What do systematic reviews say?

A permanent restorative material or technique (e.g. amalgam; glass ionomer (type I-IV); composite resin (macrofilled, microfilled, hybrid, nanofilled); resin-modified glass ionomer (compomer, giomer); cement/cermet; stainless steel or nickel-chrome crown; pre-fabricated resin/porcelain veneer facing; microabrasion) vs A different permanent restorative material or technique

The review found no eligible studies for this question.

• Interventions for the restorative care of amelogenesis imperfecta in children and adolescents 2013 · Cochrane All outcomes
  Main results: No studies met the inclusion criteria for this review. Effects of interventions: No studies met the inclusion criteria.
  0 studies
  No studies found

A permanent restorative material or technique (e.g. amalgam; glass ionomer (type I-IV); composite resin (macrofilled, microfilled, hybrid, nanofilled); resin-modified glass ionomer (compomer, giomer); cement/cermet; stainless steel or nickel-chrome crown; pre-fabricated resin/porcelain veneer facing; microabrasion) vs A different permanent restorative material or technique

The review found no eligible studies for this question.

• Interventions for the restorative care of amelogenesis imperfecta in children and adolescents 2013 · Cochrane All outcomes
  Main results: No studies met the inclusion criteria for this review. Effects of interventions: No studies met the inclusion criteria.
  0 studies
  No studies found

Initiation of water fluoridation (artificial or natural) vs Low/non-fluoridated water (0.4 ppm fluoride or less)

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes
  There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries levels across SES. Data from 3 observational studies (participants not…
  3 studies · 35399 participants
  Low

Cessation of water fluoridation (fluoride removed from the water supply) vs Continued fluoridated water

The review found no eligible studies for this question.

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes
  No evidence to determine the effect of the cessation of water fluoridation on disparities in caries across SES.
  0 studies
  No studies found

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

Interdental brushing plus toothbrushing may leads to lower gingivitis (bleeding and gingival indices; standardised across… compared with flossing plus toothbrushing (low certainty).

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  1 month (4 to 6 weeks)
  SMD -0.53 [-0.81, -0.24]
  7 studies · 326 participants
  Low
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  3 months (12 weeks)
  SMD -1.98 [-5.42, 1.47]
  2 studies · 107 participants
  Very low

Interdental brushing plus toothbrushing vs Flossing plus toothbrushing

Interdental brushing plus toothbrushing showed no clear difference in plaque (plaque indices; standardised across indices) compared with flossing plus toothbrushing (low certainty).

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  1 month (4 to 6 weeks)
  SMD 0.10 [-0.13, 0.33]
  7 studies · 326 participants
  Low
• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes

  3 months (12 weeks)
  SMD -2.14 [-5.25, 0.97]
  2 studies · 107 participants
  Very low

Lower unemployment rate vs Higher unemployment rate (low <=5% / medium >5-10% / high >10%)

Mean DMFT tended to increase with unemployment rate (low 1.23, medium 2.08, high 2.38; ANOVA p<.05); descriptive country-level means only, not meta-analyzed or GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries categorized by World Bank unemployment rate; not meta-analyzed (descriptive means + one-way ANOVA) · Low unemployment (<=5%)
  MEAN 1.23
  Studies not reported
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries categorized by World Bank unemployment rate; not meta-analyzed (descriptive means + one-way ANOVA) · Medium unemployment (>5-10%)
  MEAN 2.08
  Studies not reported
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries categorized by World Bank unemployment rate; not meta-analyzed (descriptive means + one-way ANOVA) · High unemployment (>10%)
  MEAN 2.38
  Studies not reported
  GRADE not reported

Higher per-capita expenditure on dental health care vs Lower per-capita expenditure on dental health care (USD bands: $0-50 / $51-100 / >$100)

