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Aim This study explores the acceptance of Advanced Behavior Management Techniques (ABMTs) by parents during their children’s dental treatments, comparing the opinion of parents of neurotypical children with that of parents of children with autism spectrum disorders (ASDs). Methods An observational cross-sectional study was conducted involving 440 parents, divided into two groups: 236 parents of neurotypical children and 204 parents of children with ASDs, recruited from pediatricians’ centers and centers for ASDs children in Northern and Southern Italy. A survey assessed their familiarity and acceptance of ABMTs, including protective stabilization, conscious sedation, and deep sedation/general anesthesia. Discrete variables were expressed as absolute and relative frequencies (%) and compared with Pearson’s chi-squared or Fisher’s exact test. Continue variables were expressed as mean ± SD and compared with the one-way ANOVA test. Heatmap and PCA analysis were used to determine possible correlations between items. Results Parents of children with ASDs showed a higher acceptance rate of ABMTs compared to parents of neurotypical children. Overall, only 30.68% of parents knew ABMTs before the survey. Differences between the two groups of parents in acceptance of Active Stabilization in emergency settings, Passive Stabilization in routine settings, and Deep sedation/general anesthesia in both settings were observed ( p  < 0.01). Only 6.82% of parents ever used at least one ABMT on their children. Heatmap analysis revealed that parents who have accepted one of the ABMTs tend to accept the others as well. Conclusion Differences in parental acceptance of different ABMTs was noted among the two groups of parents, with greater acceptance of ABMTs observed in the group of parents of children with ASDs. Parents of both groups have significant gaps in their knowledge of ABMTs. Therefore, increased awareness and personalized communication strategies are needed to increase acceptance of the studied techniques and, thus, facilitate access to dental care for uncooperative pediatric patients. Patient-centered behavior management strategies that meet children’s needs and parents’ preferences can contribute to the achievement of good oral health.

Background Adhesive failure is the most common complication in fixed orthodontic retention. Understanding the mechanical properties of composites used in bonding fixed retainers and finding proper bonding protocols are essential to achieve proper durability of the adhesive interface and therefore, reliable fixed retention. The aim of the systematic review is to evaluate and summarize the available evidence on composite materials used for fixed orthodontic retention bonding, particularly in relation to their shear bond strength, wear resistance, microleakage, and adhesive stability within different bonding protocols. Materials and methods A comprehensive search was conducted across five databases: PubMed, Web of Science, Scopus, Embase, and EBSCO Dentistry & Oral Sciences Source. The final search was performed on 10th July 2024. The keywords used were: “orthodontic” AND (“retention” OR “retainer” OR “fixed retainer”) AND (“composite” OR “adhesive”). Inclusion criteria were: in-vitro studies on debonding of fixed retainers, comparing multiple composites based on material type, applied forces, structural homogeneity, or bonding procedures. Exclusion criteria were: incomplete studies, case reports, editorials, short communications, and reviews. Studies published after 2000 were included with no language restrictions. The QUIN assessment tool was employed to evaluate the risk of bias. PROSPERO registration number is CRD42023487320. This research did not receive any external funding. Results The search identified 927 records, with 504 duplicates removed, leaving 423 articles for analysis. Ultimately, 39 studies were included in the qualitative synthesis. Eleven studies exhibited low risk of bias, while the remaining presented medium risk of bias. It has been found that composite with higher filler content are more resistant to mechanical stress. Urethane dimethacrylate resin demonstrated superior adhesion. Etch and rinse bonding protocols yielded higher adhesion values and reduced composite microleakage, whereas self-adhesive composites necessitated more frequent check-ups. There is no direct relationship between the power of the polymerization lamp and composite conversion rate. To optimize fixed retention outcomes, composites should have a minimum islet width of 4–4.5 mm and a thickness of at least 1 mm. Conclusions Bonding protocols to enhance the longevity and effectiveness of orthodontic retainers should comprise etch and rinse protocol, and composite islets of at least 4–4.5 mm width and 1 mm thickness.

