF was reported to achieve high caries’ arrest rates in cavitated dentin lesions of primary teeth, while its preventive effect on sound surfaces appeared comparable to other fluoride-based interventions. GICs were associated with acceptable clinical performance as pit-and-fissure sealants and in atraumatic restorative treatment. Conclusions: Minimally invasive dentistry (MID) approaches show promise for the prevention and management of childhood dental caries in public health and community-based settings. However, these findings should be interpreted with caution due to the heterogeneity of interventions and outcome measures, the predominance of short-term and surrogate (microbiological) outcomes, and the absence of a formal risk-of-bias assessment. As a scoping review, the synthesis is narrative in nature, which limits the ability to draw definitive conclusions. Further studies with standardized clinical outcomes and longer follow-up are needed to strengthen the evidence. Full article