What do systematic reviews say?

Visual examination (VE) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative)

• Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
  Summary of findings 1 (no pooled analysis): for the 7 studies with low prevalence (<=10%) sensitivity ranged from 0.50 (95% CI 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00); for the 3 higher-prevalence studies…
  10 studies · 25568 participants
  Low

Oral health knowledge, attitudes and practices assessment vs None (descriptive prevalence review; subgroup analyses by urban/rural status, country and year)

Mothers and caregivers often had adequate knowledge/attitudes but improper oral-health practices and low dental-service use, associated with education and occupation (narrative synthesis; not GRADE-rated).

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  UAE; Sharjah, Ras Al Khaimah; day care centers
  Mahmoud et al. found Sharjah mothers had higher-than-average knowledge and excellent attitudes but mostly improper practices and low dental-service utilization; knowledge/practices were associated with mothers'…
  Studies not reported
  GRADE not reported

Autism spectrum disorder vs Healthy school-aged children (for some measures)

Two studies found high caries (77%) and gingivitis and considerable oral-care challenges among children with autism spectrum disorder, with low restorative indices (narrative synthesis; not GRADE-rated).

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  Dubai, UAE
  Jaber et al. reported dental caries in 77% of children with ASD (mean dmft 2.2 in early mixed dentition), gingivitis in all children (generalized 70.4%), mostly poor oral hygiene (59%), and low met-need/restorative…
  2 studies
  GRADE not reported

Remote screening of the oral cavity (mobile application/telemedicine) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative)

• Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
  Summary of findings 4 (no pooled analysis): specificity 0.99 (95% CI 0.99 to 1.00), 1.00 (95% CI 0.91 to 1.00), and 0.72 (95% CI 0.63 to 0.80) across the 3 studies. Certainty VERY LOW.
  3 studies · 3600 participants
  Very low

Remote screening of the oral cavity (mobile application/telemedicine) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative)

• Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
  Summary of findings 4 (no pooled analysis): sensitivity 0.85 (95% CI 0.81 to 0.88), 0.82 (95% CI 0.57 to 0.96), and 0.94 (95% CI 0.70 to 1.00) across the 3 studies. Prevalence 12.2% to 30.9%. Certainty VERY LOW.
  3 studies · 3600 participants
  Very low

Prison-nursery setting / incarcerated-mother household (oral health status) vs Counterparts (community children)

One study found high caries (89.8%) and poor oral hygiene with low restorative care among preschool children of incarcerated mothers (narrative synthesis; not GRADE-rated).

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  UAE prison nurseries
  Al Salami et al. reported caries prevalence of 89.8% (mean dmft 4.97) among preschool children of incarcerated mothers, similar to their counterparts, but worse oral hygiene, higher debris/plaque (93.8% vs 81.8%) and…
  1 study
  GRADE not reported

Special health care needs vs None (descriptive; compared across disability types)

One study found very high caries (85.2%) and high unmet treatment needs among children with special healthcare needs, varying by disability type (narrative synthesis; not GRADE-rated).

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  Ras Al Khaimah, UAE
  Alkhabuli et al. (Ras Al Khaimah) reported a high caries prevalence (85.2%) and high mean dmft/DMFT (5.67) among children with special healthcare needs. About two-thirds had good oral hygiene (highest in autism 100%,…
  1 study
  GRADE not reported

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

School-based interventions may reduce dental plaque scores (SMD -0.32, favouring intervention), but the certainty of evidence is 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)
  SMD -0.32 [-0.46, -0.18]
  7 studies · 3339 participants
  Very 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

The effect of school-based interventions on gingival scores is uncertain and not statistically significant (SMD 0.12; very low certainty).

• 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 0.12 [-0.32, 0.55]
  3 studies · 1573 participants
  Very low

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Most strategies to integrate oral health into primary care were associated with improved access to oral healthcare (19 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Access to oral healthcare was the primary outcome most studied (n=19). Most studies reported results favouring the integration strategy, including improvements in referral pathways, documentation processes, operating…
  19 studies
  GRADE not reported

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Integration strategies were generally associated with positive oral health knowledge, attitudes and perceptions among staff and patients (16 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Knowledge/attitudes/perceptions of staff and patients was the second most studied outcome (n=16). Patient and staff perceptions on various aspects of the integration strategy were usually reported as positive.…
  16 studies
  GRADE not reported

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Most studies reported improved oral disease outcomes with integration strategies (8 of 9 studies improved, 1 no change; 9 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Nine studies reported oral disease outcomes, seven of which measured change in dental caries estimates. Eight of the nine studies reported improved oral disease outcomes; one (Vichayanrat 2012) reported no change in…
  9 studies
  GRADE not reported

Dental caries (carious oral microbiome) vs Caries-free / healthy oral microbiome

A group of genera/species (notably Selenomonas, Aggregatibacter, Actinomyces, Treponema) was predictive of caries, whereas Streptococcus was not (ungraded).