Background Life-long healthy behaviors are established during pregnancy and the first years of life. In this cross-sectional survey, new mothers with a high level of schooling living in Northern Italy (Lombardy Region) were interviewed to assess their knowledge and attitudes towards their and child oral health. Methods A questionnaire (27 items) was developed to assess socio-demographic factors, knowledge, and attitudes towards maternal and child oral health. The questionnaire was disseminated in perinatal courses, private gynecological clinics, and via social media. Mothers aged ≥18 years, with at least a child aged 0–36 months, with a high school diploma or higher, were included in the survey. Results A total of 1340 women completed the questionnaire, 1297 of whom had a child aged 0–36 months, 792 lived in Lombardy, and 600 had a high level of education and were finally included. About half of the sample (44.67%) was aged between 31 and 35 years, 76.50% were employed, and the majority had only one child (81.50%). During pregnancy, 28.33% of the sample reported problems with teeth and gums, while only 36.00% visited a dentist. More than 40% of the sample said they were not aware of a possible link between oral health and pregnancy, and 73.17% had not received any advice about their oral health or the future health of their baby’s mouth. Less than 20% of women were aware of the increased caries risk associated with prolonged or night-time breastfeeding. Better knowledge/attitude was associated with the age of the child ( p  < 0.05), the number of children ( p  < 0.05) and whether the mother had received advice during pregnancy ( p  < 0.05). Conclusions The results of this survey show a lack of dental care during pregnancy, a lack of information about oral health from health professionals during and after pregnancy, and consequently gaps in the knowledge needed to care for the oral health of the woman and her child. There is a need for training in oral health for pregnant women and new mothers, but also a need for behavioural change among health professionals who care for pregnant women.

Infective endocarditis (IE) is a rare but potentially life-threatening infection, often triggered by invasive procedures, dental or otherwise, in at-risk individuals. This study aimed to assess the knowledge of IE prophylaxis among healthcare professionals, focusing on dentists and physicians. Two validated, anonymous questionnaires were emailed to 27,000 healthcare providers in the province of Milan (Italy). A total of 970 responses were collected (response rate just over 3%), with 49.2% from physicians and 50.8% from dentists. No significant differences were found between the two groups regarding years of experience or guideline usage (p > 0.05), although more physicians (12.7%) than dentists (6.7%) reported unfamiliarity with any guidelines. Physicians often misclassified the risk associated with certain cardiac conditions and overprescribed prophylaxis for low-risk procedures, with overall accuracy falling below the expected performance benchmark (H0: 58.0% ± 2.0%). Dentists showed a better understanding of high-risk dental procedures, yet performance remained suboptimal, with multiple scores below the expected benchmark (H0: 68.0% ± 2.0%). These findings highlight widespread knowledge gaps and inconsistent adherence to IE prophylaxis guidelines. The results align with international observations and emphasize the urgent need for continuing education and improved dissemination of evidence-based recommendations across medical and dental settings.

Objective To investigate the education, knowledge and behaviour of Italian dentists regarding Silver Diamine Fluoride (SDF). Methods A cross-sectional study was conducted from January to December 2022, through an online survey linked to an online continuing medical education (CME) course sent to Italian dentists. A priori power analysis estimated the necessary sample to be 1480 dentists with an anticipated frequency of 50% and a power of 99.99%. The questionnaire included 46 questions on participants ‘ demographic characteristics, training received, clinical knowledge of SDF, and attitudes and behaviours regarding its use. Descriptive statistics, bivariate, and mutlivariable regression analyses were performed to determine the association between the variables. Results The response rate was 6.1% with 3876 respondents, evenly distributed geographically. Less than 10% of respondents had received training at undergraduate, postgraduate or masters level. A minority of dentists were familiar with the use of SDF for the treatment of dentine hypersensitivity (19.0%) and for the treatment of caries in children (22.2%) and adults (15.7%). The percentage of dentists who reported SDF use at least once was 20.6%. On mutlivariable analysis (χ 2 (11)  = 995.9 p- value < 0.01), dentists who used SDF were positively associated with those who cared for patients with special needs, those who received good undergraduate or postgraduate training, and those who knew how to use SDF ( p  < 0.01). A second mutlivariable analysis (χ 2 (11)  = 47.9 p- value < 0.01) revealed that younger respondents were associated with good training and knowledge of the use of SDF received during undergraduate studies, while older respondents were associated with good training received on managing hypersensitivity and caries in adults ( p  < 0.01). Conclusions Overall, Italian dentists ‘ education, knowledge, and use of SDF were relatively poor. The majority of the sample ‘s responses were not consistent with scientific evidence. The use of SDF among Italian dentists is still far from being a reality. In Italy, it is necessary to increase training on SDF, primarily through the university, to hopefully increase its use, especially in non-invasive caries treatment.

