An Integrated Care Pathway for Pediatric Oral Health: A Multicenter Study on Dental Caries, Malocclusions, and Oral Hygiene in Three Italian Regions

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gra-dients. Objectives: This multicenter study aimed to describe caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the Italian Centre for Diseases Control and Prevention (CCM) 2024 program (ID 10), 795 children aged 6–11 years were examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedici-ne/AI supported follow up for high risk children. Descriptive and multivariable statistical analyses were performed. Results: Overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with mediocre hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries expe-rience. In multivariable models, oral hygiene emerged as the main independent pre-dictor of dmft/DMFT. Conclusions: In this low caries cohort, oral hygiene was confirmed as the principal mo-difiable determinant of caries risk. A tiered, school and community based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical inter-ventions appears feasible and potentially scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.