What do systematic reviews say?

Adhesive/polyurethane sealant patch vs No treatment (both arms received flossing plus fluoride toothpaste)

Adhesive/polyurethane sealant patch showed no clear difference in caries (lesion) progression (radiographic) compared with no treatment (both arms received flossing plus fluoride toothpaste); GRADE not reported.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 36 months (radiographic follow-up) · Sealant patch
  OR 1.00 [0.14, 7.23]
  1 study
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

The review found no eligible studies for this question.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes
  None of the studies reported on costs for micro-invasive treatment or non-invasive control
  0 studies
  No studies found

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

Micro-invasive treatment (proximal sealing or resin infiltration):… probably leads to lower caries (lesion) progression measured by pairwise reading of… compared with non-invasive measures (e.g. fluoride varnish, flossing/oral hygiene… (moderate certainty).

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  18 to 36 months (radiographic follow-up)
  OR 0.31 [0.18, 0.53]
  4 studies
  Moderate
• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 36 months (radiographic follow-up)
  OR 0.24 [0.14, 0.41]
  7 studies · 365 participants
  Moderate
• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 18 months (radiographic follow-up)
  OR 0.18 [0.06, 0.50]
  3 studies
  Moderate

Initiation of water fluoridation (artificial or natural) vs Low/non-fluoridated water (0.4 ppm fluoride or less)

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes
  There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries levels across SES. Data from 3 observational studies (participants not…
  3 studies · 35399 participants
  Low

Initiation of water fluoridation (artificial or natural) vs Low/non-fluoridated water (0.4 ppm fluoride or less)

Initiation of water fluoridation (artificial or natural) may leads to higher change in proportion of caries-free children (permanent teeth) compared with low/non-fluoridated water (0.4 ppm fluoride or less) (low certainty).

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes

  Follow-up 8 to 12 years
  MD 0.14 [0.05, 0.23]
  8 studies · 53538 participants
  Low

Resin sealant (one micro-invasive treatment) vs Resin infiltration alone

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  up to 3 years
  Only one study (Martignon 2012) directly compared resin sealant versus resin infiltration; the review could not determine which technique is more advantageous and reported no direct effect estimate for this comparison.
  1 study
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  1 to 3 years
  The four studies that measured adverse events reported no adverse events after micro-invasive treatment (no events in either arm)
  4 studies
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

The review found no eligible studies for this question.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes
  No studies reported on caries measured as change in decayed, missing and filled (DMF/dmf) figures at surface, tooth or whole mouth level
  0 studies
  No studies found

Resin sealant (with or without flossing advice) vs Flossing advice (non-invasive control)

Resin sealant (with or without flossing advice) led to lower caries (lesion) progression (radiographic) compared with flossing advice (non-invasive control); GRADE not reported.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 36 months (radiographic follow-up) · Resin sealant
  OR 0.33 [0.18, 0.59]
  2 studies
  GRADE not reported

Down syndrome vs Individuals without Down syndrome (healthy controls: siblings, schoolchildren or others)

Individuals with Down syndrome had a lower prevalence of dental caries than those without (pooled OR 0.36, 95% CI 0.22 to 0.57; 2 studies; I2=0%); certainty of evidence not graded.

• Association between Dental Caries and Down Syndrome: A Systematic Review and Meta-Analysis. 2015 All outcomes

  Individuals with and without Down syndrome in Portugal (reference centre, national database and closest-age siblings); cross-sectional studies
  OR 0.36 [0.22, 0.57]
  2 studies · 314 participants
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration) vs Conventional invasive treatment (restoration / drill and fill)

The review found no eligible studies for this question.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes
  No studies compared micro-invasive treatments with invasive treatment (fillings)
  0 studies
  No studies found

Resin infiltration vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)

Resin infiltration led to lower caries (lesion) progression (radiographic) compared with fluoride varnish, sham/placebo, or flossing advice (non-invasive…; GRADE not reported.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 36 months (radiographic follow-up) · Resin infiltration
  OR 0.19 [0.08, 0.46]
  2 studies
  GRADE not reported

Initiation of water fluoridation (artificial or natural) vs Low/non-fluoridated water (0.4 ppm fluoride or less)

Initiation of water fluoridation (artificial or natural) may leads to lower caries in deciduous teeth (change in dmft) compared with low/non-fluoridated water (0.4 ppm fluoride or less) (low certainty).

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes

  Follow-up 3 to 12 years
  MD -1.81 [-2.31, -1.31]
  9 studies · 44268 participants
  Low

Initiation of water fluoridation (artificial or natural) vs Low/non-fluoridated water (0.4 ppm fluoride or less)

Initiation of water fluoridation (artificial or natural) led to lower caries in permanent teeth (change in DMFS) compared with low/non-fluoridated water (0.4 ppm fluoride or less); GRADE not reported.

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes

  Follow-up (single study, Hardwick 1982)
  MD -2.46 [-3.81, -1.11]
  1 study · 343 participants
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  3 years
  One study (Alkilzy 2011, sealant patch) reported material deficiency: 10% total and 23% partial loss of proximal sealants after three years; 53% maintained perfect margins and none had open margins. No studies reported…
  1 study
  GRADE not reported

Initiation of water fluoridation (artificial or natural) vs Low/non-fluoridated water (0.4 ppm fluoride or less)

Initiation of water fluoridation (artificial or natural) may leads to higher change in proportion of caries-free children (deciduous teeth) compared with low/non-fluoridated water (0.4 ppm fluoride or less) (low certainty).

• Water fluoridation for the prevention of dental caries 2015 · Cochrane All outcomes

  Follow-up 3 to 12 years
  MD 0.15 [0.11, 0.19]
  10 studies · 39966 participants
  Low

Primary school-based behavioural intervention (both oral hygiene and dietary components) vs No treatment (or delayed treatment)

Primary school-based behavioural intervention (both oral hygiene and… showed no clear difference in plaque indices (permanent and deciduous teeth) compared with no intervention or delayed intervention (non-intervention control;… (low certainty).

• Primary school‐based behavioural interventions for preventing caries 2013 · Cochrane All outcomes

  3 to 15 months
  SoF (Plaque indices, follow-up 3 to 15 months): 'All 3 RCTs showed a reduction in plaque in the intervention group compared to control group'; 827 participants (3 RCTs); GRADE low; comment 'Data not suitable for…
  3 studies · 827 participants
  Low

Interdental brushing plus toothbrushing vs Toothbrushing alone

• Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults 2013 · Cochrane All outcomes
  Not estimable. Only 1 study reported adverse outcomes in terms of problems with the use of the assigned interdental cleaning aids. (See comment) In this comparison the single study (Jared 2005) asked participants to…
  1 study
  GRADE not reported

Fluoride varnish vs placebo or no treatment

Fluoride varnish showed no clear difference in proportion of children developing one or more new caries… compared with placebo or no treatment; GRADE not reported.

• Fluoride varnishes for preventing dental caries in children and adolescents 2013 · Cochrane All outcomes

  At least 1 year · Primary/deciduous dentition
  RR 0.81 [0.62, 1.06]
  5 studies · 1228 participants
  GRADE not reported

Primary school-based behavioural intervention (both oral hygiene and dietary components) vs No treatment (or delayed treatment)

• Primary school‐based behavioural interventions for preventing caries 2013 · Cochrane All outcomes

  15 months
  PF 0.65 [0.12, 1.18]
  1 study · 60 participants
  Low