Search Results (80)

Background: Fear of malpractice and its potential legal, financial, and reputational consequences are associated with one of the most complex phenomena in the medical community: defensive medical practice (DMP). DMP is frequently analyzed in the specialized literature from the physician’s perspective; however, the patient’s role in triggering and maintaining defensive behaviors remains under-explored. Methods: This cross-sectional study examined contextual factors associated with fear of malpractice and the convergences between doctors’ and patients’ perspectives within a bilateral model (error–fear–perceived risk–prevention behaviors), without assuming direct causal relationship. Two questionnaires were administered in Romania to 240 dentists (March–June 2023) and 344 patients (June–December 2023). Associations were tested with chi-square and Fisher’s exact tests (reporting Cramér’s V and odds ratios), multivariate binary logistic regression, and post hoc power analysis. Results: Over half of dentists (53.3%) reported fear of malpractice despite minimal actual legal exposure (0.8%); this fear was associated with awareness of its potential consequences and perceiving patients as more demanding. In multivariate analysis, fear was the strongest independent predictor of perceiving patients as a threat (aOR = 3.98, 95% CI [1.67–9.48]). On the patient side, 57.9% would avoid a dentist with a known malpractice case and 34.0% had requested additional procedures for reassurance. Conclusions: The interaction between physician fear and patient pressure suggests the existence of a “reassurance loop”, in which the patient’s need for safety and the doctor’s fear can mutually reinforce each other, fostering defensive behaviors. We propose an exploratory typology of patient-induced DMP—direct induction (explicit requests for additional investigations/procedures) and indirect induction (relational pressure and reassurance seeking)—to guide future research. By integrating the dentist and patient perspectives within a bilateral model, the study provides a context-specific account of patient-induced defensive practice in Romanian dentistry and identifies dual-target educational interventions (addressing both clinician communication and patient health literacy) as a potential preventive direction. Full article

Objectives: Special care dentistry provides essential, customized oral health care for individuals with significant disabilities, addressing higher rates of dental issues and enhancing overall well-being. The aim of this pilot study was to evaluate the effect of an eight-week dental prevention program on oral health outcomes and cooperation during dental treatment in children with special needs. Methods: The study targeted 97 children from Pető András Conductive Practical Primary School. A total of 16 children participated in the program, which consisted of eight weeks of education sessions focusing on oral hygiene practices and dental cooperation strategies. Dental assessments were conducted at baseline, weeks 8, 16, 52 and 104 using WHO protocols. Results: Significant improvements were observed following the 8-week preventive education program. OHI-S, DI-S, and CI-S values showed significant reductions at both week 8 and week 16 compared to baseline (p < 0.05). Patient cooperation, assessed using the Frankl scale, also improved significantly during the intervention period. Accommodation type demonstrated a significant association with OHI-S values, while diagnosis did not significantly influence the measured outcomes. Long-term follow-up demonstrated sustained improvements in oral hygiene and cooperation scores at both week 52 and week 104, indicating the potential long-term effectiveness of the preventive education program in children with special needs. Conclusions: The specific prevention program significantly improved oral health outcomes and cooperation among children with special needs. Full article

Background: Osteoinduction and bone regeneration are fundamental biological mechanisms enabling osseointegration and long-term durability of endosseous dental implants. In clinical practice, poor bone conditions, aesthetic demands, and peri-implant soft tissue problems commonly need the utilization of regenerative techniques targeted at optimizing both hard and soft tissue results. The purpose of this narrative review was to examine osteo-inductive and regenerative strategies currently employed in implant dentistry, with particular emphasis on the mechanobiological integration of hard–soft tissue regeneration and its implications for peri-implant tissue stability, osseointegration, and clinical predictability. Methods: A narrative literature review was done using PubMed and Scopus databases. Based on predetermined inclusion and exclusion criteria, studies published in English during the previous five years were reviewed. The core narrative analysis comprised a selection of physiologically relevant research that addressed osteo-inductive techniques, bone regeneration, osseointegration, and peri-implant soft tissue outcomes, as well as clinical studies, randomized controlled trials, systematic reviews, and narrative reviews. A narrative synthesis was carried out because of methodological variability. Special emphasis was placed on evidence addressing the biological and clinical interaction between hard- and soft-tissue regenerative strategies, reflecting the specific conceptual focus of the review. Results: The evidence presented suggests that implant surface biofunctionalization, biologically active grafting materials, guided bone regeneration, and supplementary biological treatments may have a favorable impact on implant stability and peri-implant bone healing. Several investigations also underlined the biological dependency between peri-implant bone regeneration and soft tissue architecture, stressing the significance of soft tissue thickness, keratinized mucosa, and emergence profile stability. Even in inflammatory environments, bioactive titanium surface changes showed osteogenic potential, indicating a supporting function in early osseointegration. Conclusions: By promoting osseointegration and improving peri-implant tissue outcomes, osteo-inductive and regenerative techniques are essential to modern implant dentistry; however, their greatest potential may lie in integrated hard–soft tissue regenerative approaches aimed at improving long-term clinical predictability. To further understand the clinical efficacy of combination hard–soft tissue regeneration methods, future well-designed clinical trials with standardized outcome measures are needed. Future research should further clarify the mechanobiological principles underlying these integrated regenerative approaches. Full article

