Vanessa Machado

Background: Breastfeeding is a complex process involving coordinated activation of the orofacial musculature and dynamic mother–infant interactions, although little is known about longitudinal electromyographic (EMG) activity during early breastfeeding. Aim: We aimed to characterize EMG patterns of orofacial muscle activity during breastfeeding in infants with normal lingual frenulum anatomy and function and explore their relationship with maternal breastfeeding self-efficacy, breastfeeding-related pain and difficulties, and infant gastrointestinal discomfort. Methods: Thirteen mother-infant dyads were followed from birth to 3 months. Lingual frenulum anatomy and function were assessed using the Martinelli protocol. Surface EMG of bilateral masseter and suprahyoid muscles was recorded during breastfeeding at days 5–7, 1 month, and 3 months. Maternal self-efficacy and infant colic-related outcomes were assessed using Breastfeeding Self-Efficacy Scale–Short Form and Infant Colic Questionnaire tolls, respectively. Longitudinal changes and associations were analyzed using repeated-measures and correlation analyses. Results: Bilateral masseter activity progressively increased during follow-up, while suprahyoid activity increased at 1 month and decreased at 3 months postpartum, without significant longitudinal differences. Mothers presented high breastfeeding self-efficacy scores (62.1 ± 6.8). Infant and parental ColiQ scores significantly improved between 1 and 3 months postpartum ( p < 0.05). No significant correlations were identified between EMG activity, breastfeeding self-efficacy, and ColiQ scores. Conclusions: Infants with normal lingual frenulum anatomy and function showed relative stability of orofacial muscle activity during early breastfeeding. Maternal self-efficacy was high, infant and parental well-being improved over time, and neither BSES-SF nor ColiQ scores were significantly associated with EMG activity.

Artificial intelligence (AI) is increasingly being incorporated into oral healthcare and dental education, yet the quality and effectiveness of randomized evidence supporting these interventions remain uncertain. We systematically reviewed randomized controlled trials (RCTs) evaluating AI-based interventions in oral healthcare and dental education. A comprehensive literature search was conducted in PubMed, Embase, ClinicalTrials.gov, and OpenGrey from database inception to 30 June 2026. Twenty-eight published RCTs involving 2306 participants and 26 registered unpublished RCTs were identified. Educational applications represented the largest category (53.6%), followed by diagnosis and clinical decision support, treatment planning, and disease monitoring. Across the included RCTs, AI-based interventions were more frequently associated with improvements in educational performance, diagnostic accuracy, treatment planning, clinical decision-making, and periodontal monitoring than conventional approaches, although findings were heterogeneous, several studies reported no significant differences, and a small number favored conventional methods. No serious adverse events were reported, but safety reporting was inconsistent. Most published RCTs presented some concerns regarding risk of bias (82.1%), primarily related to randomization, deviations from intended interventions, and selective reporting. APPRAISE-AI demonstrated predominantly moderate methodological quality (median score 44%), with recurrent weaknesses in robustness, reproducibility, and data quality. The identification of 26 registered RCTs without published results also suggests a potential risk of dissemination bias. These findings indicate that AI-based interventions show promise across multiple applications in oral healthcare and dental education, but improvements in trial methodology, reporting quality, and transparency are needed to strengthen the evidence base and support clinical implementation.

Background: Molar–incisor hypomineralization (MIH) is a common developmental enamel defect that presents important diagnostic and therapeutic challenges in pediatric dentistry. Differences in dental professionals’ knowledge and clinical confidence may affect patient care. Aim: To evaluate dental professionals’ awareness, diagnostic confidence, clinical management, referral practices, and training related to MIH. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Random-effects meta-analyses were performed to calculate pooled estimates, with subgroup analyses by geographic region, dental specialty, and risk of bias. Results: Thirty-six observational studies including over 10,000 dental professionals were included. Awareness of MIH diagnostic criteria was moderate (72.1%) and higher among pediatric dentists than general dental practitioners. Diagnostic confidence (67.5%) and comfort in providing treatment (64.1%) were suboptimal, particularly among non-specialists. Most respondents perceived a distinct caries pattern in MIH-affected teeth (84.8%), while referral to pediatric dentists was inconsistent (52.5%). Approximately 80% of participants reported a need for additional MIH-related training. Substantial heterogeneity was observed across analyses. Conclusions: Despite moderate awareness of MIH, important gaps persist in diagnostic confidence, clinical management, and referral practices. Strengthening undergraduate education, continuing professional development, and structured referral pathways is essential to improve early diagnosis, appropriate management, and outcomes for children affected by MIH, highlighting the pivotal role of paediatric dentists in interdisciplinary care.

