Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

516 questions · 950 findings · 74 reviews · Dental caries

No studies found 35 · 3.7%GRADE not reported 831 · 87.5%Very low 38 · 4%Low 26 · 2.7%Moderate 13 · 1.4%High 7 · 0.7%

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Caries incidence rate (first D3 lesion) per person-year at risk (permanent dentition) · Children and adolescents (permanent dentition, D3, up to 21 y), Western or comparable populations

In the permanent dentition, the pooled caries incidence rate was 0.11 per person-year at risk (95% CI 0.09 to 0.13; random-effects meta-analysis of 15 studies), i.e., about 11 of every 100 caries-free persons develop dentine caries each year (ungraded).

1 finding from 1 review
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per person-year at risk · Western Europe, North America, Australia, New Zealand (or comparable Western populations)
    Incidence rate (per person-year at risk) 0.11 [0.09, 0.13]
    15 studies · 10768 participants
    GRADE not reported

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Annual increment in dmft (primary dentition) · Children (primary dentition, d3), Western or comparable populations

In the primary dentition, the annual dmft increment ranged from -0.3 to 0.3 across 4 studies; values were inconsistent because of tooth exfoliation and could not be pooled (ungraded).

1 finding from 1 review

Populations with a low level of schooling (>=33.60% of the population with low schooling) vs Populations with a higher level of schooling (<33.60% of the population with low schooling)

Caries experience (mean DMFT) · Adults aged 19-60 years

Population level of schooling was not significantly associated with caries experience (DMFT) in subgroup meta-analysis or meta-regression; ungraded observational evidence with very high heterogeneity.

5 findings from 1 review
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Xylitol (low-intensity sweetener/sugar alcohol) in food products (chewing gum, milk, candy, or tablets) vs Sorbitol (low-intensity sweetener)

Change in Mutans streptococci (MS) count in saliva · healthy people

Xylitol and sorbitol did not differ significantly for Mutans streptococci in saliva (SMD -0.16, 95% CI -0.44 to 0.12; 2 trials, P=.25); not GRADE-rated.

1 finding from 1 review

Xylitol (low-intensity sweetener/sugar alcohol) in food products (chewing gum, milk, candy, or tablets) vs Sorbitol (low-intensity sweetener)

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

Xylitol reduced Mutans streptococci in dental plaque more than sorbitol (SMD -0.45, 95% CI -0.69 to -0.21; 4 trials, I2=7%); not GRADE-rated.

1 finding from 1 review

Sociodemographic / socioeconomic factors (single-parent family, low parental education, family income, socioeconomic status) vs Absence of the factor / reference socioeconomic category

Caries increment in permanent teeth · School children and adolescents (6-18 years) followed from primary dentition (baseline examination before 72 months of age)

Evidence on the association between sociodemographic/socioeconomic factors and permanent-teeth caries is weak and inconsistent (3 studies; could not be pooled; not GRADE-rated).

1 finding from 1 review

Unfavourable oral hygiene and dietary habits (frequent sweet/sugar consumption; low toothbrushing frequency in early childhood) vs Favourable oral hygiene and dietary habits

Caries development in permanent teeth · School children and adolescents (6-18 years) followed from primary dentition (baseline examination before 72 months of age)

Early-childhood oral hygiene and dietary habits show inconsistent associations with permanent-teeth caries, often losing significance after adjustment for past caries (2 studies; not pooled; not GRADE-rated).

1 finding from 1 review

Chlorhexidine varnish (10%) vs placebo or no treatment

Elevated mutans streptococci levels (>=4 with caries screen; high vs low) · Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or…

It is very uncertain whether chlorhexidine varnish (10%) changes elevated mutans streptococci levels (>=4 with caries screen; high vs… compared with placebo or no treatment (very low certainty).

1 finding from 1 review

Primary dental health aide (PDHA) service-delivery models (PDHA program; PDHA + intensive staffing; PDHA + robust prevention) vs Baseline pre-intervention service-delivery scenario

Projected mean DMFT (children below 5 years) · Alaska Native children (below age 18)

A simulation projected mean DMFT in children under 5 would fall from 7.4 to 4.9 under the PDHA model (certainty not graded).

1 finding from 1 review

Low birth weight (<2500 g) vs Normal birth weight (2500 g or more)

Early childhood caries (ECC) · Children aged 6 years or younger (preschool children)

Adjusted analyses also showed no association between low birth weight and early childhood caries (adjusted OR 1.05, 95% CI 0.71 to 1.57); certainty not graded.

3 findings from 1 review

Slow-release fluoride devices vs Alternative fluoride therapy (topical fluoride: toothpaste, mouthrinse, gel, or varnish)

Outcome not reported · Children or adults

The review found no eligible studies for this question.

1 finding from 1 review

Slow-release fluoride device (fluoride glass beads) vs placebo or usual care

Caries increment, surface index D(M)FS · Children with high risk of dental decay

It is very uncertain whether slow-release fluoride device (fluoride glass beads) changes increase in DMFS at 2 years compared with baseline compared with placebo or usual care (control) (very low certainty).

1 finding from 1 review

Slow-release fluoride device (fluoride glass beads) vs placebo or usual care

Caries increment, tooth index D(M)FT · Children with high risk of dental decay

It is very uncertain whether slow-release fluoride device (fluoride glass beads) changes increase in DMFT at 2 years compared with baseline compared with placebo or usual care (control) (very low certainty).

1 finding from 1 review

Low income vs High income

Prevalence of untreated decay (% DT > 0) · Adults aged 25 years and older in Australia, Canada, New Zealand, and the United States

In Australia, low versus high income differed by 11.90 percentage points in prevalence of untreated decay.

5 findings from 1 review
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Low income vs High income

Mean number of decayed teeth (mean DT) · Adults aged 25 years and older in Australia, Canada, New Zealand, and the United States

Across four countries, low versus high income differed by 0.44 decayed teeth in mean number of decayed teeth (random-effects meta-analysis; I2=76.4%).

5 findings from 1 review
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Low income vs High income

Prevalence of fair/poor self-rated oral health · Adults aged 25 years and older in Australia, Canada, New Zealand, and the United States

Across four countries, low versus high income differed by 15.77 percentage points in prevalence of fair/poor self-rated oral health (random-effects meta-analysis; I2=13.4%).

5 findings from 1 review
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