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Evidence found and GRADE certainty

1,338 questions · 2,104 findings · 136 reviews · Dental caries

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No studies found 159 · 7.6%GRADE not reported 1,657 · 78.8%Very low 138 · 6.6%Low 111 · 5.3%Moderate 36 · 1.7%High 3 · 0.1%

Breastfeeding <18 months vs Breastfeeding for ≥18 months

Early childhood caries (ECC) · Preschool children (<6 years)

Breastfeeding for <18 vs ≥18 months was associated with significantly fewer caries (RR 0.41, 95% CI 0.18-0.92; substantial heterogeneity; ungraded).

2 findings from 1 review

Breastfeeding for <4 months vs Breastfeeding for ≥4 months

Early childhood caries (ECC) · Preschool children (<6 years)

Breastfeeding for <4 vs ≥4 months was not significantly associated with early childhood caries (RR 0.95, 95% CI 0.80-1.13; ungraded).

1 finding from 1 review

Breastfeeding for <6 months vs Breastfeeding for ≥6 months

Early childhood caries (ECC) · Preschool children (<6 years)

In cohort studies, breastfeeding for <6 vs ≥6 months was not significantly associated with early childhood caries (RR 0.97, 95% CI 0.88-1.06; ungraded).

2 findings from 1 review

Primary teeth / primary dentition (younger children) vs Permanent teeth / permanent dentition (older children)

Dental caries susceptibility · Institutionalized orphan children (roughly 3 to 18 years)

Primary teeth may carry a higher caries risk than permanent teeth in institutionalized children (RR 1.31), but the difference is not statistically significant (very low certainty).

1 finding from 1 review

Institutionalization (living in an orphanage/institution) vs Parented children living with their families

Dental caries prevalence · Institutionalized orphan children (roughly 3 to 18 years)

Institutionalized orphan children may be at higher risk of dental caries than parented children (pooled RR 1.19), but the estimate is imprecise and not statistically significant (very low certainty).

1 finding from 1 review

Teledentistry diagnosis using DSLR or smartphone extra-oral photographs vs Visual or clinical examination

Sensitivity for dental caries diagnosis · Children and adults with primary or permanent dentition

Sensitivity ranged from 48% to 98.3% across 13 studies; no meta-analysis or GRADE rating was reported.

1 finding from 1 review

Teledentistry diagnosis using DSLR or smartphone extra-oral photographs vs Visual or clinical examination

Specificity for dental caries diagnosis · Children and adults with primary or permanent dentition

Specificity ranged from 83% to 100% across 13 studies; no meta-analysis or GRADE rating was reported.

1 finding from 1 review

Mixed breast- and bottle-feeding vs Bottle feeding

Early childhood caries (ECC) · Healthy children under 6 years in South Africa

No significant difference in caries odds was found between mixed breast-and-bottle-fed and bottle-fed-only children (meta-analysis reported no difference; pooled estimate in an unavailable supplementary figure; not GRADE-rated).

1 finding from 1 review

Higher parental education (tertiary) vs Parental high school (secondary) education

Early childhood caries (ECC) · Healthy children under 6 years in South Africa

Parental tertiary education (vs high-school education) was associated with about 1.8 times higher odds of early childhood caries in South Africa (OR 1.77, 95% CI 1.22-2.57; 2 studies; not GRADE-rated).

1 finding from 1 review

Bottle-feeding only vs Breastfeeding only

Early childhood caries (ECC) · Healthy children under 6 years in South Africa

No significant difference in caries odds was found between bottle-fed-only and breast-fed-only children (meta-analysis reported no difference; pooled estimate in an unavailable supplementary figure; not GRADE-rated).

1 finding from 1 review

Low parental socioeconomic status (SES) vs High parental socioeconomic status (SES)

Early childhood caries (ECC) · Healthy children under 6 years in South Africa

No significant difference in caries odds was found between children of low- versus high-SES parents (meta-analysis reported no difference; pooled estimate in an unavailable supplementary figure; not GRADE-rated).

1 finding from 1 review

GERD vs Healthy individuals without reflux (controls)

Dental caries · Adults with gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR)

Reflux appears associated with a higher prevalence of dental caries than in healthy individuals based on three studies, though to a lesser extent than erosion; evidence is ungraded and not pooled.

1 finding from 1 review

Residence in heavily contaminated area (approx. 15-40 Ci/km2) vs Residence in non-contaminated (non-exposed) area (<1 Ci/km2)

Dental caries · Children aged 12-15 years (adolescents)

In adolescents (12-15 y) from heavily contaminated areas, individual studies gave inconsistent DMFT/dmft differences; the review did not pool them and drew no firm conclusion (ungraded).

4 findings from 1 review
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Residence in weakly contaminated area (approx. 1-5 Ci/km2) vs Residence in non-contaminated (non-exposed) area (<1 Ci/km2)

Dental caries · Children aged 5-7 years (early school-age)

In early school-age children (5-7 y) from weakly contaminated areas, individual cross-sectional studies reported mostly higher but inconsistent DMFT/dmft in exposed vs non-exposed children; the review did not pool the data and drew no firm conclusion (ungraded).

4 findings from 1 review
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Residence in heavily contaminated area (approx. 15-40 Ci/km2) vs Residence in non-contaminated (non-exposed) area (<1 Ci/km2)

Dental caries · Children of mixed ages (mean approximately 12 years; no age separation)

In children of mixed ages from heavily contaminated areas, individual studies reported modestly higher DMFT/dmft in exposed children; the review did not pool them and drew no firm conclusion (ungraded).

5 findings from 1 review
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Residence in low-contamination area (approx. 5-15 Ci/km2) vs Residence in non-contaminated (non-exposed) area (<1 Ci/km2)

Dental caries · Children aged 12-15 years (adolescents)

In adolescents (12-15 y) from a low-contamination area, individual studies reported higher DMFT/dmft in exposed than non-exposed children; not pooled (ungraded).

2 findings from 1 review

Residence in weakly contaminated area (approx. 1-5 Ci/km2) vs Residence in non-contaminated (non-exposed) area (<1 Ci/km2)

Dental caries · Children aged 12-15 years (adolescents)

In adolescents (12-15 y) from weakly contaminated areas, individual studies mostly reported higher DMFT/dmft in exposed children but with wide variation; the review did not pool the data (ungraded).

9 findings from 1 review
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