Background/Objectives: To characterize clinical values obtained from a digital jaw tracking system during the functional assessment of mandibular movements in patients undergoing prosthetic rehabilitation. Methods: Ten patients undergoing prosthetic rehabilitation were included. Mandibular movements were recorded using the Zebris JMA Jaw Tracking System and measurements including maximum mouth opening, lateral excursions, protrusion, and condylar path length. Descriptive analyses were performed. Quantitative parameters were summarized as mean ± standard deviation and range and compared with normative values reported in the literature. Results: Ten participants completed mandibular kinematics registration (8 female, 2 male). Considerable interindividual variability was observed across all parameters. Mean maximum opening was 38.19 ± 10.99 mm (range 22.5–59.6 mm), mean protrusion 5.79 ± 4.47 mm (range 3.0–17.8 mm), mean right lateral excursion 6.56 ± 3.06 mm, and mean left lateral excursion 4.90 ± 2.11 mm. Lateral asymmetry was identified in 5 out of 10 patients. Bilateral condylar path length asymmetry had a mean of 3.59 ± 1.89 mm. Conclusions: Values obtained through the jaw tracking system demonstrated considerable interindividual variability in this prosthetic rehabilitation population. These preliminary findings support the need for further research to characterize normative kinematic values in this specific population and to evaluate the clinical impact of integrating jaw tracking data into prosthetic planning workflows.

This prospective, single-arm post-market study aimed to evaluate the clinical safety and performance of a synthetic calcium phosphate ceramic used in alveolar bone regeneration procedures. Eighty adult patients requiring bone augmentation were treated with β-tricalcium phosphate (β-TCP) under routine clinical indications. Surgical approaches were adapted to defect morphology. Safety outcomes included adverse events (AEs) and device deficiencies (DDs), while performance outcomes focused on two-dimensional radiographic bone assessment. Radiographic bone consolidation was defined as continuous trabecular radiopacity without radiolucent defects or clinical signs of infection. Patients were followed for six months post-surgery, with clinical and radiographic evaluations, as well as assessment of oral health-related quality of life (OHIP-14). All 80 patients (mean age: 47.2 ± 18.9 years; 51% male) completed the immediate postoperative assessment. Eleven DDs (granule loss) were observed postoperatively (13.8%) and no AEs. At six months, 71 patients (88.8%) completed follow-up. Radiographic bone repair was confirmed in all cases clinically observed and with follow-up X-ray (100%). No AEs or DDs reported (AE-free rate: 100%) at this follow-up. The median OHIP-14 score improved significantly at six months (p = 0.037), indicating better self-reported oral health. Given the observational design, absence of a control group, and partial reliance on non-radiographic follow-up, these findings should be interpreted with caution. Within these limitations, the synthetic calcium phosphate ceramic demonstrated a favorable short-term safety profile and apparent bidimensional radiographic signs of clinical performance under real-world conditions, rather than definitive evidence of effectiveness. Further controlled studies incorporating histological and volumetric analyses are warranted to confirm its regenerative potential.

Conscious sedation is widely used in pediatric dentistry to manage dental anxiety, behavioral difficulties, and systemic diseases that compromise patient compliance with dental care. Despite its clinical importance, international recommendations vary considerably. Objective: To conduct a comparative analysis and evidence mapping of international clinical practice guidelines on conscious sedation in pediatric dentistry. Methods: A comparative guideline analysis and evidence mapping study was performed. Electronic searches were conducted in PubMed (MEDLINE), Scopus, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, LILACS, SciELO, TRIP, and OpenGrey up to December 2023. Guidelines issued by recognized professional or governmental organization addressing conscious sedation in pediatric dentistry were included. Predefined domains were analyzed, including indications, contraindications, pharmacological agents, dosages, routes of administration, monitoring, discharge criteria, and professional training. Data were synthesized descriptively and graphically mapped to illustrate coverage patterns. Results: Twelve international guidelines were included. Complete convergence (100%) was observed in core safety domains, such as patient assessment, monitoring, and professional training. A high agreement was found for discharge criteria (91.67%) and contraindications (83.33%). However, substantial variability emerged in pharmacological protocols, with only 16.67% of guidelines providing comprehensive drug and dosage descriptions. Routes of administration and emergency equipment recommendations were inconsistently reported, appearing in 66.67% and 50% of guidelines, respectively. Conclusions: Although foundational safety principles are consistently addressed, significant heterogeneity persists in pharmacological and procedural recommendations. This variability may contribute to differences in practice and uncertainty among practitioners. Greater international harmonization of guidelines may improve consistency, enhance clinical decision-making, and strengthen patient safety in pediatric dental care. Clinical Relevance: Identifying areas of convergence and variability across international guidelines may support the development of more standardized sedation protocols and promote safer evidence-based clinical practice in pediatric dentistry.

