Introduction: Endodontic-periodontal diseases frequently pose significant challenges for clinicians in terms of diagnosis, management, and prognosis. Practitioners' knowledge of endo-periodontal lesion (EPL) diagnosis is essential for formulating appropriate treatment plans. This study aimed to evaluate the knowledge of diagnostic and therapeutic approaches to EPLs among dental practitioners in Saudi Arabia. Methods: The study used a cross-sectional survey among Saudi Arabian dental practitioners using a self-administered questionnaire. The statistical methods used included descriptive analysis, Pearson's chi-square test, Fisher's exact test, and binary logistic regression. Results: The study included 312 respondents, with 95 (30.4%) females and 217 (69.6%) males. The majority were aged 25 to 30 (n = 155, 49.7%). Significant associations were found between participant knowledge and the following variables: age (P < 0.001), organization (P = 0.005), employment (P = 0.001), professional experience (P < 0.001), postgraduate degree (P = 0.002), specialty (P < 0.001), Saudi Commission for Health Specialities (SCHS) rank (P = 0.004), and continuing training (P = 0.043). Additionally, individuals aged 36-40 were 4.3 times more likely to have good knowledge compared to those aged 25-30 (adjusted odds ratio [AOR] = 4.27, P = 0.020), and lecturers were 4.4 times more likely to have good knowledge compared to interns (AOR = 4.40, P = 0.054). Conclusion: This indicates that the practitioners' overall knowledge was above average and that they possess a fundamental understanding of EPLs. These findings have valuable effects on clinical practice, suggesting that evidence-based guidelines and targeted educational programs can enhance the practitioners’ diagnostic accuracy and treatment strategies for EPLs, ultimately improving patient outcomes and clinical efficacy.

Childhood dental caries is a common and significant oral health issue globally, resulting in pain, infection, and difficulties in eating and speaking. This study aimed to investigate the impact of food-based reward behaviors on the oral health of Saudi children. An observational cross-sectional study was conducted at Jouf University Hospital, Saudi Arabia. The study included 316 medically healthy children aged 4 to 10 years and their Arabic or English-speaking guardians. Data were collected through a structured questionnaire based on the Comprehensive Feeding Practices Questionnaire (CFPQ), gathering information on socio-demographic characteristics, dietary habits, oral hygiene practices, and the use of food as a reward. Clinical examinations by specialist pediatric dentists assessed the plaque index and decayed-missing-filled tooth (dmft/DMFT) scores. Statistical analyses included descriptive analysis, the Mann-Whitney test, the Kruskal-Wallis test, Spearman’s correlation, and linear regression analysis. Significant correlations were found between food rewards and poor oral health outcomes. Food rewards were positively associated with higher dmft/DMFT scores (r = 0.43, P < 0.001) and plaque index scores (r = 0.17, P = 0.002). Socio-demographic factors, such as parental education level and the amount of time spent with the child, were significant predictors of both food reward behaviors and oral health outcomes. Female and younger parents reported higher food reward scores, which correlated with poorer oral health in their children. The study underscores the significant impact of food-based reward behaviors on the oral health of Saudi children. These findings highlight the need for targeted educational and intervention strategies that address cultural practices and promote healthier reward systems. By reducing sugary food rewards and encouraging non-food-based incentives, improvements in children’s oral health can be achieved.

Background: The endodontic-periodontal lesions (EPLs) are a complex clinical condition whose diagnosis, treatment, and prognosis remain challenging. Therefore, a clear understanding of appropriate diagnostic and therapeutic approaches is essential for optimal treatment planning. This study aimed to evaluate dental practitioners' knowledge of diagnostic and therapeutic strategies for EPLs in Pakistan. Methods: A cross-sectional survey was conducted among 380 registered dental practitioners in Pakistan using a self-administered questionnaire. Participants included 134 females (35.3%) and 246 males (64.7%), with the majority aged 25 – 30 years. The questionnaire assessed diagnostic, therapeutic, and prognostic knowledge of EPLs. Data were analyzed using descriptive statistics, Pearson's chi-square test, Fisher's exact test, and binary logistic regression. Results: There was a substantial range in the knowledge among participants based on their demographic characteristics and profession. Unadjusted analysis showed that a statistically significant association existed between knowledge levels and independent variables, including age ( p < 0.001), professional experience ( p < 0.001), specialization ( p < 0.001), and continuing professional training ( p < 0.001); however, there was no statistically significant association found between organization type ( p = 0.076). Multivariate logistic regression analysis indicated that practitioners aged 31–35 had a greater odds ratio [adjusted odds ratio (AOR) = 1.95, 95% confidence interval (CI): 0.90–4.22; p = 0.091] of good knowledge compared to those aged 25–30. However, practitioners aged 36–40 were significantly more likely to have good knowledge (AOR = 2.99, 95% CI: 1.38 – 6.47; p = 0.005). Conclusion: Practitioners had better therapeutic knowledge than diagnostic knowledge of EPLs, which indicates an overall above-average degree of awareness of EPLs, with noted gaps in diagnostic accuracy. Focused educational initiatives and evidence-based clinical practice guidelines may help improve practitioner decision-making for diagnosing EPLs as well as optimize the care provided for patients with EPLs, leading to improved patient outcomes.

Vital pulp therapy (VPT) is a minimally invasive approach aimed at preserving pulp vitality in cases of caries or trauma. Despite advancements in diagnostic tools and bioactive materials, clinical practices vary significantly. This study explored the preoperative, intraoperative, and postoperative practices of dental professionals in Saudi Arabia regarding VPT, with a focus on diagnostic tools, rubber dam isolation, and material selection. The aim was to identify practice variability and evidence-based gaps and propose strategies to standardise care. A cross-sectional study was conducted among 302 dental professionals using a validated online questionnaire. Data collection spanned December 2024 to early March 2025. Descriptive statistics, non-parametric tests, including the Mann-Whitney U and Kruskal-Wallis tests, were employed to compare practices across groups, while binary logistic regression identified predictors of good knowledge (≥70%). A P value 0.05 was considered statistically significant. Preoperative practices highlighted frequent use of pulp sensibility testing (79.1%) and periapical radiographs (50%), with cold testing as the preferred method (52.6%). However, advanced tools like CBCT were underutilised. Intraoperatively, 67.2% consistently used rubber dam isolation, while calcium hydroxide (22.5%) was the most commonly used pulp capping material, despite increasing adoption of mineral trioxide aggregate (MTA) and biodentine. Postoperatively, 46% adhered to a 3-6 month follow-up interval, relying on cold testing and percussion for assessment. Logistic regression revealed postgraduate education, specialisation, and frequency of VPT procedures as significant predictors of evidence-based practices. The findings highlight significant variability in VPT practices among dental professionals in Saudi Arabia, emphasising the need for targeted training programmes and standardised guidelines to bridge evidence-based gaps, improve clinical consistency, and optimise patient outcomes.

Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth–pulp–periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic–periodontal concepts upstream to include caries initiation and restorative modulation.