Background: In pediatric dental care, antibiotics are routinely prescribed for both therapeutic and preventive purposes. Their use is primarily indicated for the management of widespread dental or oral infections, in conjunction with appropriate clinical treatment. Additionally, antibiotics are administered to prevent infective endocarditis (IE) in patients identified as being at increased risk. The present study aimed to evaluate the knowledge and prescribing practices of Italian dentists regarding antibiotic use in pediatric patients through an anonymous online questionnaire. Methods: A specifically designed questionnaire was electronically distributed to a group of Italian dentists. The questionnaire included three sections: demographic data, general knowledge on antibiotic prescribing, and IE prophylaxis in pediatric dentistry. Data were analyzed using appropriate statistical methods. Results: The study included 242 Italian dentists. Only a limited number of statistically significant differences were observed between specialists in pediatric dentistry and general dentists or those with other specializations, as well as between practitioners who mainly treat pediatric patients and those who predominantly treat adults. Regarding antibiotic prophylaxis for IE, most respondents identified amoxicillin as the first-line antibiotic for pediatric patients without penicillin allergy, whereas nearly 30% indicated clindamycin for patients with penicillin allergy. The knowledge about the dosage of assumption of the antibiotic of choice and the timing of administration of the antibiotic prophylaxis were considered as not sufficient. Conclusions: Important gaps remain in dentists’ knowledge of current guidelines for IE prophylaxis, particularly regarding drug dosage and administration. Increased awareness of updated recommendations and potential adverse effects of alternative antibiotics, such as clindamycin, is needed. Full article

Background: General anesthesia (GA) plays a key role in pediatric dentistry by enabling comprehensive dental treatment in children who cannot be adequately managed using conventional behavioral techniques, local anesthesia, or sedation. While previous reviews have primarily focused on safety outcomes and adverse events, less attention has been given to patterns of GA utilization and their broader clinical and public health implications. Objective: The objective was to synthesize and critically analyze contemporary evidence on utilization patterns, clinical indications, and treatment characteristics associated with GA in pediatric dentistry and to interpret variability in GA use as a clinical and health-system indicator. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in EBSCOhost, Scopus, and the Cochrane Library to identify observational studies published between 2015 and 2025 reporting clinical data on pediatric dental treatment under GA. Results: Twenty-two observational studies met the inclusion criteria. Severe early childhood caries was the most frequently reported indication for GA, followed by behavioral management difficulties and treatment of children with special health care needs. Reported utilization rates varied widely across healthcare systems. Conclusions: GA remains an essential modality for managing complex pediatric dental cases; however, variability in utilization appears to reflect differences in preventive access, disease burden, and health-system organization. Interpreting GA use as a healthcare utilization indicator may support improved preventive strategies and policies aimed at reducing repeated GA exposure in vulnerable pediatric populations. Full article

