What do systematic reviews say?

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 5-8 years, net increment in DMFT was not significantly reduced (SMD -0.36); no significant subgroup difference by age.

• 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 5-8 years
  SMD -0.36 [-0.76, 0.04]
  5 studies
  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)
  SMD -0.34 [-0.69, 0.02]
  5 studies · 5492 participants
  Very low
• 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 9-12 years
  SMD -0.20 [-0.44, 0.04]
  1 study
  GRADE not reported

Silver diamine fluoride (SDF) vs Placebo, control, and/or other interventions

SDF showed no clear advantage for caries arrestment at the surface level.

• The role of silver diamine fluoride as dental caries preventive and arresting agent: a systematic review and… 2024 All outcomes

  12 months to 18 months
  OR 1.03 [0.47, 2.27]
  3 studies · 5394 participants
  Moderate

Silver diamine fluoride (SDF) vs Placebo, control, and/or other interventions

SDF showed a higher caries-arrestment proportion at the individual level, but the reported difference was not statistically significant.

• The role of silver diamine fluoride as dental caries preventive and arresting agent: a systematic review and… 2024 All outcomes

  3 weeks to 12 months
  OR 3.86 [0.34, 43.96]
  5 studies · 720 participants
  Low

Silver diamine fluoride (SDF) vs Placebo, control, and/or other interventions

SDF showed a higher caries-free proportion at the tooth level, but the reported difference was not statistically significant.

• The role of silver diamine fluoride as dental caries preventive and arresting agent: a systematic review and… 2024 All outcomes

  6 months to 12 months
  OR 1.74 [0.88, 3.46]
  5 studies · 743 participants
  Moderate

Intervention not reported

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Resin infiltration 1.3% vs standard of care 7.8% (Paris 2020, Kaplan-Meier)
  no estimate extracted
  1 study
  GRADE not reported

Glass ionomer (modified glass ionomer varnish) vs Non-invasive measures (standard of care)

In one trial, glass ionomer varnish showed no statistically significant difference versus non-invasive care in radiographic proximal caries progression (OR 0.58, CI includes 1; ungraded subgroup).

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  1 year · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Glass ionomer vs non-invasive (Fig. 5, subgroup 2.1.3)
  OR 0.58 [0.28, 1.20]
  1 study · 53 participants
  GRADE not reported

Fluoride-releasing resin-based sealant vs Non-invasive measures (fluoride varnish; no intervention)

Pooling 2 trials, resin-based sealants reduced radiographic proximal caries progression versus non-invasive measures (OR 0.24; ungraded subgroup).

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Final follow-up (1 to 3.5 years) · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Sealant vs non-invasive (Fig. 5, subgroup 2.1.2)
  OR 0.24 [0.10, 0.55]
  2 studies · 111 participants
  GRADE not reported

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)

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

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Baseline and follow-up · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings
  Reported narratively by 3 trials (Arthur 2018, Sarti 2020, Jorge 2019). No adverse events were attributed to microinvasive treatment. Gingival bleeding index: no significant difference in Arthur 2018 and Jorge 2019 but…
  3 studies
  GRADE not reported

Resin infiltration vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)

Pooling 10 trials, resin infiltration reduced radiographic proximal caries progression versus non-invasive measures (OR 0.23); this subgroup was not separately GRADE-rated.

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Final follow-up (1 to 7 years across trials) · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Resin infiltration vs non-invasive (Fig. 5, subgroup 2.1.1)
  OR 0.23 [0.15, 0.35]
  10 studies · 459 participants
  GRADE not reported

Microinvasive techniques (resin infiltration, resin/GIC sealant, or glass ionomer varnish) vs Conventional restoration

No eligible studies compared microinvasive techniques with invasive (restorative) treatment; this planned comparison had zero included studies.

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings
  no estimate extracted
  0 studies
  No studies found

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

In primary teeth (5 trials), microinvasive techniques reduced radiographic proximal caries progression versus non-invasive measures (OR 0.38; ungraded subgroup).

