Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

66 questions · 92 findings · 13 reviews · Oral Health

No studies found 1 · 1.1%GRADE not reported 74 · 80.4%Very low 6 · 6.5%Low 3 · 3.3%Moderate 6 · 6.5%High 2 · 2.2%

Xylitol lozenges (4.7 g/day) vs no treatment

Number of children with a caries increment · Children (permanent teeth; baseline 8 to 10 years)

Xylitol lozenges (4.7 g/day) showed no clear difference in number of children with a caries increment compared with no treatment; GRADE not reported.

1 finding from 1 review

Fluoride supplementation (tablets, drops, lozenges or chewing gum) vs Topical fluoride (fluoride rinse, varnish or toothpaste)

Caries increment in permanent teeth · Children and adolescents aged 16 years or less
2 findings from 1 review

Fluoride supplementation (tablets, drops, lozenges or chewing gum) vs No fluoride supplement (placebo or no treatment)

Caries increment in permanent teeth · Children and adolescents aged 16 years or less
3 findings from 1 review

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)

Oral disease outcomes, including dental caries estimates · People of all ages and abilities served through primary care and related settings (children, pregnant women, older adults in…

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

1 finding from 1 review
  • 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

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Development of >=1 new carious lesion (caries incidence) · Patients with drooling (sialorrhea) due to neurological disease

In one RCT, BoNT-B 2500 U was not associated with a statistically significant increase in new caries versus placebo (RR 2.4, 95% CI 0.48 to 11.80; not significant).

2 findings 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 Significant Caries (SiC) index · Alaska Native children (below age 18)

A simulation projected a 50% drop in the Significant Caries index for children (12.3 to 6.1) under the PDHA model (certainty not graded).

2 findings 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 proportion of caries-free children (5-18 years) · Alaska Native children (below age 18)

A simulation projected 0% of children aged 5-18 would be caries-free under the baseline scenario (certainty not graded).

3 findings from 1 review

Triclosan/copolymer-containing fluoride toothpaste vs Fluoride toothpaste without triclosan

Dental caries: prevalence of root caries · Children and adults (aged 16 years or less = children, over 16 = adults) without periodontitis at baseline; in practice mostly adults,…

Triclosan/copolymer-containing fluoride toothpaste probably leads to lower root caries at 36 months (Katz Root Caries Index) compared with fluoride toothpaste without triclosan (moderate certainty).

1 finding from 1 review

Triclosan/copolymer-containing fluoride toothpaste vs Fluoride toothpaste without triclosan

Coronal caries increment · Children and adults (aged 16 years or less = children, over 16 = adults) without periodontitis at baseline; in practice mostly adults,…

Triclosan/copolymer-containing fluoride toothpaste showed no clear difference in coronal caries increment at 30 to 36 months (decayed filled teeth,… compared with fluoride toothpaste without triclosan (high certainty).

2 findings from 1 review

Stevia (high-intensity/non-nutritive sweetener) in a daily snack vs Baseline (within-group change); white sugar snack is a parallel arm with no between-group effect size reported

Change in Mutans streptococci (MS) and Lactobacilli in saliva · Schoolchildren (6-9 years), high caries risk

The single stevia trial (Cocco 2019) reported a significant reduction in salivary Mutans streptococci and lactobacilli, but gave no effect size and was not GRADE-rated.

1 finding from 1 review
  • Clinical Effects of Sugar Substitutes on Cariogenic Bacteria: A Systematic Review and Meta-Analysis. 2024 All outcomes
    42 days · Schoolchildren in Italy, high caries risk; sweetener delivered as a daily snack · Single study (Cocco 2019); not pooled
    Cocco 2019 (the only high-intensity sweetener trial): the stevia snack showed a significant decrease in MS (P < .01) and in lactobacilli (P = .03) versus baseline, whereas the white-sugar snack showed no significant…
    1 study · 271 participants
    GRADE not reported