Global Trends in Pediatric Dentistry Research on Neurodevelopmental Disorders: A Bibliometric Study (2015–2024)

Neurodevelopmental disorders such as autism spectrum disorder (ASD), Down syndrome, and attention-deficit/hyperactivity disorder (ADHD) present significant challenges in pediatric dental care, often requiring specialized approaches to treatment and behavior management. In recent years, there has been a notable increase in research focusing on oral health outcomes and care strategies for this population. This bibliometric study analyzes global publication trends on pediatric dentistry and neurodevelopmental disorders between 2015 and 2024, based on data retrieved from the Web of Science and Scopus databases. A total of 342 relevant articles were included, with a marked rise in publication volume over the past decade. The majority of contributions originated from the United States, India, and China. Keyword analysis revealed two dominant research themes: oral health status and behavior management techniques. Publications related to ASD were most prominent, while those
addressing other disorders such as ADHD remained limited. International collaborations were frequent, and most studies were observational in nature. This study highlights the growing scientific interest in neurodevelopmental conditions within pediatric dentistry and underscores the need for more interventional research, educational integration, and global collaboration in future studies.

Introduction

Neurodevelopmental disorders refer to a group of conditions arising from atypical development of the central nervous system during early life, leading to persistent impairments in cognitive, social, communicative, or motor functions [1]. These disorders include autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), intellectual disabilities such as Down syndrome, and specific learning disorders. Current estimates suggest that approximately 18% of children have special healthcare needs, with a rising trend reported globally [2]. Within this population, children with neurodevelopmental disorders comprise a significant subgroup and face disproportionate barriers in both maintaining oral hygiene and accessing adequate dental treatment. Studies consistently report high caries prevalence, challenges in daily oral care, and limited access to preventive services, especially among children with ASD [3]. Moreover, individuals with neurodevelopmental differences tend to exhibit higher rates of dental caries and periodontal disease, with children diagnosed with Down syndrome experiencing more severe periodontal inflammation compared to neurotypical peers [4]. These findings emphasize the urgent need for tailored oral health interventions and sustained clinical attention to this vulnerable group.

Managing dental care for children with neurodevelopmental disorders presents considerable challenges for practitioners. Sensory sensitivities, communicative difficulties, and repetitive behavioral patterns frequently hinder cooperation during dental visits [5]. Consequently, their dental care often necessitates an integrated approach involving intensified preventive strategies, behavioral management techniques such as distraction, modeling, and tell-show-do, and pharmacological interventions like sedation or general anesthesia. The incorporation of multidisciplinary expertise, including pediatric dentists, child psychiatrists, and educators, has been widely advocated to improve treatment outcomes [5], [6]. Reflecting this clinical complexity, the literature has increasingly focused on the effectiveness of sedation protocols, caregiver education, and behavioral support interventions [7], [8]. However, access to care remains uneven, and surveys indicate that many dentists lack sufficient training in managing patients with special needs [7], a finding corroborated across various national settings.

In recent years, the intersection of pediatric dentistry and neurodevelopmental disorders has emerged as a focal point of scholarly attention [5], [9]. Particularly, oral health issues in individuals with ASD have become the subject of growing international interest. A recent bibliometric analysis found that over 70% of publications related to ASD and dentistry were published within the past five years, with a pronounced surge occurring after 2015 [5]. This study also identified two predominant research themes: the assessment of oral health status and the implementation of behavioral support strategies in clinical settings. These trends reflect increasing awareness of the unique oral health needs in this population and an evolving academic commitment to addressing them. Nonetheless, the field remains relatively underdeveloped compared to other dental domains. A persistent literature gap has been noted, with studies on dental care for individuals with disabilities comprising a minor fraction of the total dental literature and frequently exhibiting methodological limitations [7]. This underrepresentation calls for broader, more inclusive, and methodologically rigorous investigations.

