Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

377 questions · 736 findings · 60 reviews · Dental caries

No studies found 17 · 2.3%GRADE not reported 563 · 76.5%Very low 39 · 5.3%Low 47 · 6.4%Moderate 50 · 6.8%High 20 · 2.7%

Silver diamine fluoride (SDF) vs Other methods (pooled: nano-silver fluoride, sodium fluoride varnish)

Caries arrestment at the surface level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

SDF probably makes little to no difference to surface-level caries arrestment versus other methods (moderate certainty).

1 finding from 1 review

Er:YAG laser irradiation of enamel after demineralisation vs No anticaries intervention (untreated enamel)

Enamel surface microhardness · Demineralised / white-spot-lesion enamel (in vitro specimens)

In demineralised enamel, Er:YAG laser irradiation did not significantly change surface microhardness versus untreated control (SMD 0.66, 95% CI -1.12 to 2.44; 2 in vitro studies; ungraded).

1 finding from 1 review

Fixed orthodontic treatment with fixed (multibracket) appliances (exposure) vs None (single-group prevalence/incidence estimate)

Prevalence of ICLs (proportion of tooth surfaces affected) · Patients (permanent dentition) during or after fixed orthodontic treatment with fixed (multibracket) appliances

About 22% of tooth surfaces showed ICLs during/after fixed orthodontic treatment (pooled 0.22, 95% CI 0.14-0.33; very low certainty; extreme heterogeneity).

1 finding from 1 review

38% SDF plus oral health education vs oral health instruction plus tonic water

new root-surface carious lesions or restorations · community-dwelling older adults with root caries

SDF had a 62% preventative fraction; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

38% SDF plus potassium iodide and oral health instruction vs oral health instruction plus tonic water

new root-surface carious lesions or restorations · community-dwelling older adults with root caries

SDF plus potassium iodide had a 52% preventative fraction; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

38% SDF plus oral health education vs oral health instruction plus water

new root-surface carious lesions or restorations · community-dwelling older adults with root caries

SDF plus oral health education had a 33% preventative fraction at 24 months; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

Severity of white spot lesions (surface area and depth) · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)

White spot lesion severity was assessed narratively in a small number of studies and not meta-analyzed; evidence is limited (ungraded).

1 finding from 1 review

38% SDF varnish plus oral health instruction vs oral health instruction plus water

new root-surface carious lesions or restorations · Older adults with root caries in permanent (mature) teeth (mean age 75 years)

SDF had a 71% preventative fraction at 36 months; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

OHI + 38% SDF (applied every 12 months) vs oral health instruction plus water

new root-surface carious lesions or restorations · community-dwelling older adults with root caries

SDF had a 28% preventative fraction at 24 months; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

Oral health education only (verbal, written, or audio-visual education) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Caries experience at the surface level (dmfs/defs) · Children (mean age newborn to ~5.2 years) and their parents/carers

Oral-health-education-only interventions did not show a statistically significant effect on surface-level caries (dmfs SMD -0.20, 95% CI -0.43 to 0.03; 2 studies; not GRADE-rated).

1 finding from 1 review

Comprehensive oral health intervention (oral health education plus additional support: motivational interviewing, toothbrush/toothpaste provision, community engagement, and/or fluoride varnish/sealant application) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Caries experience at the surface level (dmfs/defs) · Children (mean age newborn to ~5.2 years) and their parents/carers

Comprehensive interventions produced a small, statistically significant reduction in surface-level caries (dmfs SMD -0.14, 95% CI -0.26 to -0.02; 10 studies; not GRADE-rated).

1 finding from 1 review

Behaviour change / oral health promotion interventions delivered by non-dental professionals and health workers (nurses, midwives, health visitors, community health workers) vs control (no intervention/usual care/isotonic exercise)

Caries experience at the surface level (dmfs/defs) · Children (mean age newborn to ~5.2 years) and their parents/carers

Behaviour change interventions delivered by non-dental health workers produced a small, statistically significant reduction in caries experience at the surface level (dmfs SMD -0.15, 95% CI -0.25 to -0.04; 12 studies); the review judged the overall evidence to be of low quality (not GRADE-rated).

1 finding from 1 review

Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

Diagnostic accuracy on surfaces with pit and fissure sealants · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…

The review found no eligible studies for this question.

1 finding from 1 review

Fluoride varnish vs Fissure sealant (resin-based or glass ionomer)

Caries incidence of occlusal surfaces of first permanent molars · Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel…

After excluding Bravo 1996, occlusal caries incidence slightly favored fluoride varnish but was not significant, with heterogeneity falling to 0% (RR 0.98, 95% CI 0.82 to 1.16; 3 RCTs; ungraded).

2 findings from 1 review

Vegetarian diet (any diet excluding all meat, poultry and fish) vs Nonvegetarian diet

Dental caries measures other than pooled DMFT (DMFS, decayed/filled surfaces and teeth, root caries, nonvisible lesions, white spots) · General population (children and adults) assessed for dental hard-tissue health

Evidence on other dental-caries measures was inconsistent: some indices (decayed surfaces/teeth, root caries, white spots) were higher in vegetarians while some studies found lower caries in vegetarian children (ungraded).

1 finding from 1 review
  • Vegetarian diet and its possible influence on dental health: A systematic literature review. 2020 All outcomes
    Multiple countries (mostly India; also Finland and other European countries, Brazil, Trinidad and Tobago); community and clinical settings
    Eleven studies reported dental caries using 11 definitions; four (DMFT) were meta-analysed (see O2). Narrative findings were inconsistent: DMFS results were mixed; decayed surfaces and decayed teeth and percentages of…
    Studies not reported
    GRADE not reported