Early childhood caries–related complications in pediatric dental emergencies: a 7-year retrospective study from Romania

Clinical Oral Investigations (2026) 30:274 https://doi.org/10.1007/s00784-026-06968-8 RESEARCH Early childhood caries–related complications in pediatric dental emergencies: a 7-year retrospective study from Romania Rebeca Daniela Marton1 · Abel Emanuel Moca1 · Petra Opriș1 · Raluca Iurcov1 · Mihai Juncar1 Received: 13 January 2026 / Accepted: 31 May 2026 / Published online: 4 June 2026 © The Author(s) 2026 Abstract Objectives Early childhood caries (ECC) is a highly prevalent and largely preventable disease that may lead to severe complications requiring emergency dental care. This study aimed to retrospectively analyze the presentation patterns, clinical characteristics, and management of ECC-related complications among children presenting to a pediatric dental emergency service over a seven-year period. Materials and methods A retrospective observational study was conducted using medical records from the dental emergency department of the County Clinical Emergency Hospital in Oradea, Romania, covering the period January 2019 to December 2025. Children aged 0–71 months presenting with ECC-related complications were included. Demographic variables, diagnosis, tooth location, and emergency treatment were recorded. Descriptive statistics were applied, and associations between variables were assessed using chi-square and Kruskal–Wallis tests. Results A total of 1490 children were included (mean age: 4.81 ± 1.11 years). Furcation periodontitis (38.1%) and pulpitis (36.8%) were the most frequent diagnoses, followed by dental abscesses (22.4%). Mandibular posterior teeth were predominantly affected (59.5%). Children from rural areas presented proportionally more often with advanced complications (p = 0.009). Significant associations were observed between diagnosis and tooth location (p < 0.001), as well as between diagnosis and age (p < 0.001). A marked reduction in emergency presentations was observed during 2020–2021, followed by a progressive increase after 2022. Conclusions ECC-related complications remain a major cause of pediatric dental emergency visits, with most children presenting at advanced stages of disease. Clinical relevance These findings highlight delayed access to preventive dental care and underscore the need for early, community-based preventive strategies to reduce severe ECC complications and emergency dental service utilization. Keywords Early childhood caries · Pediatric dental emergencies · Dental abscess · Furcation periodontitis · Preventive dentistry Introduction Early childhood caries (ECC) is defined by the International Association of Paediatric Dentistry (IAPD) in the Bangkok Declaration as the presence of one or more decayed (noncavitated or cavitated lesions), missing, or filled (due to caries) surfaces in any primary tooth of a child under six years of age [1]. ECC represents one of the most prevalent oral Abel Emanuel Moca 1 Department of Dental Medicine, University of Oradea, Oradea, Romania diseases globally and exerts a substantial negative impact on children’s quality of life [2]. The domains most severely affected include symptoms and psychological well-being [3], resulting in immediate consequences such as dental pain [4]. Furthermore, untreated ECC may lead to long-term psychosocial effects, including bullying associated with caries of the anterior teeth [5], which has been linked to difficulties in emotional well-being in adulthood [6]. The factors influencing the development of ECC are numerous, and its etiology is complex. On the one hand, several sociodemographic factors have been associated with a higher prevalence of ECC, such as low socioeconomic status, low parental educational level, and larger household size [7]. Additionally, dietary factors, including daily 274 Page 2 of 11 consumption of sweets and sugar-sweetened beverages, as well as oral hygiene–related factors, such as the absence of daily toothbrushing and the use of non-fluoridated toothpaste, play a significant role in the increased prevalence of this condition [7]. Considering the early age at which ECC may occur, including in children younger than three years, breastfeeding has been investigated as a potential risk factor. Evidence suggests that nocturnal breastfeeding is associated with an increased risk of dental caries in preschool children [8]. Although the IAPD acknowledges the protective role of breastfeeding up to the age of one year, it warns that continued breastfeeding beyond 12 months may be associated with an increased risk of caries development [9]. Despite its numerous negative effects and the fact that it is a largely preventable disease [10], ECC remains largely untreated worldwide [11]. Beyond its long-term consequences, untreated ECC may lead to immediate complications, such as pulpitis, furcation periodontitis, or dental abscesses, which in turn may result in severe systemic complications that can be life-threatening [12]. These acute complications are often the reason for a child’s first dental visit, with pain being one of the main drivers for seeking dental care [13]. In Romania, according to a report of the National Institute of Statistics on oral health, the prevalence of caries affecting primary teeth among children aged 1 to 9 years is 48.2%, exceeding the European average of 33.6% and ranking Romania first among European Union countries in this regard [14]. The underlying reasons are multiple and not yet fully elucidated; however, evidence suggests that although parents generally demonstrate relatively good knowledge and appropriate attitudes toward dental care, their oral health–related practices remain suboptimal [15]. In addition, regarding pediatric presentations to emergency dental services, a study conducted in Oradea, Romania, published in 2024 and analyzing emergency dental care data from 2022 to 2023, revealed that nearly 20% of all patients presenting to emergency services were children aged between 2 and 9 years [16]. Nevertheless, data describing the actual burden of pediatric cases presenting to dental emergency services remain limited. To date, no studies have been identified in the scientific literature that specifically analyze emergency dental presentations of children under six years of age for the urgent management of ECC-related complications. Moreover, no retrospective studies evaluating such data over a period longer than five years have been reported. Therefore, the aim of this study was to retrospectively analyze the presentation of children with ECC to the dental emergency department of the County Clinical Emergency Hospital in Oradea, Romania, over the entire period for 13 Clinical Oral Investigations (2026) 30:274 which digital records were available, from January 2019 to December 2025. The analysis focused on ECC-related complications, including pulpitis, furcation periodontitis, dental abscesses, and other complications associated with ECC. Materials and methods Study design and data co (...truncated)