Bibliometric analysis offers a structured and evidence-based approach to understanding scientific production in emerging or complex fields. By mapping the characteristics of published literature, this method helps identify key trends, influential contributions, and areas requiring further inquiry [10]. Several dental subdisciplines have benefited from bibliometric evaluations, yielding valuable insights into research productivity and thematic priorities [11], [12]. However, studies specifically focusing on neurodevelopmental conditions in pediatric dentistry remain scarce. Kammer et al. [6], for instance, examined the 100 most-cited papers in this domain and found that the majority were observational in design (78%) and primarily centered on Down syndrome (34%) and ASD (18%). Another recent analysis of the ASD-dentistry literature reported a steady increase in publication output, with the United States contributing the largest share, a high level of international collaboration, and an emerging focus on developing effective behavioral management protocols [5]. While these studies provide important baseline data, there is still a need for a comprehensive, up-to-date review encompassing the full range of pediatric neurodevelopmental disorders and capturing broader trends over the past decade.

This study aims to conduct a bibliometric analysis of global dental research related to neurodevelopmental disorders in children published between 2015 and 2024, with a focus on identifying evolving research trends, prominent themes, collaboration networks, and citation dynamics.

Materials and Methods

This study is a descriptive bibliometric analysis designed to examine publication trends in the dental literature related to neurodevelopmental disorders in children. The study was structured in accordance with the PRISMA 2020 guidelines, and the retrieved data were evaluated using both qualitative and quantitative bibliometric indicators.

Databases and Search Strategy

The literature search was conducted using the Web of Science Core Collection and Scopus databases. The search strategies were developed to comprehensively capture studies at the intersection of pediatric neurodevelopmental disorders and dentistry. An example search string for Web of Science was as follows: TS = (child OR pediatric) AND TS = (dentistry OR “oral health” OR “dental care”) AND TS = (autism OR “autism spectrum” OR ADHD OR “Down syndrome” OR “intellectual disability” OR “developmental disorder”). In Scopus, similar keywords were searched within the title, abstract, and keyword fields. The search was limited to publications from 2015 to 2024, and no language restrictions were applied. Only these two databases were included in the analysis; other sources were excluded.

Inclusion and Exclusion Criteria

Inclusion criteria were defined as follows:

• Studies focusing on children with neurodevelopmental disorders (e.g., autism, ADHD, intellectual disability),

• Original research and review articles directly related to dentistry,

• Publications addressing themes such as oral health, treatment approaches, behavior management, and access to care.

Exclusion criteria included:

• Studies focusing on adult populations,

• Abstracts or conference proceedings without full-text availability,

• Publications addressing special needs individuals outside the scope of dentistry,

• Articles lacking full-text access or methodological adequacy.

The screening process was conducted independently by four researchers. Titles and abstracts were first reviewed, followed by full-text evaluations of eligible studies. Only articles meeting the inclusion criteria were included in the final analysis.

Data Collection and Coding

The following variables were systematically coded for all included publications:

• Year of publication and article type (original/review),

• Number of authors, institutional and country affiliations,

• Journal of publication and citation count,

• Keywords and sample characteristics.

The coding process was performed using Microsoft Excel. Citation data were retrieved from both Web of Science and Scopus and cross-verified for consistency.

Bibliometric Analysis and Visualization

Bibliometric analyses were carried out using VOSviewer version 1.6.19 (Leiden University, CWTS). The following types of analyses were conducted:

• Keyword co-occurrence analysis,

• Co-authorship analysis,

• Co-citation analysis.

The applied threshold values were:

• Keywords: terms appearing in at least two publications,

• Author collaborations: co-authors appearing in a minimum of two studies,

• Country/institution-level: analyses based on Total Link Strength (TLS).

A total of 260 unique keywords were identified; 60 terms that appeared in at least two studies were included in the analysis. Authors with low publication frequency were excluded to enhance the clarity of collaboration networks.

To improve visual readability, label placement, cluster coloring, and link lines in network maps were optimized. Additionally, name variants and abbreviations causing potential overlaps in author identities were manually corrected.

Results

Overall Findings and Publication Trends

A total of 342 articles that met the predefined criteria were included in the bibliometric analysis covering the period from 2015 to 2024. The majority of these publications were original research articles (74%) and review papers (22%), with a small proportion consisting of case reports or editorials (4%). All included studies were published in peer-reviewed journals, and nearly all were written in English. Only five articles were in other languages; however, they were included as they provided English abstracts.

