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Evidence found and GRADE certainty

828 questions · 1,477 findings · 103 reviews

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No studies found 5 · 0.3%GRADE not reported 1,402 · 94.9%Very low 38 · 2.6%Low 20 · 1.4%Moderate 11 · 0.7%High 1 · 0.1%

Visual examination (VE) vs Histological validation of dental tissues (gold standard)

Diagnostic accuracy for proximal caries detection (1/3 dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro)

Under in vitro conditions, visual examination had a pooled specificity of 0.84 (95% CI 0.76, 0.89) for proximal caries detection at the 1/3 dentin detection level; ungraded.

4 findings from 1 review
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Digital bitewing radiography, phosphor plate (PSP) vs Histological validation of dental tissues (gold standard)

Diagnostic accuracy for proximal caries detection (dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro)

Under in vitro conditions, phosphor-plate digital bitewing radiography had a summary ROC AUC of 0.92 for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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Visual examination (VE) vs Histological validation of dental tissues (gold standard)

Diagnostic accuracy for proximal caries detection (dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro)

Under in vitro conditions, visual examination had a summary ROC AUC of 0.85 for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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Simplified caries prediction models (>=2 predictors; microbiome-primary studies excluded), but some pooled models include microbe predictors (Yaxuan 2023: S. mutans; Kim 2018: biofilm acidogenicity/saliva) vs No competing model

Model discrimination (area under the ROC curve, AUC) · Children and adolescents aged 1-18 years

Simplified childhood caries prediction models show moderate pooled discrimination (AUC 0.79, 95% CI 0.73-0.84) but with very high heterogeneity (I2=97.3%) and all models at high risk of bias (PROBAST); ungraded.

1 finding from 1 review

Breastfeeding for more than 24 months vs Not breastfed at the same age or breastfed for a shorter duration

Early childhood caries (ECC) - incidence/risk · Children with exclusively primary dentition (age ≤71 months)

Breastfeeding beyond 24 months is associated with an increased risk (incidence) of early childhood caries versus not breastfeeding at the same age (RR 2.44, 95% CI 1.97 to 3.02; low certainty).

1 finding from 1 review

Electronic cigarette use vs Non-smokers

Dry mouth (xerostomia) · Humans who use e-cigarettes (adolescents to adults) assessed for dental caries

Two studies reported more frequent xerostomia (dry mouth) among e-cigarette users than non-smokers, which may raise caries risk, but results were not pooled (ungraded, narrative).

1 finding from 1 review

Postbiotic products (postbiotic toothpaste; heat-killed/postbiotic oral lozenges; inactivated-bacteria tablets) vs Placebo, fluoride toothpaste, or standard post-filling care (varies by trial)

Streptococcus mutans count · Humans at risk of dental caries (children aged 6-12 years; adults with dental caries)

Postbiotic products reduce salivary S. mutans counts in human trials, though not always significantly (ungraded narrative synthesis).

1 finding from 1 review
  • Postbiotics and Dental Caries: A Systematic Review. 2025 All outcomes
    Daily for 14 days to 4 weeks · Clinical; salivary/plaque sampling
    Three RCTs reported reduced salivary S. mutans counts after postbiotic intervention; the reduction was statistically significant in Lin 2022 but non-significant in Basir 2022; no pooled estimate.
    3 studies
    GRADE not reported

Co-presence of Veillonella spp. with Streptococcus mutans vs Streptococcus mutans acidogenesis without Veillonella spp. modulation (conceptual)

Streptococcus mutans acid (lactic acid) production and cariogenic potential · Oral biofilm of children/individuals at risk of dental caries

The review concludes that Veillonella spp. may modulate (often inhibit) S. mutans acid production and compete for lactate substrate, potentially reducing cariogenesis, but the evidence is narrative and ungraded.

1 finding from 1 review

Presence of oral Candida albicans vs Absence of oral Candida albicans

Early childhood caries (ECC) · Children aged ≤6 years (early childhood)

RETRACTED. Among studies before 2017, oral C. albicans presence was associated with higher odds of ECC (OR 4.89, 95% CI 2.79-8.58); ungraded subgroup from a retracted review.

16 findings from 1 review
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Silver diamine fluoride (SDF) vs Other methods (pooled: ART/glass ionomer cement, nano-silver fluoride, sodium fluoride varnish, placebo)

Adverse effects (tooth staining and other side effects) · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

SDF commonly causes black staining of arrested lesions; only mild, transient adverse events were reported, with no major adverse events (ungraded).

1 finding from 1 review