What do systematic reviews say?

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)

Key barriers to implementing integration strategies were time/staff/resource constraints and lack of organisational support, while facilitators were professionals' knowledge and attitudes and supportive governance/leadership (qualitative; 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
  The most commonly studied qualitative outcomes were barriers and facilitators related to the strategy implementation process. Reported barriers were time and staff constraints, resource limitations and lack of…
  15 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

Intervention not reported

• Teledentistry accuracy for caries diagnosis: a systematic review of in-vivo studies using extra-oral photography… 2024 All outcomes

  Studies reporting Spearman correlation (Almosa 2014, Daniel 2017, Zotti 2022)
  Spearman correlation coefficient 0.76 to 0.99 (Almosa 0.76; Zotti 0.816; Daniel 0.99)
  3 studies
  GRADE not reported

Fluoride-releasing glass ionomer-based bonding agent vs Non-fluoride glass ionomer-based bonding agent

For a glass-ionomer-based bonding agent (single study), fluoride release significantly reduced WSL initiation (RR 0.64); subgroup not separately GRADE-rated.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  1-24 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level · Glass ionomer-based bonding agent
  RR 0.64 [0.41, 0.99]
  1 study · 144 participants
  GRADE not reported

Sealant/coating agent WITH fluoride release applied to teeth with fixed appliances vs No sealant (control/no treatment)

Among fluoride-releasing sealants, the reduction in WSL initiation versus no sealant was not statistically significant (RR 0.69); subgroup not separately GRADE-rated.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  3-27 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level · Sealant with fluoride release
  RR 0.69 [0.46, 1.05]
  3 studies · 1467 participants
  GRADE not reported

Resin infiltration vs Untreated control (natural remineralization)

Resin infiltration produced significantly greater optical improvement of white spot lesions than untreated (naturally remineralizing) controls (SMD 1.24, 95% CI 0.59 to 1.88; moderate certainty).

• Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a… 2021 All outcomes

  4 weeks to 6 months
  SMD 1.24 [0.59, 1.88]
  3 studies · 949 participants
  Moderate
• Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a… 2021 All outcomes

  4 weeks to 6 months · Visual analog scale (Senestraro et al. 2013)
  SMD 2.34 [1.68, 3.01]
  1 study · 66 participants
  GRADE not reported
• Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a… 2021 All outcomes

  4 weeks to 6 months · Spectroscopy delta-E (Knosel et al. 2013)
  SMD 0.63 [0.26, 1.01]
  1 study · 115 participants
  GRADE not reported

Coating material (bonding material or sealant) WITH fluoride release vs Coating material WITHOUT fluoride release

Fluoride-releasing coating material did not show a statistically significant reduction in new white spot lesions versus non-fluoride coating (very low certainty).

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  1 to 24 months · Fixed orthodontic treatment · Overall
  RR 0.84 [0.70, 1.01]
  10 studies · 4705 participants
  Very low

Glass ionomer cement vs Resin adhesive

Glass ionomer cement did not show a statistically significant difference in new white spot lesions versus resin adhesive (very low certainty).

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  12 to 24 months · Fixed orthodontic treatment · Overall
  RR 0.72 [0.34, 1.54]
  3 studies · 394 participants
  Very low

Glass ionomer cement (for bracket bonding) vs Resin adhesive

There is no clear difference in WSL initiation between glass ionomer cement and resin adhesive for bracket bonding (RR 0.72, not significant); certainty of evidence is very low.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  12-24 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level
  RR 0.72 [0.34, 1.54]
  3 studies · 394 participants
  Very low

Sealant (any type) vs No sealant (control/no treatment)

Sealant use reduced the incidence of new white spot lesions versus no sealant (very low certainty).

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  3 to 27 months · Fixed orthodontic treatment · Overall
  RR 0.70 [0.53, 0.93]
  6 studies · 2314 participants
  Very low

Compomer (polyacid-modified composite, fluoride-releasing) for bonding brackets vs Compomer bonding agent without fluoride release

For compomer-based bonding agents, fluoride release did not significantly change WSL initiation (RR 0.71); subgroup not separately GRADE-rated.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  1-24 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level · Compomer-based bonding agents
  RR 0.71 [0.46, 1.11]
  2 studies · 400 participants
  GRADE not reported

Sealant/coating agent WITHOUT fluoride release applied to teeth with fixed appliances vs No sealant (control/no treatment)

Among non-fluoride sealants, WSL initiation was significantly reduced versus no sealant (RR 0.69); subgroup not separately GRADE-rated.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  3-27 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level · Sealant without fluoride release
  RR 0.69 [0.49, 0.97]
  3 studies · 847 participants
  GRADE not reported

Compomer (polyacid-modified composite, fluoride-releasing) for bonding brackets vs Compomer bonding agent without fluoride release

Fluoride-releasing compomer bonding agent did not show a statistically significant reduction in new white spot lesions versus non-fluoride compomer bonding agent (very low certainty).

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  1 to 24 months · Fixed orthodontic treatment · Compomer-based bonding agents
  RR 0.71 [0.46, 1.11]
  2 studies · 400 participants
  GRADE not reported

Intervention not reported

The intervention showed no clear difference in initiation of white spot lesions (WSL), visual-tactile assessment; GRADE not reported.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  Sensitivity (glass ionomer cement vs resin adhesive, excluding high risk-of-bias studies)
  RR 1.02 [0.82, 1.27]
  Studies not reported
  GRADE not reported

Intervention not reported

The intervention showed no clear difference in initiation of white spot lesions (WSL), visual-tactile assessment; GRADE not reported.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  Sensitivity (coating with vs without fluoride release, excluding parallel-arm studies)
  RR 0.82 [0.66, 1.02]
  Studies not reported
  GRADE not reported

Intervention not reported

The intervention showed no clear difference in initiation of white spot lesions (WSL), visual-tactile assessment; GRADE not reported.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  Sensitivity (sealant vs no sealant, excluding high risk-of-bias studies)
  RR 0.85 [0.66, 1.10]
  Studies not reported
  GRADE not reported

Fluoride-releasing resin-based sealant vs Non-fluoride resin-based sealant

For resin-based sealants, fluoride release did not significantly change WSL initiation (RR 0.71, wide CI); subgroup not separately GRADE-rated.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  1-24 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level · Resin-based sealants
  RR 0.71 [0.35, 1.43]
  2 studies · 644 participants
  GRADE not reported

Sealant or coating agent (with or without fluoride release) applied to teeth with fixed appliances vs No sealant (control/no treatment)

The additional use of a sealant probably reduces the initiation of white spot lesions during fixed orthodontic treatment compared with no sealant (RR 0.70), but the certainty of evidence is very low.

• Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a… 2021 All outcomes

  3-27 months follow-up · Patients undergoing fixed (multibracket) orthodontic appliance treatment; clinical/dental setting; analysis at tooth level
  RR 0.70 [0.53, 0.93]
  6 studies · 2314 participants
  Very low