The aim was to compare two strategies for caries prevention in children with Autism Spectrum Disorders (ASDs). Participants were retrospectively retrieved and divided in two groups. Group one had first permanent molars treated with fluoride varnishes, FA group ( n  = 92, 9.43 ± 2.44 years) whilst the second, with dental sealant plus fluoride varnishes, FA + S group ( n  = 140, 7.77 ± 2.57 years). Logistic and multivariate analysis were run to evaluate the caries incidence, the retention rate of sealants, and background factors associated with caries risk over a period of at least 11 years. Survival rates from dental caries were statistically significantly higher in the FA + S group compared to the FA group (LogRank test p  < 0.01). Dental sealant plus fluoride varnish played as a protective factor towards the development of caries (HR = 0.25 95% CI = 0.00/0.55 and HR = 0.34 95% CI = 0.00/0.66 in the upper right and left first molars; HR = 0.32 95% CI = 0.00/0.66 and HR = 0.26 95% CI = 0.00/0.58 in the lower right and left first molars). Dental sealants retention rate was high, ranging between 58.02% and 64.29%. No baseline variable was statistically significantly associated to the risk of caries development. Combined dental sealant and fluoride varnish application was more effective in reducing caries risk in first permanent molars of ASDs children than fluoride varnish alone. This preventive strategy should be therefore routinely applied in high caries risk patients as ASDs children.

IntroductionThe oral microbiota plays a fundamental role in maintaining both oral and systemic health, while dysbiosis contributes to diseases such as dental caries and periodontitis. Probiotics have gained attention as adjunctive strategies to restore microbial homeostasis. Heyndrickxia coagulans (formerly Bacillus coagulans) is a spore-forming, lactic acid-producing bacterium with documented antimicrobial, antioxidant, and immunomodulatory properties. Its resilience to environmental stressors and industrial processing makes it a promising probiotic candidate. This systematic review and meta-analysis aimed to evaluate the effects of H. coagulans on oral health outcomes.MethodsA comprehensive search was performed across multiple databases up to September 2025 to identify randomized controlled trials (RCTs) and non-randomized studies assessing H. coagulans as a probiotic intervention for oral health. Data extraction followed PRISMA guidelines, and the risk of bias was evaluated using the RoB 2.0 and ROBINS-I tools. Meta-analysis was conducted using Stata SE® 18.5, with changes in salivary Streptococcus mutans levels as the primary outcome measure.ResultsEight studies (seven RCTs and one NRSI) met the inclusion criteria. Most were conducted in India, Iran, and North Macedonia, with sample sizes ranging from 30 to 183 participants aged 5–73 years. Administration of H. coagulans, via chewable tablets, mouthwash, or food matrices, resulted in a significant reduction of salivary S. mutans counts in both children and adults compared with placebo or other probiotics. Meta-analysis of four studies demonstrated a pooled effect size of −0.99 (95%CI = −1.60/0.39; p < 0.01), although substantial heterogeneity was observed (I² = 98.2%). Additional studies reported improvements in Gingival Index, bleeding on probing, and clinical attachment levels among participants with gingivitis or periodontitis. No significant adverse events were reported.ConclusionH. coagulans appears to exert beneficial effects on oral health by reducing cariogenic bacterial load and improving periodontal parameters, supporting its potential use as an adjunct in caries prevention and gingival health maintenance. H. coagulans may favorably modulate the oral microbiota and contribute to overall oral health. However, further high-quality, large-scale clinical trials are needed to confirm these findings and define their therapeutic role in preventive oral care.

