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Evidence found and GRADE certainty

13 questions · 20 findings · 9 reviews · Dental caries

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No studies found 0 · 0%GRADE not reported 17 · 85%Very low 1 · 5%Low 1 · 5%Moderate 1 · 5%High 0 · 0%

Theory-based oral health education/promotion interventions (HBM, TPB, SCT, HAPA, TTM, PMT, SOC, PRECEDE-PROCEED, MI) vs Control (waitlist, routine/standard oral health education, or minimal intervention)

Plaque index (PI) / oral hygiene · school‐age children and adolescents

Theory-based interventions significantly reduced dental plaque (SMD -1.92; moderate certainty).

1 finding from 1 review

Primary school-based behavioural intervention (both oral hygiene and dietary components) vs No treatment (or delayed treatment)

Plaque · Children aged 4 to 12 years attending primary school

Primary school-based behavioural intervention (both oral hygiene and… showed no clear difference in plaque indices (permanent and deciduous teeth) compared with no intervention or delayed intervention (non-intervention control;… (low certainty).

1 finding from 1 review
  • Primary school‐based behavioural interventions for preventing caries 2013 · Cochrane All outcomes
    3 to 15 months
    SoF (Plaque indices, follow-up 3 to 15 months): 'All 3 RCTs showed a reduction in plaque in the intervention group compared to control group'; 827 participants (3 RCTs); GRADE low; comment 'Data not suitable for…
    3 studies · 827 participants
    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

Plaque index (PI) / oral hygiene · Primary school children (aged 3-16 years) attending primary school in low- and middle-income countries (LMICs)

School-based interventions may reduce dental plaque scores (SMD -0.32, favouring intervention), but the certainty of evidence is very low.

1 finding from 1 review

Gamified oral health interventions (mobile apps, serious games, augmented reality, game-based education) vs Conventional or traditional oral health education, or non-gamified interventions (comparator varied; several studies were single-arm/uncontrolled)

Plaque index (PI) / oral hygiene · Children or adolescents

Gamified interventions appear to improve plaque control and oral hygiene status in children versus conventional methods, but the evidence is narrative and ungraded (individual-study P values only).

1 finding from 1 review
  • The Application of Gamification in Children's Oral Health Management: Systematic Review. 2025 All outcomes
    Post-intervention (predominantly short-term; long-term follow-up in a minority of studies) · School-based settings, specialized dental clinics, and home-based environments
    In the gamified mobile health app group, plaque control was superior (P<.05) compared with the conventional method group [Zolfaghari 2021]; a gamified/reminder sticker-book group showed a significant improvement in…
    Studies not reported
    GRADE not reported

Salvadora persica (miswak) mouthrinse vs Chlorhexidine mouthrinse

Plaque · Medically healthy individuals (adults and children, 6-60 years)

When usual mechanical plaque control continued, Salvadora persica and chlorhexidine did not differ significantly for plaque; not GRADE-rated.

8 findings from 1 review
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Salvadora persica (miswak) mouthrinse vs Chlorhexidine 0.2% mouthrinse

Plaque · Medically healthy individuals (adults and children, 6-60 years)

Salvadora persica was less effective than 0.2% chlorhexidine at reducing plaque (favours chlorhexidine); not GRADE-rated.

1 finding from 1 review

Salvadora persica (miswak) mouthrinse vs Placebo rinse

Plaque · Medically healthy individuals (adults and children, 6-60 years)

Salvadora persica rinse reduced plaque more than placebo (favours Salvadora persica); certainty not GRADE-rated (Shekelle grade Ia).

1 finding from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

Child plaque (any plaque visible on any teeth) · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…

Package of oral health education/promotion including oral hygiene… led to lower child plaque (any plaque visible on any teeth) compared with standard care; GRADE not reported.

1 finding from 1 review

Dietary advice on how to achieve a healthy diet for infants (tailored advice focused on a diet low in saturated fat and cholesterol intake) vs usual care

Mother plaque (sub- and supragingival calculus) · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…

Dietary advice on how to achieve a healthy diet for infants… showed no clear difference in mother plaque (sub- and supragingival calculus) compared with standard care; GRADE not reported.

1 finding from 1 review

3-month school-based supervised daily tooth-brushing program with fluoridated toothpaste (multilevel: trained school nurses plus parental involvement) vs Pre-intervention

Visible plaque and oral-hygiene behavior · Schoolchildren aged 4-6 years in the United Arab Emirates (Dubai)

One pre-post study of a school-based supervised tooth-brushing program found visible plaque fell from 76.8% to 36.7% with positive behavior change (narrative synthesis; not GRADE-rated).

1 finding from 1 review

Xylitol (low-intensity sweetener/sugar alcohol) in food products (chewing gum, milk, candy, or tablets) vs no intervention

Change in Mutans streptococci (MS) count in dental plaque · healthy people

Xylitol significantly reduced Mutans streptococci in dental plaque compared with no treatment (SMD -0.73, 95% CI -1.09 to -0.37; 5 trials, I2=53%; not GRADE-rated).

1 finding from 1 review

Microinvasive techniques (resin infiltration, resin/GIC sealant, or glass ionomer varnish) vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)

Adverse events and periodontal/secondary outcomes (gingival bleeding, gingival bleeding index, visible plaque index) · Children and adults with non-cavitated proximal (interproximal) caries lesions in primary and/or permanent teeth (ages 3-45)

Only three trials reported secondary/adverse outcomes; no adverse events were attributed to microinvasive treatment and periodontal findings were mixed and not pooled (ungraded).

1 finding from 1 review