Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

348 questions · 568 findings · 47 reviews · Dental caries

No studies found 23 · 4%GRADE not reported 485 · 85.4%Very low 27 · 4.8%Low 31 · 5.5%Moderate 2 · 0.4%High 0 · 0%

Fluoride gel (topically applied; operator- or self-applied; any fluoride agent/concentration; frequency at least once a year) vs Not specified

Remineralisation of early enamel caries · Children with early (incipient) enamel caries

One trial found sodium fluoride gel significantly remineralised early enamel caries; ungraded.

1 finding from 1 review

10% silver diamine fluoride (SDF) vs Glass ionomer restoration and tooth-brushing

Remineralisation of early enamel caries · Children with early enamel caries in erupting permanent first molars

One pilot study found 10% silver diamine fluoride worked about as well as glass ionomer restoration and tooth-brushing for remineralising early enamel caries; ungraded.

1 finding from 1 review

6% sodium fluoride with 6% calcium fluoride varnish vs no treatment

Remineralisation of early enamel caries · Children with early enamel caries (permanent dentition)

One trial found 6% sodium fluoride plus 6% calcium fluoride varnish significantly reversed early enamel caries versus no treatment; ungraded and not meta-analysed.

1 finding from 1 review

Early extraction of a compromised first permanent molar vs Contralateral non-extraction side (same patient)

Development and eruption of the second permanent molar · Children aged 5 to 15 years with a compromised first permanent molar

Root closure and eruption of the second permanent molar appeared accelerated on the extraction side in a single case-control study; ungraded and not statistically tested.

1 finding from 1 review

Early extraction of a compromised first permanent molar vs Teeth in the same arch/patient with the first permanent molar present

Caries and/or fillings in adjacent teeth · Children aged 5 to 15 years with a compromised first permanent molar

One study found fewer decayed or filled proximal surfaces but more decayed or filled occlusal surfaces in arches with an extracted first permanent molar; ungraded.

1 finding from 1 review

Early extraction of a compromised first permanent molar vs Non-extraction (retained first permanent molar) or contralateral non-extraction side

Spontaneous space closure · Children aged 5 to 15 years with a compromised first permanent molar

Early extraction of a compromised first permanent molar is followed by variable spontaneous closure of the post-extraction space (about 45.5% to 85.2% of cases); certainty was not GRADE-rated (Shekelle category III).

1 finding from 1 review

Early childhood caries (ECC) vs Caries-free primary dentition

Caries development in permanent teeth · School children and adolescents (6-18 years) followed from primary dentition (baseline examination before 72 months of age)

Early childhood caries increases the likelihood of caries in permanent teeth roughly three-fold, but the certainty of evidence is very low (OR 3.22, 95% CI 2.80 to 3.71).

1 finding from 1 review

Early extraction of a compromised mandibular first permanent molar vs Contralateral non-extraction side (same patient)

Development and eruption of the third molar · Children aged 5 to 15 years with a compromised first permanent molar

Development and eruption of the third molar appeared accelerated after early first permanent molar extraction in two studies (e.g., eruption OR 2.86, 95% CI 1.37 to 5.96); ungraded.

1 finding from 1 review

Unfavourable oral hygiene and dietary habits (frequent sweet/sugar consumption; low toothbrushing frequency in early childhood) vs Favourable oral hygiene and dietary habits

Caries development in permanent teeth · School children and adolescents (6-18 years) followed from primary dentition (baseline examination before 72 months of age)

Early-childhood oral hygiene and dietary habits show inconsistent associations with permanent-teeth caries, often losing significance after adjustment for past caries (2 studies; not pooled; not GRADE-rated).

1 finding from 1 review

Low tooth brushing frequency (<2 times/day) vs High tooth brushing frequency (>=2 times/day)

Early childhood caries (ECC) · Healthy children under 6 years of age (6 months to 6 years); preschool children

After excluding an extreme outlier (Alhabdan 2018), the association between low brushing frequency and ECC remained statistically significant (pooled OR approximately 2.0, p=0.003; I2=87.5%); the exact estimate and its CI were not reported; ungraded.

2 findings from 1 review

Not applicable (single-group prevalence) vs Not applicable (single-group prevalence)

Early childhood caries (ECC) · Children aged 0-5 years in North Africa

Pooled ECC prevalence in Tunisia was 38% (95% CI 24-51), significantly lower than Egypt and Sudan.

10 findings from 1 review
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Higher parental education (tertiary) vs Lower parental education (reference)

Early childhood caries (ECC) · Children aged 0-5 years in North Africa

Paternal tertiary education was associated with lower odds of ECC (OR 0.381).

3 findings from 1 review

Secondary (passive/secondhand) smoking exposure during childhood vs No secondary smoking exposure

Caries prevalence (early childhood caries) · Preschool children aged <=71 months (caries outcome assessed at 3-6 years)

Preschool children exposed to secondary smoking have higher odds of caries prevalence (OR 1.77), but the cross-sectional evidence is very uncertain (very low certainty).

2 findings from 1 review

Brushing vs Brushing less than daily

Early childhood caries (ECC) · Children aged 0-5 years in North Africa

Brushing twice daily was associated with lower odds of ECC (OR 0.033).

2 findings from 1 review

Sugar consumption (higher sugar intake) vs No sugar consumption (lower/no intake)

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

Higher sugar consumption is associated with early childhood caries in children under 6 years: pooled OR 1.59 (95% CI 1.50 to 1.68) from 9 cohort studies with no heterogeneity (I2=0%); the body of evidence was not GRADE-rated (ungraded).

1 finding from 1 review