• Meta-analysis of caries microbiome studies can improve upon disease prediction outcomes. 2022 All outcomes

  Oral cavity microbiome (saliva and supragingival plaque samples); pooled across 19 international studies
  Mean-decrease-accuracy discriminating taxa: Capnocytophaga HMT-338, Lactobacillus panis, Treponema HMT-230, Bifidobacterium longum, Delftia acidovorans, Staphylococcus schleiferi; higher log2FC in caries: Selenomonas HMT-146, Aggregatibacter actinomycetemcomitans, Actinomyces HMT-896, Treponema HMT-257; Streptococcus not predictive
  19 studies · 2016 participants
  GRADE not reported

Dental caries (carious oral microbiome) vs Caries-free / healthy oral microbiome

In adults, caries-vs-health alpha diversity differed for the Shannon index but not Chao1/Observed (ungraded).

• Meta-analysis of caries microbiome studies can improve upon disease prediction outcomes. 2022 All outcomes

  Oral cavity microbiome (saliva and supragingival plaque samples); pooled across 19 international studies · Adults
  In adults, there was no significant caries-vs-health difference in Chao1 or Observed diversity, whereas the Shannon index differed significantly (p < 0.001).
  Studies not reported
  GRADE not reported

Dental caries (carious oral microbiome) vs Caries-free / healthy oral microbiome

In children, caries-vs-health Shannon alpha diversity differed significantly (ungraded).

• Meta-analysis of caries microbiome studies can improve upon disease prediction outcomes. 2022 All outcomes

  Oral cavity microbiome (saliva and supragingival plaque samples); pooled across 19 international studies · Children
  In children, the Shannon alpha-diversity index differed significantly between caries and health (p < 0.001).
  Studies not reported
  GRADE not reported

Dental caries (carious oral microbiome) vs Caries-free / healthy oral microbiome

Microbiome-based random forest classifiers could not reliably discriminate caries from health across the combined cohort (best AUC approximately 0.75 in a disease-only KO subset; ungraded).

• Meta-analysis of caries microbiome studies can improve upon disease prediction outcomes. 2022 All outcomes

  Oral cavity microbiome (saliva and supragingival plaque samples); pooled across 19 international studies
  AUC 0.75
  19 studies · 2016 participants
  GRADE not reported

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

• Primary school‐based behavioural interventions for preventing caries 2013 · Cochrane All outcomes
  Worthington 2001 reported changes in oral health knowledge and skills: improvement was apparent in both intervention and control groups at the 4-month follow-up (phase one) but greater in the intervention group (34%…
  1 study
  GRADE not reported

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

• Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries 2024 · Cochrane All outcomes
  Two trials (Batliner 2018; Plutzer 2008) provided information on changes in mother oral health behaviours (other data): some benefit in favour of the intervention.
  2 studies
  GRADE not reported

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

• Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries 2024 · Cochrane All outcomes
  Three trials (Muhoozi 2017; Pereira 2021; Yu 2021) reported changes in child oral health behaviours (other data): some benefit in favour of the intervention.
  3 studies
  GRADE not reported

Oral cancer patients (cases) vs Healthy controls

Pooling all periodontal measures, oral cancer patients had worse periodontal status than controls (SMD 0.95, 95% CI 0.41-1.49; very high heterogeneity, I2=96.8%); ungraded. Note this pools clinically different measures.

• Periodontitis and the risk of oral cancer: a meta-analysis of case-control studies. 2024 All outcomes

  Not specified · Case-control studies conducted in Asia (n=6), Europe (n=5), USA (n=2) and other countries (n=3) · Overall (all periodontal measures pooled)
  SMD 0.95 [0.41, 1.49]
  5 studies
  GRADE not reported