What do systematic reviews say?

Cone beam computed tomography (CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.60 [0.51, 0.68]
  7 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (CBCT)
  Sensitivity 0.68 [0.42, 0.86]
  Studies not reported
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (CBCT)
  Sensitivity 0.76 [0.55, 0.89]
  Studies not reported
  GRADE not reported

Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Specificity 0.76 [0.43, 0.93]
  6 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · CBCT
  Specificity 0.69 [0.35, 0.90]
  6 studies
  GRADE not reported

Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · CBCT
  Sensitivity 0.76 [0.65, 0.85]
  6 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Sensitivity 0.69 [0.57, 0.80]
  6 studies
  GRADE not reported

Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Sensitivity 0.47 [0.36, 0.59]
  15 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Analogue
  Sensitivity 0.41 [0.30, 0.53]
  15 studies
  GRADE not reported

Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.49 [0.42, 0.56]
  40 studies
  GRADE not reported

Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Specificity 0.87 [0.82, 0.91]
  40 studies
  GRADE not reported

Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)

The review found no eligible studies for this question.

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Restorations (secondary caries)
  Pre-specified heterogeneity investigation of teeth with previously applied restorations (secondary caries): no study intentionally included restored teeth in its sample. Studies evaluating secondary caries were…
  0 studies
  No studies found

Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  ECM (4 studies, 475 tooth surfaces): sensitivity ranged from 0.61 to 0.98 (0.61-0.65 in three studies; 0.98 in the most recent ECM IV study). No evidence of a difference in accuracy by device type (Chi2=0.05, df=1,…
  4 studies
  GRADE not reported

Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  ECM (4 studies, 475 tooth surfaces): specificity ranged from 0.73 to 0.96.
  4 studies
  GRADE not reported

Canary System (Quantum Dental Technologies; red fluorescence, scale 0-100) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation

The review found no eligible studies for this question.

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  The Canary System was not used by any included study.
  0 studies
  No studies found

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition
  Permanent dentition (4 studies): sensitivity ranged from 0.55 to 0.65.
  4 studies
  GRADE not reported
• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition
  Primary dentition (3 studies): sensitivity ranged from 0.91 to 0.93. No evidence of a difference in accuracy by dentition (removing accuracy covariate: Chi2=3.15, df=1, P=0.08).
  3 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

The review found no eligible studies for this question.

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  No eligible studies. All included studies assessed occlusal surfaces only; smooth surfaces were a planned surface subgroup with no data.
  0 studies
  No studies found

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition
  Permanent dentition (4 studies): specificity ranged from 0.73 to 1.00.
  4 studies
  GRADE not reported
• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition
  Primary dentition (3 studies): specificity ranged from 0 to 0.92.
  3 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Diagnostic odds ratio (DOR) 15.65 [1.43, 171.15]
  7 studies
  Very low

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

The review found no eligible studies for this question.

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  No eligible studies. 'No included studies reported inclusion criteria of previously applied restorations or pit and fissure sealants' (a planned subgroup).
  0 studies
  No studies found

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

The review found no eligible studies for this question.

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  No eligible studies. All included studies assessed occlusal surfaces only ('All studies assessed the use of the electrical conductance devices on occlusal surfaces.'); proximal surfaces were a planned surface subgroup…
  0 studies
  No studies found

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

The review found no eligible studies for this question.

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  No eligible studies. 'No studies reported the inclusion of a low prevalence (0% to 14%) of d3/D3 of tooth surfaces'; all included studies reported d3/D3 prevalence of 15% or above, so the planned low-prevalence…
  0 studies
  No studies found

Veillonella spp. abundance

Veillonella spp. predicted future caries among children without a caries history, but no quantitative effect estimate was reported.

• A systematic review of Streptococcus Mutans and Veillonellae species interactions in dental caries progression:… 2025 All outcomes

  USA
  Among children without a previous history of caries, Veillonella spp., but not S. mutans or other acid-producing species, predicted future caries.
  1 study · NA (subgroup without prior caries history; n not reported) 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 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

Inactivated-bacteria tablets vs Placebo, fluoride toothpaste, or standard post-filling care (varies by trial)

Adjuvant postbiotics after dental filling improve caries prognosis by restoring the oral microbiota in one RCT (ungraded).

• Postbiotics and Dental Caries: A Systematic Review. 2025 All outcomes

  14 days · Clinical; salivary/plaque sampling
  One RCT reported that adjuvant postbiotic tablets after dental filling improved caries prognosis by restoring oral microbiota diversity, structure and function and reducing potentially pathogenic bacteria (Liu 2024);…
  1 study
  GRADE not reported