What do systematic reviews say?

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities)

Seven studies measured change in dental caries estimates.

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, schools, and aged-care facilities
  6 of 7 studies reported improved dental caries outcomes; 1 (Vichayanrat 2012) reported no change
  7 studies
  GRADE not reported

Outer carious dentin (by lesion depth/location) vs Inner carious dentin

No clear direction of MMP-9 expression by lesion depth/location was found; the evidence is very uncertain (very low certainty).

• Presence of host and bacterial-derived collagenolytic proteases in carious dentin: a systematic review of ex vivo… 2023 All outcomes

  Ex vivo (extracted teeth / clinical carious or biofilm samples)
  The evidence is very uncertain about the MMP-9 expression in different locations and lesion depth, as studies showed opposite effect directions.
  3 studies
  Very low

CPP-ACP vs CPP-ACFP

CPP-ACP did not differ significantly from CPP-ACFP (SMD 0.25, 95% CI -0.24 to 0.73); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD 0.25 [-0.24, 0.73]
  2 studies
  GRADE not reported

Toothache vs No dental pain

Toothache/dental pain is associated with worse OHRQoL in adolescents (narrative synthesis; no pooled estimate or GRADE rating).

• Oral-health-related quality of life in adolescents: umbrella review. 2023 All outcomes

  Community/school/clinic settings; adolescents 10-19 years; included reviews conducted in multiple countries
  Toothache, DMT and tooth loss have a high impact on OHRQoL in adolescentes [26]. There is low evidence that dental pain has a negative impact on OHRQoL [37].
  Studies not reported
  GRADE not reported

Periodontal disease (periodontitis; clinical attachment loss >=4 mm) vs Adults without periodontal disease (healthy periodontal status; CAL <=3 mm)

Adults with periodontal disease had significantly higher odds of root caries than those without (pooled OR 1.38, 95% CI 1.25 to 1.53; 2 observational studies; low certainty).

• Is there an association between periodontal disease and root caries? A systematic review and meta-analysis. 2023 All outcomes

  Population-based dental surveys: England (Adult Dental Health Survey 2009) and China (4th National Oral Health Survey) for the two pooled studies; included studies from China, England, Japan, and Finland
  OR 1.38 [1.25, 1.53]
  2 studies · 7664 participants
  Low

38% SDF one-time application without brushing programme vs no treatment without brushing programme

The review reported no significant result for SDF; no effect estimate or GRADE rating was reported.

• A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth. 2023 All outcomes

  18 months · Cagayan de Oro and Manila Philippines
  Mean new caries increment (surfaces) 0.12
  1 study · 1016 participants
  GRADE not reported

Access to dental care / health services vs No / limited access to dental care

Access to dental care is associated with better OHRQoL in adolescents (narrative synthesis; no pooled estimate or GRADE rating).

• Oral-health-related quality of life in adolescents: umbrella review. 2023 All outcomes

  Community/school/clinic settings; adolescents 10-19 years; included reviews conducted in multiple countries
  having parents who can provide dental care and safe housing are positive predictors for OHRQoL. access to dental care and the performance of health promotion programs are directly proportional to OHRQoL in adolescents.
  Studies not reported
  GRADE not reported

Superselective neck dissection vs Elective selective neck dissection

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: outcome not reported in a usable way in either study.
  0 studies
  No studies found

Treatment of traumatic dental injury vs No treatment of traumatic dental injury

The umbrella review reported that traumatic dental injury treatment reduces negative oral health-related quality-of-life impact, based on parental perception.

• Oral-health-related quality of life in adolescents: umbrella review. 2023 All outcomes
  no estimate extracted
  Studies not reported
  GRADE not reported

Glass ionomer cement vs Resin composite restoration

Over 2 or more years in permanent teeth, GIC probably reduces secondary caries versus resin composite (RR 0.50, 95% CI 0.28-0.91; moderate certainty).

• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  2 or more years of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 0.50 [0.28, 0.91]
  14 studies · 1571 participants
  Moderate
• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  1 year of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 0.33 [0.10, 1.05]
  5 studies · 380 participants
  Low

Supraomohyoid neck dissection vs Modified radical neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: significant difference in complication rates, lower for supraomohyoid (SOND 13.0% vs MRND 21.9%, P=0.040). UW-QOL at 1 year: supraomohyoid superior in pain relief (78.8% vs 75.2%, P=0.013) and shoulder…
  1 study · 332 participants
  Very low

Carious dentin before cavity sealing vs Carious dentin after cavity sealing

MMP-2 shows no difference before vs after cavity sealing; the evidence is very uncertain (very low certainty).

• Presence of host and bacterial-derived collagenolytic proteases in carious dentin: a systematic review of ex vivo… 2023 All outcomes

  Before vs after sealing (Kuhn 2016: 60 days follow-up) · Ex vivo (extracted teeth / clinical carious or biofilm samples)
  There is no difference of MMP-2 expression/activity before and after cavity sealing, although the evidence is very uncertain.
  2 studies · 48 participants
  Very low

Malocclusion vs No malocclusion

Malocclusions probably have a negative effect on OHRQoL in adolescents, after adjustment for confounders (moderate certainty).

• Malocclusions and quality of life among adolescents: a systematic review and meta-analysis. 2023 All outcomes

  Schools and dental clinics (multiple countries)
  Impaired OHRQoL, qualitative synthesis: relative effect not estimable across the 13 studies (13,864 participants); moderate quality of evidence (GRADE).
  13 studies · 13864 participants
  Moderate

Amalgam (AAG) vs Resin-modified glass ionomer cement (RMGIC)

Over 2 or more years in deciduous teeth, amalgam probably had a higher risk of secondary caries than RMGIC (RR 2.46, 95% CI 1.42-4.27; moderate certainty).

• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  2 or more years of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 2.46 [1.42, 4.27]
  8 studies · 1135 participants
  Moderate

Irradiated carious dentin vs Non-irradiated carious dentin

MMP-20 shows no difference between irradiated and non-irradiated carious dentin; the evidence is very uncertain (very low certainty).

• Presence of host and bacterial-derived collagenolytic proteases in carious dentin: a systematic review of ex vivo… 2023 All outcomes

  Ex vivo (extracted teeth / clinical carious or biofilm samples)
  There is no difference about the MMP-20 expression in irradiated vs. non-irradiated carious dentin, but the evidence is very uncertain (Gomes-Silva et al., 2017b).
  1 study · 36 participants
  Very low

PET-CT following chemoradiotherapy (neck dissection only if no/incomplete response) vs Planned neck dissection before or after chemoradiotherapy

PET-CT following chemoradiotherapy (neck dissection only if… showed no clear difference in locoregional recurrence compared with planned neck dissection before or after chemoradiotherapy (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 1.00 [0.94, 1.06]
  1 study · 564 participants
  Moderate

Elective neck dissection (at time of primary tumour resection) vs Therapeutic (delayed) neck dissection

Elective neck dissection (at time of primary tumour resection) probably leads to lower locoregional recurrence compared with therapeutic (delayed) neck dissection (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.58 [0.43, 0.78]
  4 studies · 458 participants
  Moderate

Intervention not reported

• A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth. 2023 All outcomes

  Llodra 2005 (6-monthly SDF, Cuba)
  Mean new active carious lesions per child 0.4 vs 1.1
  1 study
  GRADE not reported

Herbal mouthwash vs Blank control

Herbal mouthwash reduced several plaque-related indices, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  PI was significantly reduced compared to baseline [39; 48; 54; 58]; BBPI was significantly reduced compared to blank control [47]; TI and dental plaque amount were significantly reduced compared to baseline [45; 38].
  8 studies
  Very low

Intervention not reported

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Compound impression material
  Proportion 3.27
  1 study
  GRADE not reported