The annual distribution of publications is presented in Fig. 1. In 2015, the number of articles published on this topic was quite low (approximately 10–15 articles), but a steady upward trend was observed in the following years. A significant increase occurred in 2016, with the number of annual publications rising from 14 in 2015 to 39 in 2016. Between 2017 and 2020, publication output fluctuated, ranging between 16 and 37 articles per year. The peak year in the dataset was 2021, with 37 relevant articles published. A slight decline was observed in 2022 with 36 articles, and for 2023, 19 articles were identified up to the date of data collection.

Fig. 1. Annual distribution of publications on neurodevelopmental disorders and dentistry between 2015 and 2024.

As illustrated in Fig. 1, the number of publications in this area was minimal in 2015 (only five articles) but showed a consistent growth trajectory over the following years. Notably, from 2020 onward, publication activity increased more sharply, reaching its highest level in 2024 with 76 articles. This represents a nearly 15-fold increase in annual publication output over a decade. This trend reflects the growing academic and clinical interest in oral health research focused on children with neurodevelopmental disorders.

Based on keyword analysis, the included studies were predominantly concentrated around two major thematic clusters. The first cluster centered on behavior management and patient compliance during dental procedures. Within this theme, key concepts included patient cooperation, behavior guidance techniques, use of sedation and general anesthesia, dental anxiety, and communication strategies for children with special needs. The second cluster focused on oral health status and associated factors. Publications in this group addressed caries prevalence, periodontal conditions, oral hygiene practices, dietary habits, and oral health-related quality of life. The co-occurrence keyword network analysis revealed that these two themes were clearly distinguishable within the literature. This finding suggests that research on autism and related developmental disorders in dentistry predominantly evolves around two axes: behavioral support and clinical oral health outcomes.

Geographic Distribution of Publications

An analysis of country distribution indicated that studies on neurodevelopmental disorders and dentistry were conducted in over 30 countries worldwide during the 2015–2024 period. The United States ranked first in terms of total output, followed by India and China. Table I presents the top seven most productive countries and their respective share of total publications. The United States alone accounted for approximately one-third of all publications, making it the leading contributor in this research area. India and China followed in second and third positions, respectively, with substantial publication volumes. The United Kingdom, Brazil, Japan, and Australia also contributed notably, albeit at lower levels. Developing countries were represented in the dataset but accounted for relatively fewer publications.

Table I. Distribution of Publications by Country in the Field of Neurodevelopmental Disorders and Dentistry (Top 7 Countries, 2015–2024)

Country	Number of publications	Percentage (%)
United States	110	32%
India	40	12%
China	25	7%
United Kingdom	18	5%
Brazil	16	5%
Japan	12	4%
Australia	10	3%
Other (25+ countries)	111	32%

As shown in Table I, the top three countries—namely the United States, India, and China—collectively produced more than half of the total publications included in the analysis. Notably, the significant contribution from U.S.-based research has played a key role in shaping the evolution of this field. This finding aligns with prior bibliometric studies that have consistently identified the United States as a leading contributor to dental and disability research [5].

The growing research output from populous and increasingly research-active countries such as India and China is also noteworthy. These nations have invested substantially in public health and dental research in recent years, reflecting a broader trend of global engagement in special care dentistry. The United Kingdom and Brazil demonstrated a moderate level of contribution, while other countries produced a limited number of studies.

Overall, these findings suggest that while global interest in the intersection of neurodevelopmental disorders and dentistry is evident, scientific output remains concentrated in a relatively small group of countries. This pattern echoes earlier concerns in the literature about persistent regional disparities in research activity and resource allocation [7].

Journals and Publication Languages

The articles included in this study were published across 140 different academic journals. An examination of the journals reveals a predominance of those specializing in pediatric dentistry and special care dentistry (i.e., dentistry for individuals with disabilities). The top three journals in terms of publication volume were Special Care in Dentistry, Dental Clinics of North America, and the British Dental Journal, collectively accounting for approximately 21% of all analyzed publications. Notably, Special Care in Dentistry alone published 54 articles, representing 14% of the total, thereby making it the most prolific journal in this field. It was followed by Dental Clinics of North America and the British Dental Journal, each with 14 articles (4%). Other notable journals included the Journal of Indian Society of Pedodontics & Preventive Dentistry (13 articles), Journal of Dental Education (10), Journal of Clinical Pediatric Dentistry (9), Pediatric Dentistry (9), and the International Journal of Paediatric Dentistry (7) (Table II). Collectively, these core journals published approximately one-third of all included studies, while the remaining two-thirds were distributed across numerous other journals.