Background: Passive protective stabilization (PPS) remains controversial in pediatric dentistry, particularly in invasive procedures such as pulp therapy. This systematic review and meta-analysis aimed to evaluate current parental acceptance of PPS. Methods: A systematic search of PubMed/MEDLINE, Cochrane Library, Scopus, and Embase was conducted up to 25 November 2025. Cross-sectional studies assessing parental acceptance of PPS in children aged 2–10 years were included. Studies published in English within the last 10 years and including at least 100 participants were eligible. Case reports, reviews, editorials, and studies not aligned with the objectives were excluded. Risk of bias was assessed using the Joanna Briggs Institute checklist. A random-effects meta-analysis with logit transformation was performed. Heterogeneity was quantified using I² statistics. Certainty of evidence was evaluated using GRADE. Results: Five cross-sectional studies, including 1005 parents, were included. The pooled parental acceptance of PPS was 48.9% (95% CI: 29.0–69.2%), with substantial heterogeneity (I² = 97%). Acceptance was consistently higher in emergency situations and among parents of children with special health care needs. Three studies showed low risk of bias and two moderate risk. The overall certainty of evidence was rated as very low due to inconsistency and imprecision. Conclusions: Parental acceptance of PPS is context-dependent and influenced by treatment urgency and patient characteristics. Given the high heterogeneity and low certainty of evidence, results should be interpreted cautiously. Further high-quality research is required. 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: In recent years, scientific interest in probiotics in oral health has grown exponentially. This systematic review aims to analyze the effectiveness of probiotic use in dentistry, specifically in two areas: orthodontics and pediatric dentistry. Methods: Forty studies (RCTs, systematic reviews, clinical and preclinical studies) published between 2001 and 2025 were selected from the literature (PubMed) to evaluate the impact of probiotics on clinical, microbiological, and patient-specific parameters. Results: Results generally indicate that the most observed effect is the reduction in Streptococcus mutans levels, while in orthodontics, probiotics have proven beneficial primarily in reducing halitosis and traumatic lesions. In pediatric dentistry, early and prolonged use of probiotics has been shown to benefit both the reduction in caries and the improvement of gingival health, with significant results also observed in pediatric patients with special needs. Conclusions: Although the data obtained so far are very encouraging, further clinical studies are needed to define standardized protocols, identify the most effective strains, and evaluate the effects of long-term probiotic use. Probiotics therefore represent a promising and potentially valuable addition to preventive strategies in dentistry, particularly in orthodontics and pediatric dentistry, when integrated into a sustainable and personalized approach to patient oral health. Full article

Background: Artificial intelligence (AI) is influencing pediatric dentistry by supporting diagnostic accuracy, optimizing treatment planning, and improving patient care, especially for children with special needs. Previous studies explored various aspects of AI in pediatric dentistry and special care dentistry, predominantly focusing on clinical implementation or technical advancements. However, no prior review has specifically addressed its application at the intersection of pediatric dentistry and special care dentistry, particularly with respect to ethical and environmental perspectives. Objective: This scoping review provides a comprehensive synthesis of AI technologies in pediatric dentistry with a dedicated focus on children with special health care needs. It aims to critically evaluate current applications and examine the clinical, ethical, and environmental implementation challenges unique to these populations. Methods: A structured literature search was conducted in PubMed, Scopus, and Web of Science from inception to August 2025, using predefined inclusion and exclusion criteria. Eligible studies investigated AI applications in pediatric dental care or special needs contexts. Studies were synthesized narratively according to thematic domains. Results: Sixty-five studies met the inclusion criteria. Thematic synthesis identified nine domains of AI application: (1) diagnostic imaging and caries detection, (2) three-dimensional imaging, (3) interceptive and preventive orthodontics, (4) chatbots and teledentistry, (5) decision support, patient engagement and predictive analytics, (6) pain assessment and discomfort monitoring, (7) behavior management, (8) behavior modeling, and (9) ethical considerations and challenges. The majority of studies were conducted in general pediatric populations, with relatively few specifically addressing children with special health care needs. Conclusions: AI in pediatric dentistry is most developed in diagnostic imaging and caries detection, while applications in teledentistry and predictive analytics remain emerging, and areas such as pain assessment, behavior management, and behavior modelling are still exploratory. Evidence for children with special health care needs is limited and seldom validated, highlighting the need for focused research in this group. Ethical deployment of AI in pediatric dentistry requires safeguarding data privacy, minimizing algorithmic bias, preventing overtreatment, and reducing the carbon footprint of cloud-based technologies. Full article

