Closing the gap between evidence and practice

For decades, the scientific community has produced guidelines, consensus statements, and shared recommendations. The literature on the prevention of early childhood caries is extensive, robust, and consistent. Yet epidemiological data have not improved in proportion to the effort invested. Early childhood caries remains one of the most prevalent chronic diseases worldwide. Evidently, a substantial gap persists between knowledge and practice. The issue does not lie in the quality of the evidence. Rather, it lies in the assumption, too often implicit, that dissemination alone is sufficient to translate evidence into action. We have produced rigorous and well-argued documents, assuming that their intrinsic strength would be enough to modify behaviours. It is not. Between recommendations and everyday practice lies a divide that no consensus statement, in isolation, can bridge. A shift in perspective is therefore required. Not less research, but different research: fewer studies on what is already known to be effective, and greater focus on how to make such interventions genuinely adoptable in vulnerable contexts-among families with limited time and difficult access, within the constraints of brief paediatric consultations, and in healthcare systems operating under pressure and with limited resources. Evidence-based medicine has taught us to ask whether an intervention is effective; today, we must add an equally critical question: how can we ensure its actual implementation? Alongside evidence of efficacy, we therefore need evidence-based implementation, capable of identifying the conditions, organisational frameworks, and engagement strategies that render interventions feasible in routine practice. Implementation science is not a secondary discipline; it is the missing one. Idealism without pragmatism produces literature. Pragmatism guided by ideals produces health. Paediatric prevention requires the latter, and the scientific community, if it is to remain true to its mission, cannot afford to overlook it. Knowledge without change is insufficient; it is merely nostalgia.