Background: Hypophosphatemic rickets (HR) is a bone disorder affecting phosphate–calcium metabolism, with both skeletal and dental manifestations. This review aims to analyze dental manifestations of HR in children and, where possible, compare them to those in healthy children or affected adults. Methods: The protocol was registered at PROSPERO (CRD42024596022). The study conformed to the PRISMA guidelines. Three databases were searched for studies reporting the prevalence or incidence of any dental manifestation in children with HR. Risk of bias was assessed using JBI, RoB 2.0, and ROBINS-E tools, and Stata/SE 18.0 was used for meta-analysis. Meta-regression was used to examine the effects of therapy duration and mean age on dental manifestations’ prevalence. The study received no funding. Results: A total of 1308 records were identified, with 660 screened after removing duplicates. Forty-six studies were eligible for full-text evaluation; sixteen were included in the qualitative analysis and twelve in the meta-analysis. The dental manifestations observed included dental abscesses, developmental defects of enamel and dentin, dental caries, taurodontism, and large pulp chambers. Dental abscesses were the most common manifestation, with a pooled prevalence of 0.39. Meta-regression showed no association between therapy duration and abscess occurrence but revealed a negative association between mean age and abscess prevalence. Conclusions: Dental abscesses were the most frequent manifestation in children with HR. The role of therapy in improving oral health remains unclear due to insufficient data, indicating a need for further studies on the impact of HR on children’s oral health.

Vitamin B12 deficiency is a widespread condition, particularly among elderly individuals, patients with malabsorption syndromes, and those following plant-based diets. This systematic review and meta-analysis aimed to evaluate and compare the effectiveness of sublingual and oral vitamin B12 administration in comparison with intramuscular (IM) injections, both for improving serum cobalamin and reducing homocysteine levels. A comprehensive search was conducted across PubMed, Scopus, and Embase up to July 2024. Eligible studies included randomised controlled trials, cohort, and case-control studies assessing B12 supplementation efficacy via oral, sublingual, or IM administration routes. Meta-analyses were performed using random-effects models. Subgroup analyses evaluated four key factors: administration route efficacy, daily dosage, age group and clinical conditions that may affect vitamin B12 metabolism (e.g., underlying pathology). Sixteen studies were included in the quantitative synthesis, comprising a total of 6,098 participants. Vitamin B12 supplementation was associated with a significant increase in serum cobalamin levels across all routes of administration (pooled mean difference = +402.6 pg/mL; 95% CI: 293.6 to 511.5; p < 0.001). Homocysteine levels were also significantly reduced across all groups (pooled mean difference = -4.83 μmol/L; 95% CI: -6.55 to -3.11; p < 0.001). No statistically significant differences were observed between oral, sublingual, and intramuscular (IM) routes of administration (p = 0.270 for cobalamin levels and p = 0.485 for homocysteine levels), nor between randomised controlled trials and observational studies (p = 0.268 for cobalamin levels). No dose-response effect was observed (p = 0.485), suggesting that absorption efficiency rather than dosage may be the determining factor. Subgroup analyses by age and clinical conditions (e.g., gastrectomy, unspecified deficiency) revealed comparable efficacy across populations. However, heterogeneity was substantial (I > 80% in most comparisons), and Egger's test indicated potential publication bias. Given the high heterogeneity, further studies are needed to confirm the results. Sublingual and oral B12 supplementation appear to be as effective as intramuscular (IM) injections in improving cobalamin status and reducing homocysteine levels. Given their non-invasive nature, accessibility, and cost-effectiveness of sublingual formulations, they may represent a promising approach for long-term B12 management, particularly in patients with impaired absorption or in resource-limited settings. Further high-quality RCTs are warranted to refine dosing strategies and confirm long-term outcomes. CRD42024554513.

Gestational diabetes mellitus (GDM) affects approximately 5–20% of pregnant women and is associated with adverse pregnancy outcomes. This review aimed to assess whether the oral microbiota of infants and their mothers with GDM had a different composition from that found in unaffected women and offspring. PubMed, Embase, Scopus, and Google Scholar were searched in December 2023 after protocol registration in the International Prospective Register of Systematic Reviews (CRD42023406505). Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. Overall, 1113 articles were identified; after evaluating the full texts, 12 papers were included in the qualitative analysis. In six studies of the eight included, significant differences in microbiota between M-GDM and M-nGDM were found. In four studies, a depletion of Firmicutes and an enrichment of Proteobacteria was found in the microbiota of infants. Since all included studies were judged to have high risk of bias, a quantitative synthesis of the results was not carried out. In conclusion, although the oral microbiota of infants from mothers with GDM could be different from that of infants from mothers without GDM, there is insufficient evidence to clarify this aspect so far.