Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

417 questions · 819 findings · 72 reviews

No studies found 9 · 1.1%GRADE not reported 759 · 92.7%Very low 39 · 4.8%Low 5 · 0.6%Moderate 6 · 0.7%High 1 · 0.1%

Laser enamel preparation alone (Er,Cr:YSGG or CO2 laser) vs Acid-etching (phosphoric acid)

Development of >=1 new carious lesion (caries incidence) · Caries-free children to young adults with premolars/molars requiring pit-and-fissure sealants

In the single study reporting it, caries incidence was 0% in both the laser-alone and acid-etching groups (ungraded, single study).

1 finding from 1 review

Er:YAG laser preparation combined with acid-etching vs Acid-etching (phosphoric acid)

Development of >=1 new carious lesion (caries incidence) · Children (high caries risk) with permanent molars requiring pit-and-fissure sealants

Caries incidence was 10% with laser-plus-acid versus 22% with acid-etching at 18 months, a non-significant difference (ungraded, single study).

1 finding from 1 review

Down syndrome vs Individuals without Down syndrome (healthy controls: siblings, schoolchildren or others)

Mean DMFT (decayed, missing, filled permanent teeth) · Individuals of all ages

Individuals with Down syndrome had a lower mean DMFT in permanent teeth than controls (pooled SMD -0.18, 95% CI -0.35 to -0.02; 6 studies; I2=20%); certainty of evidence not graded.

1 finding from 1 review

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

Caries in primary teeth: dmft (3 years) · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, the dmft (primary dentition) index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 0.92, 95% CI -0.09 to 1.93; very low certainty).

2 findings from 1 review

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

Dental caries severity (dmfs index, primary dentition) · Children and adolescents (<18 years) living with HIV (CLWH)

In case-control studies, HIV+ children on ART had a significantly higher dmfs index than HIV-negative peers (MD 5.15, 95% CI 2.20 to 8.11; not separately GRADE-rated).

2 findings from 1 review

School-based supervised toothbrushing (STB) vs no intervention

Dental caries increment, DMFT/dmft (whole-tooth level) · Children in school or kindergarten settings (aged 3-14 years)

School-based supervised toothbrushing has no statistically significant effect on whole-tooth caries (DMFT/dmft SMD 0.05, 95% CI -0.27 to 0.37; ungraded).

1 finding from 1 review

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

Caries in primary teeth: dmft (3 years) · Children and adolescents (<18 years) living with HIV (CLWH)

Among HIV+ children, HAART versus no HAART showed no significant difference in the dmft index in case-control studies (MD 0.66, 95% CI -0.26 to 1.58; ungraded).

1 finding from 1 review

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

Dental caries in permanent teeth · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, the DMFT index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 0.60, 95% CI -0.53 to 1.72; very low certainty).

2 findings from 1 review

School-based supervised toothbrushing (STB) vs no intervention

Caries increment on tooth surfaces (dmfs/DMFS) (prevented fraction) · Children in school or kindergarten settings (aged 3-14 years)

School-based supervised toothbrushing produces a small but statistically significant reduction in tooth-surface caries (DMFS/dmfs SMD -0.22, 95% CI -0.42 to -0.01; ungraded).

1 finding from 1 review

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

Dental caries in permanent teeth · Children and adolescents (<18 years) living with HIV (CLWH)

Among HIV+ children, HAART was associated with a significantly higher DMFT index than no HAART in case-control studies (MD 2.02, 95% CI 1.24 to 2.80; ungraded).

1 finding from 1 review

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

Dental caries (by severity) · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, HIV+ children on ART had a significantly higher DMFS index than HIV-negative peers (MD 2.00, 95% CI 1.54 to 2.46; not separately GRADE-rated).

2 findings from 1 review

Male sex vs Female sex

Dental caries susceptibility · Institutionalized orphan children (roughly 3 to 18 years)

Male institutionalized children had a marginally higher caries risk than females (RR 1.02), a non-significant difference (very low certainty).

1 finding from 1 review

Primary teeth / primary dentition (younger children) vs Permanent teeth / permanent dentition (older children)

Dental caries susceptibility · Institutionalized orphan children (roughly 3 to 18 years)

Primary teeth may carry a higher caries risk than permanent teeth in institutionalized children (RR 1.31), but the difference is not statistically significant (very low certainty).

1 finding from 1 review

Obesity or overweight (higher BMI, mostly WHO BMI ≥25/≥30; 2 studies used waist circumference) vs Normal Weight or Non‐Obese

Dental caries · Adults (≥18 years)

After adjustment for confounders, obesity/overweight was not associated with dental caries (OR 1.00, 95% CI 0.89 to 1.12; ungraded).

9 findings from 1 review
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High-frequency sugar consumption (three or more times daily) vs Low sugar intake (fewer than three times daily)

Early childhood caries experience (mean dmft) · Nigerian children with primary dentition (approximately 6 months to 5 years)

In primary dentition, high-frequency sugar consumption was associated with slightly higher, non-significant odds of caries (OR 1.13, 95% CI 0.23 to 5.44), with high heterogeneity (I2=83%; ungraded).

1 finding from 1 review

Nocturnal breastfeeding vs No nocturnal breastfeeding

Early childhood caries (ECC) · Preschool children (<6 years)

After excluding one study, nocturnal breastfeeding was associated with higher ECC risk (RR 3.05, 95% CI 2.40 to 3.87; I²=33%).

2 findings from 1 review

Breastfeeding <24 months vs Breastfeeding for ≥24 months

Early childhood caries (ECC) · Preschool children (<6 years)

After excluding Peres et al. (2017), breastfeeding for less than 24 months was associated with fewer caries (RR 0.49, 95% CI 0.39 to 0.62; I²=6%).

2 findings from 1 review

Breastfeeding vs No breastfeeding

Early childhood caries (ECC) · Preschool children (<6 years)

After excluding five studies, breastfeeding was associated with lower ECC risk in cohort studies (RR 0.82, 95% CI 0.71 to 0.95; I²=0%).

3 findings from 1 review

Breastfeeding <12 months vs Breastfeeding for ≥12 months

Early childhood caries (ECC) · Preschool children (<6 years)

Breastfeeding for <12 vs ≥12 months was associated with significantly fewer caries (RR 0.65, 95% CI 0.50-0.86), indicating breastfeeding beyond 12 months increases ECC risk (substantial heterogeneity; ungraded).

2 findings from 1 review

Breastfeeding <18 months vs Breastfeeding for ≥18 months

Early childhood caries (ECC) · Preschool children (<6 years)

Breastfeeding for <18 vs ≥18 months was associated with significantly fewer caries (RR 0.41, 95% CI 0.18-0.92; substantial heterogeneity; ungraded).

2 findings from 1 review