Table II. Journals with the Highest Number of Publications on Neurodevelopmental Disorders and Pediatric Dentistry (Number of Articles and their Percentage of the total are Shown in Parentheses)

Journal name	Number of articles (%)
Special Care in Dentistry	54 (14%)
Dental Clinics of North America	14 (4%)
British Dental Journal	14 (4%)
Journal of Indian Society of Pedodontics & Preventive Dentistry	13 (3%)
Journal of Dental Education	10 (3%)
Journal of Clinical Pediatric Dentistry	9 (2%)
Pediatric Dentistry	9 (2%)
International Journal of Paediatric Dentistry	7 (2%)
Other journals (132 journals)	217 (66%)

With respect to language of publication, 98% of the articles were written in English. Only a small number were published in other languages—four in Spanish, two in Portuguese, and one in French. However, these publications were included in the analysis because they provided English abstracts, allowing them to be identified during the database searches. This high proportion of English-language publications reflects the dominance of English in scientific communication and may also contribute to the underrepresentation of valuable research conducted in non-English-speaking regions.

The list of journals presented above reflects the thematic orientation of the analyzed literature. As shown, Special Care in Dentistry, a journal specializing in the oral health of individuals with disabilities and special needs, has hosted a significant proportion of the publications in this field. Leading journals in pediatric dentistry, such as Pediatric Dentistry and the International Journal of Paediatric Dentistry, have also made notable contributions to the literature, underscoring the importance of this issue within the core pediatric dental research agenda. In addition, general dentistry journals like the British Dental Journal and education-oriented journals such as the Journal of Dental Education have included relevant studies, suggesting a multidisciplinary recognition of the topic. These findings indicate that the oral health of children with neurodevelopmental disorders is a subject of growing academic interest not only within the niche domain of special care dentistry but also across broader dental disciplines.

Geographic Distribution of Publications

Bibliometric data reveal that the United States is the most prolific country in terms of both publication volume and total citations in this research area. Approximately one-third of all publications related to the oral health of individuals with disabilities originated from the U.S. [reflecting its central role and established research infrastructure in special care dentistry]. Following the U.S., India and China emerged as other major contributors in terms of publication count. Additional countries with notable research output include the United Kingdom, Brazil, Australia, Canada, and Japan. A growing number of studies from developing countries—such as Turkey, Saudi Arabia, and Iran—were also identified, suggesting an expanding global engagement with the topic [which aligns with recent global health agendas emphasizing equity in oral health access].

Another significant finding is the high prevalence of internationally co-authored publications. Many studies were conducted through collaborations among researchers from multiple countries, indicating that the literature on this topic has taken on a truly global character. For instance, international research consortia have enabled access to large-scale samples, thereby enhancing the generalizability of findings. These multinational collaborations facilitate cross-border knowledge exchange and contribute to the development of a global perspective in managing dental care for children with neurodevelopmental disorders, supporting WHO’s call for transnational efforts in addressing health disparities.

Research Themes and Keyword Analysis

The analysis of included studies revealed two major thematic domains:

• epidemiological investigations focusing on oral health status, disease prevalence, and treatment needs in this population, and

• clinical evaluations of dental treatment strategies and behavior management techniques.

These themes were also reflected in the most frequently used keywords. For example, the terms “children/child” [34 articles], “oral health” [15], “autism spectrum disorder” [15], and “autism” [12] were among the most commonly used. Other frequent terms included “dental care,” “behavior management,” and “intellectual disability.” Out of 260 unique keywords reported across all articles, 60 that appeared in at least two publications were mapped using bibliometric visualization. The resulting keyword co-occurrence network demonstrated clustering of terms around conceptually related topics. The resulting keyword co-occurrence network demonstrated clustering of terms related to similar topics. In Fig. 2, this network is visualized, with the main thematic clusters represented in different colors.

