What do systematic reviews say?

Individually designed, patient-centred preventive programme: dietary counselling (snacking timing, regular meals, fermentable carbohydrates) plus toothbrushing counselling, delivered by trained dental hygienists (a multi-intervention) vs Basic prevention offered as standard in public dental clinics

• One‐to‐one dietary interventions undertaken in a dental setting to change dietary behaviour 2012 · Cochrane All outcomes

  2 to 4 years
  Table 2: 87% (218) versus 86% (212) at follow-up (baseline 81% versus 87%). No significant change.
  1 study · 497 participants
  GRADE not reported

Individually designed, patient-centred preventive programme: dietary counselling (snacking timing, regular meals, fermentable carbohydrates) plus toothbrushing counselling, delivered by trained dental hygienists (a multi-intervention) vs Basic prevention offered as standard in public dental clinics

Individually designed, patient-centred preventive programme: dietary… led to higher using xylitol products more than 3 times per day compared with basic prevention offered as standard in public dental clinics; GRADE not reported.

• One‐to‐one dietary interventions undertaken in a dental setting to change dietary behaviour 2012 · Cochrane All outcomes

  2 to 4 years
  RR 1.32 [1.04, 1.68]
  1 study · 497 participants
  GRADE not reported

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)

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).

• The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes

  Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Comprehensive intervention (vs oral health education only)
  SMD -0.14 [-0.26, -0.02]
  10 studies
  GRADE not reported

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)

Comprehensive interventions produced a statistically significant reduction in tooth-level caries (dmft SMD -0.47, 95% CI -0.84 to -0.10; 4 studies; not GRADE-rated), though heterogeneity was very high.

• The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes

  Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Comprehensive intervention (vs oral health education only)
  SMD -0.47 [-0.84, -0.10]
  4 studies
  GRADE not reported

Quantitative light-induced fluorescence (QLF) vs Reference standard

QLF had pooled sensitivity of 0.83 and specificity of 0.74 for proximal caries (all dentitions, in vitro).

• Diagnostic accuracy of quantitative light-induced fluorescence in detecting caries of various types and locations: a… 2025 All outcomes

  in vitro · Permanent dentition (all 3 included studies)
  Sensitivity 0.83
  3 studies
  GRADE not reported
• Diagnostic accuracy of quantitative light-induced fluorescence in detecting caries of various types and locations: a… 2025 All outcomes

  in vitro · permanent dentition
  Sensitivity 0.83
  3 studies
  GRADE not reported
• Diagnostic accuracy of quantitative light-induced fluorescence in detecting caries of various types and locations: a… 2025 All outcomes

  in vitro · Permanent dentition (all 3 included studies)
  Specificity 0.74
  3 studies
  GRADE not reported

Quantitative light-induced fluorescence (QLF) vs Reference standard

QLF had pooled sensitivity of 0.86 and specificity of 0.80 for occlusal caries (permanent dentition, in vivo).

• Diagnostic accuracy of quantitative light-induced fluorescence in detecting caries of various types and locations: a… 2025 All outcomes

  in vivo · permanent dentition
  Specificity 0.80
  3 studies
  GRADE not reported
• Diagnostic accuracy of quantitative light-induced fluorescence in detecting caries of various types and locations: a… 2025 All outcomes

  in vivo · all dentitions
  Specificity 0.82
  4 studies
  GRADE not reported

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Control: fluoride toothpaste alone, placebo mouthrinse + toothpaste, or non-fluoride (chlorhexidine) mouthrinse + toothpaste

Only one included study assessed proximal caries incidence from bitewing radiographs; it was not included in the meta-analysis and no pooled estimate is available (ungraded).

• Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and meta-analysis. 2025 All outcomes

  At debonding (~23-24 months) · Clinical orthodontic (fixed multi-bracket appliance) treatment
  In one study assessments of proximal caries incidence were made as well [18]. However, just the data on the incidence of white spot lesions was included in our meta-analysis as different endpoints for the assessments…
  1 study
  GRADE not reported

Referral letter based on the common-sense model (CSM) of self-regulation vs Standard referral letter

It is very uncertain whether referral letter based on the common-sense model (CSM) of… changes proportion of children with treated/untreated caries (receipt of… compared with standard referral letter (very low certainty).

• School dental screening programmes for oral health 2022 · Cochrane All outcomes

  mean 8 months
  OR 0.97 [0.62, 1.51]
  1 study · 388 participants
  Very low

Analogue (conventional) 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 0.44 [0.38, 0.50]
  51 studies
  GRADE not reported

Radiographic imaging methods (any: analogue radiographs, digital radiographs, or 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) · Reference standard: enhanced visual (non-CBCT)
  Sensitivity 0.47 [0.29, 0.66]
  8 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) · Permanent dentition (non-CBCT)
  Sensitivity 0.44 [0.37, 0.51]
  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) · Dentine-caries (D3) prevalence medium 15-34% (non-CBCT)
  Sensitivity 0.51 [0.40, 0.61]
  Studies not reported
  GRADE not reported

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) · Proximal surfaces (CBCT)
  Specificity 0.90 [0.77, 0.96]
  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)
  Specificity 0.81 [0.73, 0.88]
  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) · Occlusal surfaces (CBCT)
  Specificity 0.54 [0.31, 0.75]
  Studies not reported
  GRADE not reported

Radiographic imaging methods (any: analogue radiographs, digital radiographs, or 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) · Permanent dentition (non-CBCT)
  Specificity 0.90 [0.85, 0.93]
  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) · Sensitivity analysis: low risk of bias for index test
  Specificity 0.88 [0.82, 0.92]
  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) · Dentine-caries (D3) prevalence high >=35% or unreported (non-CBCT)
  Specificity 0.89 [0.82, 0.93]
  Studies not reported
  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) · Analogue
  Specificity 0.91 [0.86, 0.94]
  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) · Digital
  Specificity 0.88 [0.83, 0.92]
  15 studies
  GRADE not reported

Analogue (conventional) 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 0.90 [0.86, 0.93]
  51 studies
  GRADE not reported

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