Research into oral mucosa-targeted drug delivery systems (DDS) is rapidly evolving, with growing emphasis on enhancing bioavailability and precision targeting while overcoming the unique anatomical and physiological barriers of the oral environment. Despite considerable progress, challenges such as enzymatic degradation, limited mucosal penetration, and solubility issues continue to hinder therapeutic success. Recent advancements have focused on innovative formulation strategies—including nanoparticulate and biomimetic systems—to improve delivery efficiency and systemic absorption. Simultaneously, smart and stimuli-responsive materials are emerging, offering dynamic, environment-sensitive drug release profiles. One particularly promising area involves the application of glycosaminoglycans, a class of naturally derived polysaccharides with excellent biocompatibility, mucoadhesive properties, and hydrogel-forming capacity. These materials not only enhance drug residence time at the mucosal site but also enable controlled release kinetics, thereby improving therapeutic outcomes. However, critical research gaps remain: standardized, clinically meaningful mucoadhesion/permeation assays and robust in vitro–in vivo correlations are still lacking; long-term stability, batch consistency of GAGs, and clear regulatory classification (drug, device, or combination) continue to impede scale-up and translation. Patient-centric performance—palatability, mouthfeel, discreet wearability—and head-to-head trials versus standard care also require systematic evaluation to guide adoption. Overall, converging advances in GAG-based films, hydrogels, and nanoengineered carriers position oral mucosal delivery as a realistic near-term option for precision local and selected systemic therapies—provided the field resolves standardization, stability, regulatory, and usability hurdles.

While smoking is recognized as one of the factors for the development and progression of periodontal diseases, a relation between the composition of the subgingival microbiota and smoking is yet to be elucidated. The aim of this study was to investigate the prevalence of subgingival bacteria in young smokers and non-smokers without clinical signs of periodontal disease. In this cross-sectional study, performed at the Department of Pharmacology, School of Dental Medicine, University of Zagreb, we enrolled 32 periodontally healthy smokers and 32 non-smokers, aged 25–35 years old. The number of oral bacteria and the prevalence of particular bacteria were assessed for each subject. Subgingival plaque samples were collected with sterile paper points from two first molars for microbiological analyses with MALDI-TOF mass spectrometry. In smokers, a significantly higher prevalence of Actinomyces odontolyticus was observed compared to non-smokers, and a significantly lower prevalence of Streptococcus sanguinis was observed compared to non-smokers. Smoking affects the composition of subgingival microbiota, either via depletion of beneficial bacteria or the increase in pathogenic bacteria.

The 2019 coronavirus pandemic (COVID-19) has affected clinical practice and, consequently, drug prescribing in dental practice. We investigated how the pandemic affected the prescribing behavior of dentists in Croatia. Data on prescribing practices for this study were provided by the Croatian Health Insurance Institute. The analysis included the number of prescriptions, costs, and the number of packages prescribed. The World Health Organization’s defined daily dose per 1000 inhabitants (DID) per day was used as an objective utilization comparison. During the first pandemic year, prescribing practice changed the most. Wide-spectrum antibiotics, analgesics, and antiseptics showed the highest trend in change. A statistically significant change in prescribing practices during the pandemic period was noted for amoxicillin with clavulanic acid, ibuprofen, and ketoprofen which showed an increase in trend, while cephalexin and diclofenac showed a statistically significant decrease. The highest increase in trend was recorded for azithromycin, at +39.3%. The COVID-19 pandemic has been associated with a marked increase in medication utilization, especially in the first year of the pandemic. The increase in wide-spectrum antibiotic classes needs to be addressed and regulated so that patients accept that antibiotics are not a substitute for dental treatment and dentists always start treatment with narrow-spectrum antibiotics regardless of specific times, as is the case with the pandemic.

Prescribing antibiotics is a regular part of daily dental practice. Antibiotics have a significant but a limited role in general dental practice due to the threat of emergence of antimicrobial resistance (AMR). As such, the aim of this study was to assess prescribing trends in dental antibiotics use from 2014–2023 in Croatia. Data on antibiotic prescribing practices for this study were provided by the Croatian Health Insurance Fund. The analysis included the number of prescriptions, packages, cost, and the World Health Organization’s defined daily dose per 1000 inhabitants (DID) per day as an objective utilization for comparison. Over the 10-year period, dentists in Croatia prescribed an annual average of 357,875 antibiotic prescriptions, representing an annual average of 78.7% of all dental prescriptions. The most commonly prescribed antibiotic was the combination of amoxicillin and the beta-lactamase inhibitor clavulanic acid, which made up 58.54% of antibiotics and 46.1% of all dental prescriptions. This was followed by amoxicillin (12.61%), clindamycin (12.58%), and metronidazole (9.96%). The trend showed two discontinuations, the first for the pandemic years, and the second caused by disruption in amoxicillin production. The rise in the use of broad-spectrum antibiotics needs to be addressed and regulated to ensure patients and dentists understand that antibiotics are not a substitute for dental treatment. Dentists should always begin treatment with narrow-spectrum antibiotics regardless of possible exceptional circumstances.

Fluoride remains the keystone of evidence-based caries prevention by stabilizing the mineral balance at the tooth–biofilm–saliva interface. Contemporary understanding emphasizes a predominantly post-eruptive, topical mode of action where fluoride inhibits demineralization and accelerates remineralization. This interfacial catalysis is reinforced by pH-responsive calcium-fluoride-like reservoirs that release fluoride during acid challenges. While community water fluoridation confers population-level reductions, the most effective approach is sustaining low-level fluoride in the biofilm environment. Evidence confirms that toothpastes with 1000–1500 ppm fluoride provide a dose–response benefit in children, while 5000 ppm concentrations are indicated for high-risk scenarios such as root caries and xerostomia. Beyond physicochemical effects, fluoride modulates the oral microbiome by inhibiting bacterial enzymes and proton pumps, shifting community function toward a health-associated state without reducing overall diversity. In restorative dentistry, glass ionomer cements offer superior preventive effects against secondary caries compared to amalgam; however, marginal integrity, adhesive performance, and clinical technique, rather than fluoride release alone, remain the primary determinants of success. Despite well-known risks associated with high systemic intake, such as fluorosis, current evidence does not indicate genotoxic or adverse microbiome effects in humans from routine topical use of standard fluoride products at recommended preventive concentrations. Overall, fluoride’s cariostatic value rests on frequent, low-level exposures that maintain tissues in a repair-favoring state.

Salivary calcium is a biologically plausible but methodologically challenging biomarker because of its central role in enamel demineralization/remineralization, dental calculus formation, and oral mineral homeostasis. This narrative review summarizes the analytical challenges and clinical interpretation of salivary calcium measurements in oral and systemic disease. Evidence from periodontal research generally indicates higher salivary calcium concentrations in periodontitis, although interpretation is complicated by calculus formation, gingival crevicular fluid contribution, smoking, inflammation, and variation in saliva collection protocols. In dental caries, findings are heterogeneous, and calcium appears more meaningful when interpreted together with salivary flow rate, pH, phosphate, buffering capacity, and fluoride exposure than as an isolated diagnostic marker. Studies in osteoporosis, chronic kidney disease, hemodialysis, and diabetes suggest possible associations with systemic disturbances, but salivary calcium does not currently provide sufficient specificity or predictive value to replace established serum, imaging, or clinical biomarkers. Overall, salivary calcium should be regarded as a context-dependent component of broader salivary biomarker panels. Its clinical translation requires standardized sampling, clear distinction between total and ionized calcium, appropriate analytical validation, and careful control of pre-analytical and biological confounders.