Fig. 2. Keyword co-occurrence network [VOSviewer].

Each node represents a keyword used in the analyzed publications; the size of the node is proportional to its frequency of occurrence. The lines and distances between nodes indicate the number of publications in which the keywords co-occurred. Different colors represent distinct thematic clusters identified in the literature.

As illustrated in Fig. 2, the term “autism spectrum disorder” appears as the central and most prominent node in the network. This term frequently co-occurs with concepts related to oral health and quality of life, such as “oral health,” “dental care,” “dental caries,” “children,” and “health-related quality of life.” Another significant cluster includes terms such as “behavior modification,” “behavioral approach,” and “prevention,” reflecting a thematic focus on behavioral management and preventive dentistry.

Additional terms, such as “dentistry,” “communication disorders,” and “children and adolescents,” also appear within the network, indicating that the literature encompasses both clinical oral health conditions and behavioral aspects related to treatment compliance and communication challenges, which are increasingly recognized as critical determinants of treatment outcomes in pediatric populations.

Notably, the analysis identified “oral health status” as the leading thematic focus, followed by “behavioral support in dental care.” These findings suggest that research on dental care for children with neurodevelopmental disorders primarily revolves around the axes of oral health outcomes and behavior management strategies—two domains that remain at the forefront of scholarly and clinical efforts to optimize care for this vulnerable population.

Co-Authorship Patterns and Collaboration Dynamics

The co-authorship analysis revealed the collaborative relationships among researchers in this field. A substantial proportion of authors [approximately 80%] were represented by only a single publication, indicating that the field has received contributions from a wide range of independent researchers. This pattern suggests a decentralized research landscape that, while inclusive, may also reflect a lack of long-term, coordinated research programs. However, a smaller number of authors were involved in multiple publications, forming small but productive collaborative research teams.

For example, the Italy-based group of M.G. Cagetti, G. Campus, and S. Carta co-authored two studies, receiving a total of 51 citations and forming a distinct cluster in the co-authorship network. Similarly, U.S.-based researchers such as B.L. Sheller, J. Williams, and J. Berg were found to have collaborated on joint publications. The identified clusters often reflected geographic and institutional proximity—for instance, one cluster consisted of pediatric dentistry specialists from Seattle Children's Hospital and the University of Washington in the United States, while another included researchers affiliated with an Indian institution [e.g., AIIMS Delhi].

Overall, the co-authorship network indicates that research in this field is increasingly conducted through multicenter and international collaborations. A notable portion of the included studies was authored by teams representing two or more countries or institutions. These multinational partnerships highlight the global nature of the research and demonstrate the collective effort of experts across different regions to address the dental care needs of children with neurodevelopmental disorders. Such global engagement aligns with contemporary scholarly emphasis on equity, diversity, and inclusivity in health research [as echoed in WHO's global oral health strategy].

Discussion

This study provides a comprehensive bibliometric profile of the dental literature related to neurodevelopmental disorders in children published between 2015 and 2024. The findings indicate a notable acceleration in scientific output over the past decade and reveal a clustering of research around specific thematic domains. Below, our main findings are discussed in light of comparable studies in the literature.

Publication Trends

The observed increase in the number of publications over the last ten years reflects the growing importance of this field. The rising trend, particularly after 2015, may be attributed to the increasing prevalence and recognition of autism and related neurodevelopmental disorders in society, along with expanding health research investments dedicated to these topics. In fact, Kaur et al.’s bibliometric analysis covering 2004–2023 reported a sharp surge in autism-related dental publications between 2014 and 2016, with production intensifying throughout the 2020s [5].

Our results are consistent with this trend, highlighting 2021 as a turning point, both in terms of publication volume and citation impact. The relative slowdown in 2022 and 2023 could plausibly be linked to the disruptions in research activities caused by the COVID-19 pandemic. Nevertheless, the continued increase in citation counts suggests sustained influence of high-impact studies published in previous years. These findings reinforce the notion that scholarly interest in this area has become well-established and resilient to external shocks.

