Research in paediatric dentistry: the paradox of reviews without trials

Bibliometrics is not an exercise in academic vanity, but a diagnostic tool: it measures not only how much we produce, but what we choose to study - and what we leave behind. Over the past two decades, scientific output in paediatric dentistry has grown exponentially. More articles, greater visibility, broader internationalisation. Yet a higher volume of publications does not automatically translate into improved clinical decision-making. Bibliometric analyses reveal a polarised discipline: cariology and orofacial development predominate, whilst emerging topics such as molar-incisor hypomineralisation (MIH) are steadily gaining ground. This is a predictable, yet telling distribution: what is common tends to be studied; what is complex tends to be avoided. The critical issue, however, is methodological. Amongst the most highly cited works, reviews - both systematic and narrative - vastly outnumber randomised clinical trials (RCTs), which remain marginal and are frequently methodologically weak. Even when present, RCTs demonstrate notable limitations, with reporting quality that remains insufficient. The outcome is a paradox: increasingly sophisticated syntheses constructed upon limited primary data. Meta-analyses cite meta-analyses; clinical guidelines are based on reviews of reviews. The evidence pyramid thus risks resting on fragile foundations, yielding descriptive rather than decisional evidence. This is not a matter of quantity, but of direction. Without a determined investment in robust primary studies, growth risks becoming self-referential. The literature continues to describe problems far more readily than it tests solutions. A further concern relates to representativeness: research today is concentrated in a limited number of countries, yet it is widely acknowledged that children's oral health is profoundly influenced by local contexts. A truly mature discipline must therefore critically appraise how inclusive its knowledge base is, and whether it adequately represents diverse realities. Bibliometrics thus offers a clear picture: paediatric dentistry is productive, yet still limited in its capacity to generate decisive evidence. The challenge is not to publish more, but to produce better. What is needed is not further reviews of weak data, but sufficiently robust primary data to render fewer reviews necessary. In this context, scientific journals play a pivotal role. Editorial choices shape the direction of research: prioritising methodologically sound studies - even those that may be less readily 'citable' - means directly influencing the future quality of evidence. For editors, reviewers, and authors alike, the responsibility is tangible: to shift the emphasis towards studies capable of genuinely guiding clinical practice. Because the true indicator of a discipline's maturity is not what it publishes, but what it is able to demonstrate - and to change.