Digital technologies have significantly advanced implant dentistry, refining diagnosis, treatment planning, surgical precision, and prosthetic rehabilitation. This review explores recent developments, emphasizing accuracy, efficiency, and clinical impact. A literature analysis identifies key innovations, such as digital planning, guided surgery, dynamic navigation, digital impressions and CAD/CAM prosthetics. Digital workflows enhance implant placement by improving precision and reducing deviations compared to freehand techniques. Dynamic navigation provides real-time guidance, offering accuracy comparable to static guides and proving benefits in complex cases. Digital impressions demonstrate high precision, which can match or, in some scenarios, surpass conventional methods, though conventional impressions remain the gold standard for full-arch cases. CAD/CAM technology optimizes prosthetic fit, aesthetics, and material selection. Artificial intelligence and machine learning contribute to treatment planning and predictive analytics, yet challenges persist, including high costs, the need for specialized training, and long-term clinical validation. This review underscores the advantages of digital approaches—improved accuracy, better communication, and minimally invasive procedures—while addressing existing limitations. Emerging technologies, such as AI, augmented reality, and 3D printing, are expected to further transform implantology. Continued research is crucial to fully integrate digital advancements and enhance patient outcomes. Full article

Background: Regenerative endodontic procedures (REPs) are promising treatments for immature teeth with necrotic pulp. Artificial intelligence (AI) is increasingly used in dentistry; thus, this study evaluates the reliability of AI-generated information on REPs, comparing four AI models against clinical guidelines. Methods: ChatGPT-4o, Claude 3.5 Sonnet, Grok 2, and Gemini 2.0 Advanced were tested with 20 REP-related questions from the ESE/AAE guidelines and expert consensus. Questions were posed in Turkish and English, with or without prompts. Two specialists assessed 640 AI-generated answers via a four-point rubric. Inter-rater reliability and response accuracy were statistically analyzed. Results: Inter-rater reliability was high (0.85–0.97). ChatGPT-4o showed higher accuracy with English prompts (p < 0.05). Claude was more accurate than Grok in the Turkish (nonprompted) and English (prompted) conditions (p < 0.05). No model reached ≥80% accuracy. Claude (English, prompted) scored highest; Grok-Turkish (nonprompted) scored lowest. Conclusions: The performance of AI models varies significantly across languages. English queries yield higher accuracy. While AI shows potential for REPs information, current models lack sufficient accuracy for clinical reliance. Cautious interpretation and validation against guidelines are essential. Further research is needed to enhance AI performance in specialized dental fields. Full article

Staphylococcus aureus, an opportunistic bacterium found in the oral cavity, has been reported as a causative agent of infective endocarditis and pneumonia. Salt is an essential mineral for cell maintenance in the human body. This study was conducted to clarify how salt affects the formation of biofilms by S. aureus and Streptococcus mutans, pathogens implicated in dental caries. Bacteria were cultivated with various concentrations of NaCl on a 96-well microtiter plate in tryptic soy broth with 0.25% sucrose or 0.25% glucose (TSBs and TSBg, respectively) for 16 h. The effects of glucosyltransferase in S. mutans membrane vesicles (MVs) and extracellular DNA during biofilm formation were also analyzed. S. aureus biofilms were induced by 0.004–0.25 M NaCl but not by NaCl at concentrations greater than 0.25 M in TSBs. The mixed S. aureus and S. mutans biofilms gradually grew and were constructed by dead cells in a NaCl concentration-dependent manner in both TSBs and TSBg. Moreover, biofilms were slightly induced by glucan generation mediated by the glucosyltransferases in MVs under high-salinity conditions. The formation of mixed-species S. aureus and S. mutans biofilms increased in the presence of both extracellular DNA and MVs. Therefore, extracellular DNA, MVs, and dead cells are factors that promote S. aureus biofilm formation under harsh conditions containing NaCl. The sugar (sucrose and glucose) ingestion-induced S. mutans biofilm may be a risk factor for infection by opportunistic pathogens such as S. aureus in individuals who consume food and drinks containing high concentrations of salt. Full article