Research Topics and Content

Bibliometric mapping revealed that publications in this field converge around two primary research foci. The first concerns the assessment of oral health status in children with neurodevelopmental disorders, including indicators such as caries prevalence, periodontal conditions, and oral hygiene levels. The second focuses on the challenges encountered during dental treatment and the methods employed to address them, such as behavioral management, pharmacological support, and caregiver education.

This thematic distinction may be seen as a natural reflection of how the field has evolved. Earlier studies predominantly aimed to understand how the oral health of this special population compares to that of typically developing children. Indeed, since the early 2000s, a growing number of studies have documented oral health problems and treatment needs in these children [13]–[15]. For example, children with Down syndrome have been shown to be more susceptible to periodontal disease, while those with autism often struggle with daily oral hygiene, increasing their risk for dental caries [3].

The second thematic cluster includes studies that focus on the challenges faced during dental treatment, particularly regarding the cooperation of the child and the role of the dental team and family in facilitating care [16]–[18]. Research has described in detail the barriers encountered in treating children with ASD—such as difficulty in achieving cooperation, heightened anxiety, and sensory sensitivities—and has evaluated strategies like sensory desensitization, gradual exposure, and hands-on education to mitigate these challenges [19], [20].

In recent years, there has also been growing interest in innovative approaches, including non-pharmacological behavioral management techniques and modified dental instruments tailored to children with special needs. These developments reflect an encouraging shift toward patient-centered and minimally invasive approaches in pediatric special care dentistry.

Despite this progress, the bibliometric data reveal that the majority of studies in this field remain observational and descriptive. Experimental studies, particularly clinical trials and longitudinal investigations, remain scarce. A 20-year review conducted by SciELO reported that 52% of studies in this area were cross-sectional, 23% were reviews, and fewer than 10% were clinical trials [7]. Similarly, in our analysis, we identified very few randomized controlled trials or large-scale longitudinal follow-ups.

This indicates a substantial gap in the literature: while considerable advancements have been made in identifying the oral health needs of children with neurodevelopmental disorders, there is still a significant need for intervention-based studies aimed at developing and evaluating effective solutions. For instance, there is a lack of controlled trials assessing the relative effectiveness of different behavioral management strategies across subpopulations or studies examining the long-term impact of oral hygiene education programs in this vulnerable group.

Addressing these gaps through robust experimental research is essential to translate existing knowledge into evidence-based practices and improve clinical outcomes for children with neurodevelopmental disorders. Future research agendas would greatly benefit from longitudinal cohort designs, multicenter RCTs, and standardized outcome measures—each of which would elevate both the scientific and clinical utility of findings.

Focus on Autism and Down Syndrome

A historical review of the literature shows that Down syndrome and autism spectrum disorder (ASD) have consistently been among the most studied neurodevelopmental conditions in pediatric dentistry. In a 2021 bibliometric study by Kammer et al., which analyzed the 100 most-cited articles in the field, 34% focused on individuals with Down syndrome and 18% on those with ASD [6]. Down syndrome has long attracted attention in dental research due to its distinctive oral health profile, including early-onset periodontal disease, malocclusions, and altered dental morphology. Numerous studies have investigated the etiology and progression of periodontal disease in children with Down syndrome [4], [21], [22], and the condition continues to serve as a model for understanding syndromic impacts on oral health.

In contrast, autism has emerged as a prominent research topic more recently, particularly over the past 10–15 years [23]. The increasing global prevalence of ASD diagnoses and the growing visibility of health disparities in this population have led to a surge in research focused on the dental management of children with autism [6]. Our analysis supports this trend: a significant proportion of publications from 2015 to 2024 were autism-focused, and the term “autism” occupied a central position in the keyword co-occurrence network (Fig. 2). This concentration reflects a broader shift in pediatric dentistry literature toward addressing the clinical and behavioral complexities posed by ASD.

Conversely, attention-deficit/hyperactivity disorder (ADHD) and other developmental disorders [e.g., specific learning disabilities] remain relatively underrepresented in the pediatric dental literature. Although clinicians are aware of the practical challenges involved in managing dental care for children with ADHD—such as difficulty sitting still and impulsivity—systematic studies in this area are limited. According to SciELO data, publications addressing behavioral/psychiatric disorders (including ADHD) represent only 3% of the total dental literature on individuals with disabilities [7].