Countries with higher per-capita dental expenditure had lower mean DMFT (>$100: 0.96; $51-100: 2.14; $0-50: 3.06) (Figure 4); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries stratified by OECD per-capita dental health-care expenditure (USD); test of group differences Q_b(2)=30.51, p<0.01; expenditure-stratified overall pooled DMFT 2.10 (95% CI 1.61-2.59), 32 countries · $0-50 per capita
  MEAN 3.06 [2.32, 3.79]
  14 studies
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries stratified by OECD per-capita dental health-care expenditure (USD); test of group differences Q_b(2)=30.51, p<0.01; expenditure-stratified overall pooled DMFT 2.10 (95% CI 1.61-2.59), 32 countries · >$100 per capita
  MEAN 0.96 [0.64, 1.28]
  12 studies
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries stratified by OECD per-capita dental health-care expenditure (USD); test of group differences Q_b(2)=30.51, p<0.01; expenditure-stratified overall pooled DMFT 2.10 (95% CI 1.61-2.59), 32 countries · $51-100 per capita
  MEAN 2.14 [1.40, 2.89]
  6 studies
  GRADE not reported

Higher national income (GNI per capita) vs Lower national income (GNI categories: middle <=$15,000 / high $15,001-25,000 / very high >$25,000)

Higher national income was strongly associated with lower odds of poor oral health (OR 0.10, 95% CI 0.03 to 0.37; about 90% lower odds); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries; ordinal logistic regression of DMFT category on socioeconomic indicators (adjusted) · Higher vs lower income (ordinal logistic regression, adjusted)
  OR 0.10 [0.03, 0.37]
  Studies not reported
  GRADE not reported

Western/Northern Europe (UN M49 region) vs Eastern/Southern Europe (UN M49 geographical categorization)

Mean DMFT is lowest in West Europe (0.88) and North Europe (1.34) and highest in East Europe (2.76) and South Europe (2.61) (Figure 3); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries grouped by UN M49 geographical categorization; test of group differences Q_b(3)=66.57, p<0.01 · North Europe
  MEAN 1.34 [0.62, 2.06]
  8 studies
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries grouped by UN M49 geographical categorization; test of group differences Q_b(3)=66.57, p<0.01 · East Europe
  MEAN 2.76 [2.44, 3.08]
  9 studies
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries grouped by UN M49 geographical categorization; test of group differences Q_b(3)=66.57, p<0.01 · West Europe
  MEAN 0.88 [0.54, 1.22]
  5 studies
  GRADE not reported

AI algorithms (predominantly CNN/deep learning) as index test vs Dental expert / visual-tactile clinical assessment (reference standard)

AI algorithms have high pooled sensitivity (0.85) for detecting dental caries; ungraded, with very high heterogeneity (I2>95%) and evidence of publication bias.

• Examining the diagnostic accuracy of artificial intelligence for detecting dental caries across a range of imaging… 2025 All outcomes

  Cross-sectional diagnostic accuracy (index test vs reference standard) · Dental imaging: intraoral photographs, periapical, bitewing, panoramic radiographs, CBCT, near-infrared transillumination · Overall (all imaging modalities pooled)
  Sensitivity 0.85 [0.83, 0.93]
  20 studies · 29423 participants
  GRADE not reported

Higher national income (GNI per capita) vs Lower national income (GNI categories: middle <=$15,000 / high $15,001-25,000 / very high >$25,000)

Mean DMFT in 12-year-olds rises as national income falls: 0.90 (very high income), 2.38 (high income), 3.30 (middle income) (Figure 2); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries stratified by World Bank GNI per capita (modified 3-category); test of group differences Q_b(2)=51.35, p<0.01 · Very high income (GNI >$25,000)
  MEAN 0.90 [0.66, 1.15]
  14 studies
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries stratified by World Bank GNI per capita (modified 3-category); test of group differences Q_b(2)=51.35, p<0.01 · High income (GNI $15,001-25,000)
  MEAN 2.38 [1.78, 2.97]
  8 studies
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries stratified by World Bank GNI per capita (modified 3-category); test of group differences Q_b(2)=51.35, p<0.01 · Middle income (GNI <=$15,000)
  MEAN 3.30 [2.57, 4.03]
  12 studies
  GRADE not reported

Very high Human Development Index (HDI >=0.800) vs High Human Development Index (HDI 0.700-0.799)

Mean DMFT was higher in high-HDI (3.41) than very-high-HDI (1.73) countries (ANOVA p<.01); descriptive country-level means only, not meta-analyzed or GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries categorized by HDI (high 0.700-0.799 vs very high >=0.800); not meta-analyzed (descriptive means + one-way ANOVA) · High HDI (0.700-0.799)
  MEAN 3.41
  Studies not reported
  GRADE not reported
• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries categorized by HDI (high 0.700-0.799 vs very high >=0.800); not meta-analyzed (descriptive means + one-way ANOVA) · Very high HDI (>=0.800)
  MEAN 1.73
  Studies not reported
  GRADE not reported

