Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

310 questions · 590 findings · 34 reviews

No studies found 12 · 2%GRADE not reported 470 · 79.7%Very low 23 · 3.9%Low 34 · 5.8%Moderate 51 · 8.6%High 0 · 0%

Digital bitewing radiography, phosphor plate (PSP) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography)

Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces

In in vitro, digital bitewing radiography (phosphor plates) pooled specificity was 0.95 (95% CI 0.59 to 0.995) for occlusal caries at the dentin detection level; ungraded.

4 findings from 1 review
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Visual examination (VE) vs Cavity preparation or biopsy (operative validation)

Diagnostic accuracy for occlusal caries detection at the 1/3 dentin caries detection level (Ekstrand; D0-2 versus D3-4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces

In in vivo, visual examination pooled specificity was 0.77 (95% CI 0.67 to 0.85) for occlusal caries at the 1/3 dentin detection level; ungraded.

4 findings from 1 review
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Conventional bitewing radiography (E-speed film) vs Cavity preparation or biopsy (operative validation)

Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces

In in vivo, conventional bitewing radiography (E-speed) pooled diagnostic odds ratio was 127.56 (95% CI 7.38 to 2203.70) for occlusal caries at the dentin detection level; ungraded.

4 findings from 1 review
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Visual examination (VE) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography)

Diagnostic accuracy for occlusal caries detection at the 1/3 dentin caries detection level (Ekstrand; D0-2 versus D3-4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces

In in vitro, visual examination pooled diagnostic odds ratio was 16.6 (95% CI 4.85 to 56.79) for occlusal caries at the 1/3 dentin detection level; ungraded.

4 findings from 1 review
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Conventional bitewing radiography, F-speed film vs Histological validation (serial sectioning, grinding, hemisection, or microradiography)

Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces

In in vitro, conventional bitewing radiography (F-speed) pooled specificity was 0.97 (95% CI 0.71 to 0.998) for occlusal caries at the dentin detection level; ungraded.

4 findings from 1 review
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Conventional bitewing radiography (D-speed film) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography)

Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces

In in vitro, conventional bitewing radiography (D-speed) pooled specificity was 0.73 (95% CI 0.53 to 0.87) for occlusal caries at the dentin detection level; ungraded.

4 findings from 1 review
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Silver diamine fluoride (SDF; 30% or 38%) vs Fluoride varnish

Arrest of dentine caries · Preschool children with active dentine caries in primary teeth (mean age 3.4-4.0 years)

Silver diamine fluoride was about 2.5 times more likely than sodium fluoride to arrest dentine caries surfaces at 18 months (pooled OR 2.51, 95% CI 1.25 to 5.10; 2 RCTs), although between-study heterogeneity was high (I2=90.3%); certainty of evidence was not formally graded.

2 findings from 1 review

Spectra caries detection device (Air Techniques; blue fluorescence) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review
  • Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    The Spectra caries detection device fits into the blue fluorescence category but no studies provided data for inclusion in the meta-analysis (Markowitz 2015).
    1 study
    GRADE not reported

Minimally invasive caries removal (MIT): selective removal to soft dentin, self-limiting chemomechanical removal, or partial/incomplete caries removal vs Conventional caries removal (CT): selective removal to firm dentin, stepwise excavation, or complete caries removal

Pulp exposure rate · Patients with deep carious lesions in permanent (mainly posterior) teeth

Minimally invasive caries removal was associated with a lower mean pulp exposure rate than conventional removal (1.2% vs 8.1%), but the difference was not statistically significant (Wilcoxon, p = 0.068); certainty of evidence was not graded.

1 finding from 1 review

Minimally invasive caries removal (MIT): selective removal to soft dentin, self-limiting chemomechanical removal, or partial/incomplete caries removal vs Conventional caries removal (CT): selective removal to firm dentin, stepwise excavation, or complete caries removal

Treatment success (caries lesion arrest or restoration survival) · Patients with deep carious lesions in permanent (mainly posterior) teeth

Minimally invasive caries removal showed a marginally higher mean restoration success rate than conventional removal (83.6% vs 75.4%), but the difference was not statistically significant (Mann-Whitney U, p > 0.05); certainty of evidence was not graded.

1 finding from 1 review

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

Specificity for detection of enamel caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

Sensitivity for detection of enamel caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

Carious dentin vs Sound dentin

Cathepsin K (CT-K) presence/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

Cathepsin K may be increased in carious dentin (one study), but no certainty rating was assigned (ungraded).

1 finding from 1 review

Carious dentin vs Sound dentin

MMP-8 expression/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

For MMP-8, no clear direction of difference between carious and sound dentin was found; the evidence is very uncertain (very low certainty).

1 finding from 1 review

Carious dentin vs Sound dentin

MMP-2 presence/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

MMP-2 may be increased in carious dentin compared with sound dentin, but the evidence is very uncertain (very low certainty).

1 finding from 1 review

Carious dentin vs Sound dentin

MMP-9 presence/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

MMP-9 may be increased in carious dentin compared with sound dentin, but the evidence is very uncertain (very low certainty).

1 finding from 1 review

Carious dentin vs Sound dentin

MMP-13 presence/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

MMP-13 may be increased in carious dentin compared with sound dentin, but the evidence is very uncertain (very low certainty).

1 finding from 1 review

Carious dentin vs Sound dentin

Cathepsin B (CT-B) presence/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

Cathepsin B may be increased in carious dentin compared with sound dentin, but the evidence is very uncertain (very low certainty).

1 finding from 1 review

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

Sensitivity for detection of enamel caries · Children, adolescents, or adults presenting asymptomatically or suspected of early enamel caries (in vivo), or extracted teeth of…
1 finding from 1 review
  • Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    SoF findings (HSROC; no summary operating point reported): 'ECM: sensitivity from 0.61 to 0.98 ... CarieScan Pro: sensitivity from 0.55 to 0.91'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites…
    7 studies
    Very low

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

Specificity for detection of enamel caries · Children, adolescents, or adults presenting asymptomatically or suspected of early enamel caries (in vivo), or extracted teeth of…
1 finding from 1 review
  • Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    SoF findings (HSROC; no summary operating point reported): 'ECM: specificity from 0.73 to 0.96 ... CarieScan Pro: specificity from 0 to 1.00'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites (no…
    7 studies
    Very low