Oro-Dental Characteristics Associated with Pediatric Dental Neglect: A Retrospective Study

<b>Background/Objectives:</b> Dental neglect represents a preventable form of child maltreatment that may lead to significant oral and systemic health complications. This study primarily aimed to investigate the main oral manifestations and determinants of dental neglect in a pediatric population from Bihor County, Romania. Additionally, it assessed the association between systemic factors, such as nutritional status and psychological conditions, and the severity of oro-dental lesions, with the goal of informing future preventive strategies and public health interventions. <b>Methods:</b> A retrospective analysis was conducted on 333 pediatric patients diagnosed with dental neglect. Clinical data were collected from two centers between 2020 and 2024. Oral health status, socio-demographic characteristics, and psychological conditions were evaluated. Statistical analyses included Fisher's Exact Test, Mann-Whitney U Test, and Bonferroni-adjusted Z-tests, with significance set at <i>p</i> ≤ 0.05. <b>Results:</b> Among the 333 participants, 52.9% were male, with a mean age of 8.75 ± 3.29 years. Most children (81.7%) resided in rural areas, and 55.6% were first-born. Carious lesions were identified in 100% of cases, with 54.7% showing complications such as endodontic pathology. Poor oral hygiene was reported in 99.1% of children, while 58.6% presented signs of periodontal disease and 37.2% reported spontaneous gingival bleeding. Acute pain was experienced by 40.2% of participants. Nutritional issues were prevalent, with 24.3% classified as obese and 21.6% as malnourished. Significant associations were found between lesion severity and both psychological disorders (<i>p</i> < 0.001) and malnutrition (<i>p</i> < 0.001). <b>Conclusions:</b> This study identifies untreated carious lesions, poor oral hygiene, acute dental pain, and oro-dental trauma as key clinical indicators of pediatric dental neglect, with rural residency and limited education as significant socio-demographic risk factors. The findings highlight the urgent need for integrated, community-based strategies, including school-based screenings, parental education, and referral pathways, to improve early detection and prevention in Romania.