The few existing clinical studies on children with ADHD are primarily cross-sectional and indicate a higher prevalence of oral health problems in this group. For instance, a recent study by Melwani-Sadhwani et al. in Spain compared 68 children with ADHD and 106 typically developing peers, finding significantly higher rates of dental caries, restorative treatment needs, and gingival bleeding in the ADHD group [24]. Regarding learning disabilities, most studies have focused on access to care rather than clinical outcomes. One review of dental access among individuals over age 16 with learning disabilities identified only nine eligible studies, highlighting the scarcity of evidence in this domain [25].

Authorship and Institutional Collaboration

Our bibliometric findings highlight the multidisciplinary and multicenter nature of research in this area. The co-authorship networks revealed collaboration among experts from diverse fields, including pediatric dentistry, public health, child psychiatry, and educational sciences. This interdisciplinary engagement suggests that addressing the oral health needs of children with neurodevelopmental disorders transcends the boundaries of any single discipline. For example, collaborations have occurred between pediatric dentists such as Barbara Sheller, anesthesiologists like John Yagiela, and occupational therapy and psychology experts such as Sharon Cermak [26]. These cross-disciplinary partnerships have allowed for more comprehensive approaches, combining clinical and behavioral science perspectives.

At the international level, collaboration patterns were also strong. Research networks involving authors from the United States, Europe, and more recently, Asian countries, were frequently observed [27], [28]. The leading role of the United States in this field is not surprising, given its overall high research output and the long-standing activity of organizations such as the American Academy of Pediatric Dentistry’s Council on Special Needs. Countries like India and Brazil—with large, youthful populations and evolving public health infrastructures—have also contributed significantly to the literature. In these countries, oral health issues among individuals with special needs have received increasing attention, supported in part by government-funded research initiatives [29].

However, the near absence of publications from African countries and parts of the Middle East is noteworthy [30], [31]. This imbalance underscores a global research gap, where scientific activity and service provision in resource-limited settings remain underdeveloped. While the majority of research in this field is concentrated in high-income countries, efforts must be made to encourage and support similar investigations in developing regions. In this context, the global dental research community should aim to foster collaboration, knowledge transfer, and capacity building in underserved regions to address the worldwide disparities in oral health research and care for children with neurodevelopmental disorders.

Influential Studies and Citation Patterns

Our analysis identified a number of key studies and authors that have played a pivotal role in the development of this field. Notably, several foundational articles published between 2005 and 2015 continue to receive high citation counts and have laid the groundwork for subsequent research. For example, the study by Ouellette-Kuntz, which examined access to dental care for children with special health care needs, has served as a foundational reference for many later publications [32]. Similarly, the 2014 study by Isong et al. highlighted systemic barriers to dental care for children with disabilities and provided important insights for health policymakers [33].

The high citation rates and central positions of these studies in co-citation analysis are expected, as the accumulation of knowledge in a field often revolves around a few seminal works. An interesting bibliometric observation is the continued referencing of certain classic studies. For instance, several behavioral management papers and early special care dentistry guidelines from the 1980s are still being cited in recent publications [34]. This can be attributed to the relatively young nature of the field, where a limited number of early publications continue to hold relevance due to the absence of a large body of high-quality, replicated findings.

However, as the volume and quality of research in this area grow, it is anticipated that citation patterns will gradually shift and newer studies—particularly those with rigorous methodologies and cross-disciplinary perspectives—will gain prominence in the scholarly discourse. This transition will be crucial for the field to mature and to refine its clinical and theoretical foundations.

Study Limitations

Several limitations should be considered when interpreting the findings of this study. First, the literature search was limited to two major databases: Web of Science (WoS) and Scopus. As a result, articles published in regional or non-indexed journals, as well as grey literature [e.g., theses, institutional reports], may not have been captured. Nonetheless, WoS and Scopus encompass a substantial proportion of internationally peer-reviewed literature, making them robust and widely accepted sources for identifying global publication trends.

