{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T08:43:38Z","timestamp":1794645818139,"version":"4.9.1"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Caries experience, plaque accumulation, gingival inflammation, and periodontal screening findings may coexist as manifestations of a shared oral-health burden. We examined whether these routinely recorded indicators form distinct multivariable profiles or primarily represent ordered levels along a common burden continuum in children and adolescents. Materials and Methods: This secondary exploratory analysis included 638 participants from a multicenter cross-sectional clinical database: 407 aged 6\u201312 years and 231 aged 13\u201319 years. Permanent-dentition Decayed, Missing, and Filled Teeth score, Plaque Index, Gingival Index, and Community Periodontal Index were standardized and analyzed separately by age stratum. Unsupervised K-means clustering compared solutions containing two to five groups to summarize participant-level patterns without imposing predefined clinical categories. Hierarchical Ward classification assessed algorithmic concordance; principal component analysis and a composite standardized burden score assessed dimensionality. Sensitivity analyses excluded the periodontal index or treated it as ordinal with Gower-distance partitioning around medoids, and 1000 repeated 80% subsamples assessed sampling stability using the adjusted Rand index. Results: A single principal component explained 91.0% of variance at 6\u201312 years and 91.8% at 13\u201319 years, with all four indicators loading strongly on the same dimension. Ordered cluster membership correlated closely with the composite burden score (Spearman \u03c1 = 0.942 and 0.939; both p &lt; 0.001). The retained low-, intermediate-, and high-burden groupings were highly consistent when the periodontal index was excluded or treated as ordinal and under repeated subsampling. In adolescents, a two-group alternative preserved the low- and high-burden extremes while dividing the intermediate group, indicating that the number of groups changes descriptive granularity rather than revealing a separate phenotype. Conclusions: The principal new finding is that four commonly used oral-health indicators converge on one dominant participant-level burden dimension rather than defining distinct clinical phenotypes. This supports an integrated epidemiological description of cumulative oral-health burden while cautioning against interpreting data-driven groups as diagnostic or treatment categories. The numerical group distributions are sample-specific and require external and longitudinal validation before being transferred to other populations or clinical decision-making.<\/jats:p>","DOI":"10.3390\/medicina62091654","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:33:52Z","timestamp":1787942032000},"page":"1654","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploratory Grouping Along a Shared Oral-Health Burden Continuum in Children and Adolescents: An Age-Stratified Cluster Analysis"],"prefix":"10.3390","volume":"62","author":[{"given":"Narcis Mihaita","family":"Bugala","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9667-4715","authenticated-orcid":false,"given":"Smaranda-Adelina","family":"Bugala","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6535-3152","authenticated-orcid":false,"given":"Mihaela Jana","family":"\u021auculin\u0103","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ancuta Ramona","family":"Camen","sequence":"additional","affiliation":[{"name":"Department of Occupational Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3108-2451","authenticated-orcid":false,"given":"Alina Nicoleta","family":"Capitanescu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragos","family":"Cadea","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Macovei","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana","family":"Selaru","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Rica","sequence":"additional","affiliation":[{"name":"Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana Maria","family":"Albulescu","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022). 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