Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

348 questions · 568 findings · 47 reviews · Dental caries

No studies found 23 · 4%GRADE not reported 485 · 85.4%Very low 27 · 4.8%Low 31 · 5.5%Moderate 2 · 0.4%High 0 · 0%

Fluorides combined with CPP-ACP vs Fluorides alone (monotherapy)

Visual inspection scores · Patients with early caries lesions in permanent teeth (non-fluoridated water area)

Two trials reported visual inspection scores but could not be pooled (different criteria, missing standard deviations) and gave inconsistent findings, so no quantitative conclusion could be drawn.

1 finding from 1 review

Fluorides combined with CPP-ACP vs Fluorides alone (monotherapy)

Laser fluorescence (LF) change · Patients with early caries lesions in permanent teeth (non-fluoridated water area)

For occlusal early caries lesions, adding CPP-ACP to fluorides produced significantly greater laser-fluorescence improvement than fluorides alone (favors the combination); not GRADE-rated.

2 findings from 1 review

Fluorides combined with CPP-ACP vs Fluorides alone (monotherapy)

Total lesion area divided by total surface area (visual) · Patients with early caries lesions in permanent teeth (non-fluoridated water area)

Adding CPP-ACP to fluorides did not significantly change the lesion-area outcome for smooth-surface early caries lesions versus fluorides alone; not GRADE-rated.

1 finding from 1 review

Dental caries (ECC/severe ECC) as exposure/grouping vs Caries-free controls

Relative abundance of S. mutans in saliva · Individuals assessed for dental caries, predominantly children with early childhood caries (ECC) or severe ECC (age about 1 to 4 years)

A few small studies report Streptococcus mutans relative abundance in caries versus caries-free children without pooling; the evidence is ungraded and not meta-analyzed.

1 finding from 1 review

Dental caries (ECC/severe ECC) as exposure/grouping vs Caries-free controls

Relative abundance of Veillonella spp. · Individuals assessed for dental caries, predominantly children with early childhood caries (ECC) or severe ECC (age about 1 to 4 years)

Evidence on whether Veillonella spp. relative abundance is higher or lower in children with dental caries than caries-free controls is inconsistent across 7 small observational studies; no pooled estimate was produced and the evidence is ungraded.

1 finding from 1 review

Remineralizing orthodontic adhesives vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control

Enamel remineralization / anti-demineralization extent · Human teeth with early enamel lesions surrounding orthodontic brackets

No meta-analysis was conducted; most included in vitro studies reported significant remineralization with remineralizing orthodontic adhesives versus controls.

1 finding from 1 review

Remineralizing orthodontic adhesives vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control

Ion release · Human teeth with early enamel lesions surrounding orthodontic brackets

No meta-analysis was conducted; most studies reported increased ion release over time, but few reported peak values.

1 finding from 1 review

Er:YAG laser irradiation of enamel after demineralisation vs No anticaries intervention (untreated enamel)

Enamel surface microhardness · Demineralised / white-spot-lesion enamel (in vitro specimens)

In demineralised enamel, Er:YAG laser irradiation did not significantly change surface microhardness versus untreated control (SMD 0.66, 95% CI -1.12 to 2.44; 2 in vitro studies; ungraded).

1 finding from 1 review

Resin infiltration vs CPP-ACFP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration did not differ significantly from CPP-ACFP (SMD -0.52, 95% CI -1.16 to 0.12; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

P11-4 + fluoride varnish vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

P11-4 plus fluoride varnish was significantly better than CPP-ACP (SMD -0.78, 95% CI -1.33 to -0.24; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Resin infiltration vs Fluoride varnish

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration was significantly better than fluoride varnish (SMD -0.70, 95% CI -1.18 to -0.21); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Resin infiltration vs P11-4 + fluoride varnish

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration and P11-4 plus fluoride varnish did not differ significantly (SMD 0.01, 95% CI -0.62 to 0.65; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Resin infiltration vs Self-assembling peptide P11-4

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration did not differ significantly from P11-4 alone (SMD -0.39, 95% CI -0.97 to 0.20); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

SDF plus potassium iodide vs Split into two contrasts: (1) TCS paste (arrest 100%); (2) CPP-ACP (arrest 100%); SDF+KI arrest 54.8% at 24 months, p<.001

Caries arrest · Patients with early enamel carious lesions on permanent molars

SDF plus potassium iodide arrested 54.8% of early enamel lesions at 24 months; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

P11-4 + fluoride varnish vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · People or specimens with white spot lesions or early caries lesions

The NMA estimated an SMD of -0.78 for P11-4 + fluoride varnish versus CPP-ACP (95% CI -1.33 to -0.28).

1 finding from 1 review

Self-assembling peptide P11-4 vs Placebo or no active treatment

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Self-assembling peptide P11-4 significantly improved remineralization versus control (SMD -0.56, 95% CI -0.96 to -0.15); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

P11-4 + fluoride varnish vs Fluoride varnish

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

P11-4 plus fluoride varnish was significantly better than fluoride varnish alone (SMD -0.71, 95% CI -1.13 to -0.29); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Resin infiltration vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration was significantly better than CPP-ACP (SMD -0.77, 95% CI -1.31 to -0.23); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Resin infiltration vs Placebo or no active treatment

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration significantly improved remineralization versus control (SMD -0.94, 95% CI -1.46 to -0.43), ranking second of seven therapies by SUCRA (88.7%); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Fluoride varnish vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Fluoride varnish did not differ significantly from CPP-ACP (SMD -0.07, 95% CI -0.44 to 0.29); certainty of evidence not assessed (no GRADE).

1 finding from 1 review