Background: Oral frailty is an emerging determinant of late-life disability. While objective functional measures have been proposed as key indicators, their combined role in predicting frailty among physically active older adults remains unclear. Therefore, this study aimed to investigate the association between the presence of oral frailty and lip pressure, bite force, and denture use. Methods: This cross-sectional study included 192 participants aged 60 years or older from Brazil (n = 131) and Portugal (n = 61), all physically active and with ≥20 natural or rehabilitated teeth. Data were collected through a questionnaire on sociodemographic data and the Oral Frailty Index-8. The clinical assessment included lip pressure, bite force, and denture use. Multiple logistic regression identified independent predictors; model fit and discrimination were examined using the Hosmer–Lemeshow test and ROC curve. Results: Participants were mainly female (83.3%), mean age ≈72 years; 76% used dentures and frailty prevalence was ≈49%. Higher lip pressure (OR = 0.986, 95% CI = [0.973–0.999]) and higher bite force (OR = 0.925, 95% CI = [0.885–0.967) were independently protective, whereas denture use (OR = 6.898, 95% CI = [2.994–15.895]) markedly increased oral frailty odds. The model showed good discrimination (AUC 0.779). Conclusions: Even small increases in lip pressure and bite force reduced the likelihood of frailty, while denture use identified individuals at substantially higher risk. These findings highlight orofacial muscle strength and masticatory capacity as core components of oral frailty and support incorporating lip pressure and bite force testing into multidimensional frailty assessment and targeted rehabilitation.

Objectives: To assess the periodontal health, perceived quality of life, and oral health values among Portuguese Air Force (PT-AF) pilot cadets. Methods: This cross-sectional study included cadets from the PT-AF Academy (December 2024–Mar 2025). Participants completed sociodemographic, behavioral, Oral Health Impact Profile-14 (OHIP-14) and Oral Health Values Scale-12 (OHVS-12) questionnaires, followed by full-mouth periodontal examinations to compute Periodontal Inflamed Surface Area (PISA) and Periodontal Epithelial Surface Area (PESA), and classify periodontal status according to the 2017 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) criteria. Descriptive and inferential analyses were conducted, with a significance level set at p ≤ 0.05. Results: Among 90 participants (72% of the contingent; mean age 21.1 ± 1.7 years), 22.2% [95% confidence interval (CI): 14.6–31.6] had periodontitis and 22.2% (95% CI: 14.6–31.6) gingivitis. Only 34.4% reported regular interproximal cleaning. Periodontitis was significantly associated with smoking habits ( p = 0.029) and was more prevalent among 5th-year cadets ( p = 0.002). No significant differences were found in OHIP-14 or OHVS-12 scores by periodontal status, except for the “Appearance and Health” OHVS-12 domain, where those with periodontitis scored higher ( p = 0 034). Age correlated positively with PISA ( p = 0.003). Conclusions: Despite their young age and military fitness, nearly half of PT-AF cadets presented clinical signs of periodontal disease. The findings underscore the importance of structured and integrating oral health surveillance and preventive strategies within military occupation health programs.

Breastfeeding is a renewable biological system that simultaneously advances human, environmental, and societal health. Human milk provides unparalleled nutrition and immunological protection, improving infant survival, neurodevelopment, and long-term metabolic outcomes, while reducing maternal risk of breast and ovarian cancer. However, and despite decades of evidence, only 48% of infants under six months are exclusively breastfed worldwide, and breastfeeding remains absent from most sustainability and One Health strategies. This narrative review synthesizes evidence demonstrating that breastfeeding functions as a low-carbon, zero-waste food system that avoids greenhouse gas emissions, land conversion, water consumption, and biodiversity loss linked to commercial milk formula production. At the societal level, breastfeeding reduces health-system costs, strengthens emergency resilience when supply chains fail, and generates long-term economic returns. By integrating evidence across human health, environmental impact and social determinants, this review positions breastfeeding as a strategic One Health intervention and a high-value investment for achieving multiple Sustainable Development Goals. Strengthening policy support—including protection against formula marketing, workplace accommodations, and expansion of baby-friendly systems—is essential to unlock breastfeeding’s potential for planetary and public health.

Background/Objectives: This study aimed to externally validate the screening model for severe PD proposed by Verhulst in a Portuguese population, assessing its discriminative performance and clinical applicability. Methods: A cross-sectional study was conducted with 310 adults recruited from a university dental clinic in Portugal. The participants completed a validated self-reported oral health questionnaire (screening model) and underwent a full-mouth periodontal examination using the CPITN index, with severe PD defined as a score of 4. Model performance was evaluated for discrimination, calibration, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Of the 310 participants, 51% were diagnosed with severe PD. The Verhulst model showed an area under the curve (AUC) of 0.72 (95% CI: 0.67–0.77), with sensitivity and specificity of 0.709 (95% CI: 0.639–0.779) and 0.724 (95% CI: 0.651–0.796) and PPV and NPV of 0.727 (95% CI: 0.673–0.784) and 0.704 (95% CI: 0.651–0.764), respectively. Calibration was reasonable, with an observed-to-expected ratio of 1.10 (95% CI: 0.939–1.291). Conclusions: The model demonstrated acceptable external validity and could serve as a feasible screening tool for severe PD in Portuguese dental settings. Its integration may enhance early diagnosis and interdisciplinary care. Future studies should consider broader diagnostic criteria to refine accuracy.