What do systematic reviews say?

Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs HIV-negative individuals

In cross-sectional studies, children and adolescents with HIV on antiretroviral therapy had about twice the odds of dental caries versus HIV-negative peers (OR 2.04, 95% CI 1.21 to 3.42; very low certainty).

• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Not specified (cross-sectional) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Cross-sectional studies
  OR 2.04 [1.21, 3.42]
  6 studies · 2206 participants
  Very low
• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Not specified (case-control) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Case-control studies
  OR 3.15 [0.98, 10.15]
  1 study · 99 participants
  Very low
• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Prospective follow-up (single cohort) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Cohort studies
  OR 2.11 [1.41, 3.17]
  1 study · 544 participants
  Very low

HAART (highly active antiretroviral therapy, >=3 drugs) vs HIV-positive not receiving HAART (standard ART or HAART-naive)

Among HIV+ children, HAART versus no HAART showed no significant difference in the odds of dental caries by DMFT in cross-sectional studies (OR 1.29, 95% CI 0.59 to 2.84; ungraded).

• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Not specified (cross-sectional) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Cross-sectional studies; DMFT index
  OR 1.29 [0.59, 2.84]
  Studies not reported
  GRADE not reported
• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Not specified (cross-sectional) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Cross-sectional studies; deft index
  OR 1.09 [0.65, 1.82]
  Studies not reported
  GRADE not reported

HIV-infected children on antiretroviral therapy (HI) vs HIV-unexposed uninfected children (HUU)

HIV-infected children on ART had higher odds of dental caries than HUU children in case-control studies (OR 1.61, 95% CI 1.02 to 2.56; ungraded).

• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Not specified (case-control) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Case-control studies
  OR 1.61 [1.02, 2.56]
  Studies not reported
  GRADE not reported
• Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review… 2025 All outcomes

  Not specified (cross-sectional) · Dental examination of children/adolescents with HIV in clinic and community settings; low- and middle-income countries (Brazil, India, Nigeria, Cambodia, Uganda, West Africa) · Cross-sectional studies
  OR 1.80 [0.98, 3.28]
  Studies not reported
  GRADE not reported

Machine-learning algorithms for dental caries detection vs Different machine-learning algorithms for caries prediction

The review reported 70% accuracy for dental caries detection in Mayank et al. (Ungraded).

• Uses of Different Machine Learning Algorithms for Diagnosis of Dental Caries. 2022 All outcomes

  USA · Mayank et al., 2017; F-CNN
  Accuracy 70
  1 study · 3000 participants
  GRADE not reported
• Uses of Different Machine Learning Algorithms for Diagnosis of Dental Caries. 2022 All outcomes

  Mexico · Zanella-Calzada et al., 2018; ANN
  Accuracy 69
  1 study · 189 participants
  GRADE not reported
• Uses of Different Machine Learning Algorithms for Diagnosis of Dental Caries. 2022 All outcomes

  India · Geetha et al., 2020; backpropagation
  Accuracy 97.1
  1 study · 105 participants
  GRADE not reported

Intervention not reported

In Africa, the pooled prevalence of permanent-teeth caries in children was 58.9% (95% CI 29.4 to 83.1); certainty not graded.

• Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and… 2020 All outcomes

  Community- and school-based child populations worldwide (multiple continents) · Africa
  Prevalence 0.589 [0.294, 0.831]
  5 studies · 2794 participants
  GRADE not reported

Intervention not reported

In Europe, the pooled prevalence of permanent-teeth caries in children was 44.1% (95% CI 36.1 to 52.5); certainty not graded.

• Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and… 2020 All outcomes

  Community- and school-based child populations worldwide (multiple continents) · Europe
  Prevalence 0.441 [0.361, 0.525]
  22 studies · 115141 participants
  GRADE not reported

Intervention not reported

In Australia, the pooled estimate of permanent-teeth caries prevalence in children was 54.9% (95% CI 50.9 to 58.8) from a single study; certainty not graded.

• Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and… 2020 All outcomes

  Community- and school-based child populations worldwide (multiple continents) · Australia
  Prevalence 0.549 [0.509, 0.588]
  1 study · 612 participants
  GRADE not reported

Intervention not reported

The pooled worldwide prevalence of dental caries in permanent teeth in children was 53.8% (95% CI 50.0 to 57.5), with very high heterogeneity (I2=99.8%); certainty not graded.

• Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and… 2020 All outcomes

  Community- and school-based child populations worldwide (multiple continents)
  Prevalence 0.538 [0.5, 0.575]
  83 studies · 1454871 participants
  GRADE not reported

Intervention not reported

In the Americas, the pooled prevalence of permanent-teeth caries in children was 48.9% (95% CI 37.6 to 60.3); certainty not graded.

• Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and… 2020 All outcomes

  Community- and school-based child populations worldwide (multiple continents) · America
  Prevalence 0.489 [0.376, 0.603]
  7 studies · 5009 participants
  GRADE not reported

Intervention not reported

In Asia, the pooled prevalence of permanent-teeth caries in children was 58.8% (95% CI 53.4 to 64.0); certainty not graded.

• Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and… 2020 All outcomes

  Community- and school-based child populations worldwide (multiple continents) · Asia
  Prevalence 0.588 [0.534, 0.64]
  50 studies · 1334133 participants
  GRADE not reported

Intervention not reported

• Oral health in children and adolescents with juvenile idiopathic arthritis - a systematic review and meta-analysis. 2019 All outcomes

  -
  Proportion with untreated caries NR (significantly higher in JIA)
  2 studies
  GRADE not reported

Slum / urban-disadvantaged setting vs Non-slum urban / general-urban / national population

Mean DMFT ranges from 0.26 to 16.6 across LMIC urban/slum populations; ungraded.

• Systematic review of oral health in slums and non-slum urban settings of Low and Middle-Income Countries (LMICs):… 2024 All outcomes

  Cross-sectional · Urban slums and non-slum/general-urban settings, LMICs
  Mean DMFT (usually reported at population level) ranged from 0.26 to 16.6 across studies; the Missing component was typically highest and the Filled component lowest, reflecting limited access to dental care.
  12 studies
  GRADE not reported

Intervention not reported

• Association between prenatal vitamin D deficiency with dental caries in infants and children: a systematic review and… 2024 All outcomes

  Meta-regression adjusted estimate
  Proportion 0.21 [0.16, 0.26]
  Studies not reported
  GRADE not reported

ADGRL2 gene (aggregate gene-based signal, MAGMA) vs Genome-wide gene background (FDR threshold)

Gene-based analysis found ADGRL2 significantly associated with dental caries (FDR q<0.05); ungraded.

• Genome-wide association meta-analysis identifies two novel loci associated with dental caries. 2024 All outcomes

  Lifelong (germline genotype) · Population-based genetic association study (Japanese direct-to-consumer genetic testing cohort) · MAGMA gene-based test (present study)
  Gene-based association analysis (MAGMA): ADGRL2 was the only gene associated with dental caries at false-discovery-rate q<0.05 (no effect size reported).
  1 study · 45525 participants
  GRADE not reported

Disability (developmental, intellectual, or sensory) vs Persons without disabilities

Dental caries prevalence and severity are high among persons with disabilities in Saudi Arabia (60% to over 80%), and the one comparative autism study reported significantly higher caries than controls; synthesized narratively (ungraded).

• Disabilities and Disparities in Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis in Saudi… 2024 All outcomes

  Cross-sectional · Autism centres and dental/hospital settings in Saudi Arabia (Riyadh, Jeddah)
  Narrative synthesis (no pooled estimate). High dental caries burden among PWDs: caries prevalence 60% to over 80% (abstract). Alkahtani 2019 (hearing-impaired adults, single-arm): caries prevalence 82.2%, treatment…
  Studies not reported
  GRADE not reported

High-frequency sugar consumption (three or more times daily) vs Low sugar intake (fewer than three times daily)

High-frequency sugar consumption was associated with 18% higher but non-significant odds of dental caries in Nigeria (OR 1.18, 95% CI 0.87 to 1.59; I2=36%; ungraded).

• A systematic review and meta-analysis of the association between sugar intake and dental caries in Nigeria. 2024 All outcomes

  Community and school-based observational studies in Nigeria (12 of 14 in Southwest Nigeria) · Overall (all dentitions pooled)
  OR 1.18 [0.87, 1.59]
  7 studies
  GRADE not reported

Combined antiretroviral therapy (cART) vs Monotherapy or dual antiretroviral therapy

No significant difference in dental caries/severity between ART regimens (very low certainty).

• Impact of Antiretroviral Therapy on Oral Health among Children Living with HIV: A Systematic Review and Meta-Analysis. 2022 All outcomes

  Hospitals and AIDS outpatient centres in India, Brazil, and several Asian countries
  No significant difference in dental caries/severity between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 2 study(ies).
  2 studies
  Very low

Primary school-based interventions (one or more of: school health policy, oral health education, healthy school environment, access to oral health services, community involvement) vs usual practice

Among children aged 6-8 years, DMFT scores were significantly reduced (SMD -0.11); subgroup not separately GRADE-rated.

• Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes

  Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Age 6-8 years
  SMD -0.11 [-0.17, -0.04]
  Studies not reported
  GRADE not reported
• Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes

  Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · <=3 intervention activities
  SMD -0.58 [-1.62, 0.45]
  Studies not reported
  GRADE not reported
• Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes

  <2 years · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention duration <2 years
  SMD 0.01 [-0.16, 0.18]
  3 studies
  GRADE not reported

Traditional screening (referral card given if the inspecting dentist judges the child needs to see a dentist) vs No screening

• School dental screening programmes for oral health 2022 · Cochrane All outcomes
  Milsom 2006 measured prevalence of dental caries as mean number of teeth with active caries in primary teeth (dt) and permanent teeth (DT); post-intervention changes from baseline were not significant, and the authors…
  1 study · 16684 participants
  GRADE not reported

Illicit drug use vs People who do not use drugs

Illicit drug use was associated with substantially higher odds of dental caries experience (DMFT) (pooled OR 4.11, 95% CI 2.07-8.15; 7 studies; high heterogeneity I2=90.5%; ungraded).

• Dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis. 2020 All outcomes

  High-income countries (USA, Germany, Australia, Croatia) and India (low/middle-income); studies 2007-2016
  OR 4.11 [2.07, 8.15]
  7 studies
  GRADE not reported