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Final follow-up (1 to 2 years across trials) · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Primary teeth (Fig. 6, subgroup 2.1.2)
  OR 0.38 [0.25, 0.57]
  5 studies · 266 participants
  GRADE not reported

Intervention not reported

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Caries depth: lesions up to DEJ (favored microinvasive; narrative, no numeric estimate)
  no estimate extracted
  Studies not reported
  GRADE not reported

Intervention not reported

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Caries depth: lesions extending beyond DEJ (favored microinvasive; narrative, no numeric estimate)
  no estimate extracted
  Studies not reported
  GRADE not reported

Microinvasive techniques (mostly resin infiltration; incl. resin sealant) vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)

In permanent teeth (7 trials), microinvasive techniques reduced radiographic proximal caries progression versus non-invasive measures (OR 0.18; ungraded subgroup).

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Final follow-up (1 to 7 years across trials) · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Permanent teeth (Fig. 6, subgroup 2.1.1)
  OR 0.18 [0.10, 0.32]
  7 studies · 296 participants
  GRADE not reported

Microinvasive technique (proximal sealing) vs no intervention

In one trial including both primary and permanent teeth, proximal sealing reduced radiographic caries progression versus no intervention (OR 0.16; ungraded subgroup).

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  3.5 years · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Both permanent and primary (Fig. 6, subgroup 2.1.3)
  OR 0.16 [0.06, 0.44]
  1 study · 61 participants
  GRADE not reported

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)

Microinvasive techniques probably reduce radiographic progression of non-cavitated proximal caries lesions compared with non-invasive measures (moderate certainty).

• Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic… 2025 All outcomes

  Final follow-up (1 to 7 years across trials) · Multiple countries (Brazil, Saudi Arabia, Netherlands, USA, Turkey, Switzerland, Germany, New Zealand, Chile, Thailand); dental clinic/community settings · Overall (all microinvasive vs non-invasive pooled)
  OR 0.27 [0.19, 0.38]
  13 studies · 623 participants
  Moderate

Oral health education only (verbal, written, or audio-visual education) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Oral-health-education-only interventions showed at most a marginal effect on tooth-level caries (dmft SMD -0.11, 95% CI -0.21 to -0.00; 2 studies; not GRADE-rated).

• The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes

  Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Oral health education only (vs comprehensive intervention)
  SMD -0.11 [-0.21, 0.00]
  2 studies
  GRADE not reported

Oral health education only (verbal, written, or audio-visual education) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Oral-health-education-only interventions did not show a statistically significant effect on surface-level caries (dmfs SMD -0.20, 95% CI -0.43 to 0.03; 2 studies; not GRADE-rated).

• The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes

  Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Oral health education only (vs comprehensive intervention)
  SMD -0.20 [-0.43, 0.03]
  2 studies
  GRADE not reported

Comprehensive oral health intervention (oral health education plus additional support: motivational interviewing, toothbrush/toothpaste provision, community engagement, and/or fluoride varnish/sealant application) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Comprehensive interventions produced a small, statistically significant reduction in surface-level caries (dmfs SMD -0.14, 95% CI -0.26 to -0.02; 10 studies; not GRADE-rated).

• The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes

  Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Comprehensive intervention (vs oral health education only)
  SMD -0.14 [-0.26, -0.02]
  10 studies
  GRADE not reported

Comprehensive oral health intervention (oral health education plus additional support: motivational interviewing, toothbrush/toothpaste provision, community engagement, and/or fluoride varnish/sealant application) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Comprehensive interventions produced a statistically significant reduction in tooth-level caries (dmft SMD -0.47, 95% CI -0.84 to -0.10; 4 studies; not GRADE-rated), though heterogeneity was very high.

• The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes

  Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Comprehensive intervention (vs oral health education only)
  SMD -0.47 [-0.84, -0.10]
  4 studies
  GRADE not reported