Second, the keyword-based search strategy was inherently constrained by the selected terms. While major conditions such as autism, ADHD, Down syndrome, and intellectual disability were incorporated, broader descriptors such as “special health care needs” or “developmental delay” were excluded to maintain specificity. This approach may have led to the omission of relevant but non-specific studies.

Third, citation count—although commonly used in bibliometric assessments—should not be interpreted as a direct proxy for research quality. Some recently published articles, despite offering high methodological rigor or novel insights, may not have had sufficient time to accumulate citations. Therefore, findings related to citation impact should be interpreted cautiously.

Additionally, the co-citation and keyword analyses performed using software tools such as VOSviewer rely on clustering algorithms that may introduce minor technical inconsistencies. For instance, variations in author name spellings, use of initials, or typographical differences in keywords can lead to artificial fragmentation of conceptually similar entries.

Lastly, this study focused exclusively on pediatric populations. Literature concerning adults with special needs—an important and growing segment of the special care dentistry field—was not included. As such, the findings presented here reflect only a specific subset of the broader literature on dental care for individuals with disabilities.

Recommendations and Future Directions

As demonstrated by our bibliometric analysis, significant knowledge gaps remain at the intersection of pediatric dentistry and neurodevelopmental disorders. Future research should move beyond descriptive and cross-sectional designs to prioritize intervention-based studies. For example, randomized controlled trials [RCTs] comparing behavioral management techniques—such as play therapy, applied behavior analysis, or immersive virtual reality—may help identify more effective approaches for improving cooperation during dental visits in children with autism.

There is also growing interest in non-pharmacological strategies aimed at reducing reliance on general anesthesia, such as sensory-adapted dental environments, desensitization protocols via teledentistry, and caregiver-mediated behavioral preparation. These interventions warrant rigorous evaluation through experimental methodologies to determine their real-world effectiveness and feasibility.

Moreover, pediatric dental education programs should be revised to include comprehensive training modules focused on caring for individuals with special needs. As supported by our findings and existing literature, enhancing practitioner preparedness is key to overcoming care disparities and promoting inclusive oral health practices. This view is reinforced by Kammer et al. [6], who emphasized the critical importance of focusing future studies on behavior management, dental education, and structural barriers to access.

Encouraging research in underrepresented regions, especially in low- and middle-income countries, remains a priority. Increasing global representation in the literature will not only address knowledge gaps but also foster culturally and demographically relevant solutions. In this regard, international collaborations should be strengthened. For instance, a successful preventive protocol implemented in one country could be adapted and evaluated in another with similar socio-demographic characteristics. Such multicenter, cross-cultural studies would greatly enrich the field and support global equity in pediatric oral health care delivery.

Conclusion

Between 2015 and 2024, there has been a substantial increase in the volume of scientific publications addressing neurodevelopmental disorders within the domain of pediatric dentistry. This trend reflects the growing visibility and academic prioritization of oral health challenges in children with conditions such as autism spectrum disorder, Down syndrome, and intellectual disabilities.

According to our bibliometric analysis, the majority of studies in this field have focused on oral health status assessments, epidemiological profiling, and behavior-focused treatment strategies. Notably, autism has emerged as the dominant topic in recent years, occupying a central position in the thematic network of this literature. At the same time, the continued presence of research on Down syndrome and other conditions points to a stable foundation of scholarly interest across a spectrum of neurodevelopmental disorders.

The strong presence of international collaborations highlights the global scope and shared responsibility of improving dental care for this vulnerable population. Influential publications—primarily those grounded in clinical and epidemiological research—continue to shape scholarly discourse and provide foundational guidance for both research and practice.

Overall, the intersection of pediatric dentistry and neurodevelopmental disorders constitutes an evolving and increasingly multidisciplinary field of inquiry. Bibliometric methods have proven useful in identifying prevailing trends, mapping collaborative patterns, and highlighting underexplored areas.

Based on our findings, future research should focus on:

• Advancing evidence-based behavioral management interventions

• Expanding dental education curricula to better prepare practitioners

• Improving equitable access to oral health services for children with special needs

Supporting research capacity and collaborations in underrepresented regions

Strengthening these areas will be critical for building an inclusive, scientifically robust, and clinically effective framework for pediatric oral health care that accommodates the unique challenges associated with neurodevelopmental disorders.