All European countries pooled (overall) vs None (overall pooled prevalence)

Across European countries the overall pooled mean DMFT in 12-year-olds was 2.10 (95% CI 1.63 to 2.57), with very high between-country heterogeneity (I2=100%); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European region (36 countries; 493,360 twelve-year-olds from 61 national/regional reports) · Overall
  MEAN 2.10 [1.63, 2.57]
  34 studies · 493360 participants
  GRADE not reported

AI algorithms (predominantly CNN/deep learning) as index test vs Dental expert / visual-tactile clinical assessment (reference standard)

AI algorithms have high pooled specificity (0.90) for detecting dental caries; ungraded, with very high heterogeneity (I2>95%).

• Examining the diagnostic accuracy of artificial intelligence for detecting dental caries across a range of imaging… 2025 All outcomes

  Cross-sectional diagnostic accuracy (index test vs reference standard) · Dental imaging: intraoral photographs, periapical, bitewing, panoramic radiographs, CBCT, near-infrared transillumination · Overall (all imaging modalities pooled)
  Specificity 0.90 [0.85, 0.95]
  20 studies · 29423 participants
  GRADE not reported

Lower unemployment rate vs Higher unemployment rate (low <=5% / medium >5-10% / high >10%)

Unemployment rate was not independently associated with DMFT category in the adjusted model (OR 0.99, 95% CI 0.44 to 2.23); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries; ordinal logistic regression of DMFT category on socioeconomic indicators (adjusted) · Unemployment rate (ordinal logistic regression, adjusted)
  OR 0.99 [0.44, 2.23]
  Studies not reported
  GRADE not reported

AI algorithms (predominantly CNN/deep learning) as index test vs Dental expert / visual-tactile clinical assessment (reference standard)

The area under the summary ROC curve for AI caries detection is 0.86, indicating high overall diagnostic accuracy; ungraded.

• Examining the diagnostic accuracy of artificial intelligence for detecting dental caries across a range of imaging… 2025 All outcomes

  Cross-sectional diagnostic accuracy (index test vs reference standard) · Dental imaging: intraoral photographs, periapical, bitewing, panoramic radiographs, CBCT, near-infrared transillumination · Overall (all imaging modalities pooled)
  AUC 0.86
  20 studies · 29423 participants
  GRADE not reported

Western/Northern Europe (UN M49 region) vs Eastern/Southern Europe (UN M49 geographical categorization)

In the adjusted ordinal model geographical location was not independently significant for DMFT category (OR 0.57, 95% CI 0.24 to 1.35); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries; ordinal logistic regression of DMFT category on socioeconomic indicators (adjusted) · Geographical location (ordinal logistic regression, adjusted)
  OR 0.57 [0.24, 1.35]
  Studies not reported
  GRADE not reported

Very high Human Development Index (HDI >=0.800) vs High Human Development Index (HDI 0.700-0.799)

HDI was not independently associated with DMFT category in the adjusted model (OR 1.82, 95% CI 0.32 to 10.47); not GRADE-rated.

• Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomes

  Cross-sectional (survey data 2011-2022) · European countries; ordinal logistic regression of DMFT category on socioeconomic indicators (adjusted) · Human Development Index (ordinal logistic regression, adjusted)
  OR 1.82 [0.32, 10.47]
  Studies not reported
  GRADE not reported

AI algorithms (predominantly CNN/deep learning) as index test vs Dental expert / visual-tactile clinical assessment (reference standard)

A positive AI test raises caries probability substantially (LR+ 10.44; positive post-test probability 79%); ungraded.

• Examining the diagnostic accuracy of artificial intelligence for detecting dental caries across a range of imaging… 2025 All outcomes

  Cross-sectional diagnostic accuracy (index test vs reference standard) · Dental imaging: intraoral photographs, periapical, bitewing, panoramic radiographs, CBCT, near-infrared transillumination · Overall (all imaging modalities pooled)
  LR+ 10.443 [7.505, 14.531]
  20 studies · 29423 participants
  GRADE not reported