Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

398 questions · 757 findings · 66 reviews · All outcomes

No studies found 20 · 2.6%GRADE not reported 574 · 75.8%Very low 39 · 5.2%Low 49 · 6.5%Moderate 53 · 7%High 22 · 2.9%

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

Clinical examination with 24-month recall vs Clinical examination with 6-month recall

Dental caries · Dentate adults (aged 18 years and older) receiving dental check-ups in UK general dental practices (regular attenders)

Clinical examination with 24-month recall showed no clear difference in dental caries: number of tooth surfaces with any caries (ICDAS 1-6) compared with clinical examination with 6-month recall (moderate certainty).

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

Resin-based fissure sealant (visible-light-polymerized) vs Fluoride varnish

Incidence of dentinal carious lesion on treated occlusal surfaces of molars or premolars (yes/no) · Children and adolescents (general population, aged under 20 years)

It is very uncertain whether resin-based fissure sealant (visible-light-polymerized) changes incidence of dentinal carious lesion on treated occlusal surfaces of… compared with fluoride varnish (very low certainty).

2 findings from 1 review

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

Increment of occlusal DMFS (decayed, missing, filled surfaces) of FPMs · Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel…

Fluoride varnish and fissure sealant did not differ significantly in occlusal DMFS increment of FPMs (MD 0.13, 95% CI -0.09 to 0.34; 3 RCTs; ungraded).

2 findings from 1 review

Resin-modified glass ionomer fissure sealant plus oral health education vs Fluoride varnish plus oral health education

Change in DMF increment on occlusal surfaces of first permanent molars · Children and adolescents (general population, aged under 20 years)

Resin-modified glass ionomer fissure sealant plus oral health… showed no clear difference in change in DMF increment on occlusal surfaces of first permanent molars compared with fluoride varnish plus oral health education; GRADE not reported.

2 findings from 1 review

Clinical examination with risk-based recall vs Clinical examination with 6-month recall

Dental caries · Dentate adults (aged 18 years and older) receiving dental check-ups in UK general dental practices (regular attenders)

Clinical examination with risk-based recall showed no clear difference in dental caries: number of tooth surfaces with any caries (ICDAS 1-6) compared with clinical examination with 6-month recall (high certainty).

1 finding from 1 review

Resin-based fissure sealant vs Fluoride varnish

Change in DMFS (decayed, missing and filled permanent surfaces) increment · Children and adolescents (general population, aged under 20 years)

Resin-based fissure sealant led to lower change in DMFS (decayed, missing and filled permanent surfaces)… compared with fluoride varnish; GRADE not reported.

1 finding from 1 review

All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic odds ratio (DOR) by subgroup: Smooth or secondary-caries surfaces (detection of early enamel caries, D1 threshold) · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

Clinical examination with risk-based recall vs Clinical examination with 24-month recall

Dental caries · Dentate adults (aged 18 years and older) receiving dental check-ups in UK general dental practices (regular attenders)

Clinical examination with risk-based recall showed no clear difference in dental caries: number of tooth surfaces with any caries (ICDAS 1-6) compared with clinical examination with 24-month recall (moderate certainty).

1 finding from 1 review

All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic odds ratio (DOR) by subgroup: Proximal surfaces (detection of early enamel caries, D1 threshold) · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic odds ratio (DOR) by subgroup: Occlusal surfaces (detection of early enamel caries, D1 threshold) · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review