In pediatric dentistry, antibiotics are currently prescribed for both therapeutic and prophylactic purposes. Antibiotic therapy can be prescribed for the treatment of diffuse dental or oral cavity infections, always as a complement to the most suitable dental procedure for the specific case. The aim of this study was to investigate the knowledge regarding the use and prescribing practices of antibiotics in pediatric patients in a sample of Italian dentists by using an anonymous and telematic questionnaire. Methods: A specially prepared questionnaire was electronically transmitted to a cohort of Italian dentists. The questionnaire consisted of two parts: demographic information and general knowledge of antibiotic prescription in pediatric dentistry. The statistical analysis of the obtained data was performed. Results: The study sample consisted of 242 Italian dentists. Poor statistically significant differences emerged between specialists in Pediatric Dentistry and dentists without specialization or specialists in other branches, as well as between dentists who, in their clinical activity, mainly treat children/adolescents or adults. For the complementary treatment of dental or oral cavity infections, Amoxicillin was the antibiotic indicated as the first choice for pediatric patients with no allergy to penicillins by most of the sample, while more than 20% of dentists would prescribe Clindamycin in patients with an allergy to penicillin. The knowledge regarding the dosage of administration of the chosen antibiotic appeared not to be sufficient. Conclusions: An improvement in the knowledge of the Guidelines in Pediatric Dentistry appeared necessary regarding the posology of the antibiotic of choice. More information about the adverse effects of Clindamycin is needed. Full article

Background/Objectives: Children with special healthcare needs (SHCNs) face various physical, developmental, sensory, behavioral, or cognitive challenges affecting oral health and highlighting the need for specialized and more accessible oral and dental care. Mobile health (m-health) applications have emerged as a promising solution to bridge oral health education gaps and improve dental care access. This narrative review aimed to examine the available dental m-health applications designed for children with cognitive and physical impairments, exploring the perspectives of children, parents/caregivers, and dentists regarding their use and potential contribution to oral health. Based on these insights, a concept for a tailored dental m-health app is proposed, considering the interactions between children, caregivers, and dentists to support oral care. Methods: A literature search was conducted using MEDLINE/PubMed, Scopus, and Web of Science to identify studies on the use of m-health apps in pediatric dentistry for SHCN children. Results: Six studies were included in this review. M-health applications helped manage anxiety, behavioral issues, and compliance in children and were generally well received by parents and caregivers, thus improving oral hygiene practices and regular dental visits, and having the potential to reduce oral health disparities in children with cognitive and physical impairments and their families. However, current apps designed for children are limited and may not fully accommodate the diverse sensory needs of these SHCN children. Conclusions: The development of a tailored dental m-health app that adapts to the individual characteristics of SHCN children could enhance oral health awareness and support better compliance among children, parents/caregivers, and dentists. Full article

Objective: Access to dental care is critical for overall health, yet individuals with Down Syndrome (DS) face numerous barriers, including communication difficulties, insufficiently trained professionals, and financial constraints leading to poor oral health outcomes. These obstacles are compounded by a shortage of specialized services and geographic disparities that limit access to appropriate care. This scoping review aimed to explore the existing literature about these barriers and to identify strategies to enhance dental care for this vulnerable population. Methods: This scoping review followed the Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. A comprehensive search was conducted across PubMed, Scopus, and Web of Science focusing on peer-reviewed studies published in English within the last 10 years that examined barriers and strategies related to patients with DS. To ensure methodological rigor, eligible studies were independently screened and reviewed by two reviewers. Any disagreements were resolved through discussion, and if consensus could not be reached, a third reviewer made the final decision. Data were extracted using a standardized form. The extracted data were analyzed and synthesized to identify and categorize barriers and strategies across different studies. Results: The initial search yielded 58 articles, with 42 remaining after duplicates were removed. Following titles and abstracts screening, 13 studies were considered for full-text review, and 6 studies met the inclusion criteria. These studies, published between 2015 and 2023, primarily employed cross-sectional designs and identified key barriers, including challenges in maintaining oral hygiene, limited access to specialized dental services, and behavioral and sensory difficulties affecting dental care for children with DS. Strategies to overcome these barriers included enhancing dental professional training, developing tailored care approaches, and integrating preventive dental programs into broader health initiatives. Conclusions: This review highlights significant, persistent barriers to dental care for children with DS. By emphasizing the need for enhanced dental professional training, personalized care approaches, and integrated preventive programs, this review provides a framework for improving dental care accessibility for this population. Addressing these barriers can lead to better oral health outcomes and improved overall well-being for children with DS. Full article