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Each row is one question a systematic review asked: who, what, compared with what, and which outcome, with the effect it found and how certain that is. Words match anywhere in the field.
288 questions in 13 reviews · Dental public health and special care
current versionsNo studies 73 · 25.3%Ungraded 90 · 31.3%Very low 90 · 31.3%Low 29 · 10.1%Moderate 6 · 2.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
| Question | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Powered toothbrushing (as part of comprehensive oral care) vs Manual toothbrushing (standard oral care) Mortality · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 1.05 [0.16, 7.10] | 1 study · 78 participants | Ungraded |
Povidone iodine rinse vs Saline rinse or placebo Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.69 [0.50, 0.95] | 3 studies · 356 participants | Ungraded |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Duration of mechanical ventilation · Critically ill adults receiving mechanical ventilation in ICU · Follow-up: mean 1 month Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -0.43 [-1.17, 0.30] | 4 studies · 810 participants | Low |
Povidone iodine rinse vs Usual care (suction alone, no rinse) Mortality · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Povidone iodine versus usual care: single study (67 participants), no evidence of a difference in mortality. | 1 study · 67 participants | Ungraded |
Saline rinse plus swab vs Saline-soaked swab alone (usual care) Duration of mechanical ventilation · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -3.91 [-5.85, -1.97] | 1 study · 47 participants | Ungraded |
Povidone iodine rinse vs Saline rinse or placebo Duration of ICU stay · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -0.35 [-3.90, 3.21] | 2 studies · 217 participants | Ungraded |
Saline rinse vs Usual care (no rinse) Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 0.60 [0.39, 0.91] | 2 studies · 324 participants | Ungraded |
Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to healthcare workers, with or without the same intervention given to the patients with COVID-19 vs No treatment or saline or water Other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa, long-term staining of mucous membranes or teeth, accidental ingestion · Healthcare workers (HCWs) treating patients with suspected or confirmed COVID-19 infection Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when… (2020) · Cochrane | No data available (no included studies) | 0 studies | No studies |
Laminar air flow with HEPA filter vs Without laminar flow or filter Reduction in level of contamination in aerosols (CFU per cubic feet/min/patient) using Andersen cascade sampler 20-30 cm from mouth · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -483.56 [-550.02, -417.10] | 1 study · 50 participants | Very low |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Cost / economic data · Critically ill adults receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | The outcome of cost was not reported by any study in this comparison. | 0 studies | No studies |
Ionisation (ionic air purifier) vs No ionisation / standard operatory Outcome NR · Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental… Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | no estimate extracted | 0 studies | No studies |
Any method, procedure or policy to reduce contaminated aerosols in dental clinics vs Any other method, no treatment or combination of methods Incidence of infection of dental staff or patients · Dental healthcare providers (dentist, dental surgery assistant, dental hygienist, dental technologist, dental… Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | Rate of infection of dental staff or patients: Not reported (row present in all Summary of findings tables) | 0 studies | No studies |
Chlorhexidine vs Hydrogen peroxide Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Chlorhexidine versus hydrogen peroxide (Dahiya 2012): no evidence of a difference in incidence of VAP; single study. | 1 study | Ungraded |
Combination system (Isolite) vs Rubber dam + HVE Reduction in level of contamination in aerosols (CFU) during water spray using high-speed handpiece · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -125.20 [-174.02, -76.38] | 1 study · 1 participants | Very low |
High-volume evacuation (HVE) vs No HVE Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling and air polishing at less than 1 foot (~30 cm) from oral cavity (RCTs) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -47.41 [-92.76, -2.06] | 3 studies · 122 participants | Very low |
Rubber dam vs No rubber dam Reduction in level of contamination in aerosols (CFU) during restorative procedures at operator's forehead (RCT) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD 0.98 [-0.73, 2.70] | 1 study · 47 participants | Very low |
Chlorhexidine (mouthrinse or gel), as part of oral hygiene care vs Placebo or usual care Duration of systemic antibiotic use · Critically ill patients (adults and children) receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD 0.65 [-0.58, 1.88] | 1 study · 146 participants | Ungraded |
Antimicrobial mouthwash and/or nasal spray (alone or in combination), any concentration, frequency or dosage vs No treatment, saline, or water Changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx · Patients with suspected or confirmed COVID-19 infection Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed… (2020) · Cochrane | No data available (no included studies) | 0 studies | No studies |
Rubber dam + HVE vs Cotton roll + HVE Reduction in level of contamination in aerosols (CFU) during restorative procedures at dental unit light · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -12.70 [-12.85, -12.55] | 1 study · 21 participants | Very low |
Air cleaning system (ACS) vs No air cleaning system Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -32.40 [-51.55, -13.25] | 1 study · 2 participants | Very low |
Powered toothbrushing (as part of comprehensive oral care) vs Manual toothbrushing (standard oral care) Duration of mechanical ventilation · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD 0.00 [-1.78, 1.78] | 1 study · 78 participants | Ungraded |
Combination system (Isolite) vs HVE Reduction in level of contamination in aerosols (CFU) during water spray using high-speed handpiece · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -109.30 [-153.01, -65.59] | 1 study · 1 participants | Very low |
Saline rinse vs Usual care (no rinse) Mortality · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | RR 1.10 [0.87, 1.39] | 2 studies · 324 participants | Ungraded |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Adverse effects · Critically ill adults receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Adverse effects: information from two studies, which stated that there were none; very low certainty. There is a lack of evidence about adverse effects. | 2 studies | Very low |
Rubber dam vs No rubber dam Reduction in level of contamination in aerosols (CFU) during restorative procedures at 1 metre from mouth (RCT) · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -16.20 [-19.36, -13.04] | 1 study · 10 participants | Very low |
Air cleaning system (ACS) vs No air cleaning system Reduction in level of contamination in aerosols (CFU) during cavity preparation · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -66.70 [-120.15, -13.25] | 1 study · 2 participants | Very low |
Sodium bicarbonate rinse (plus toothbrushing) vs Water rinse (plus toothbrushing) Adverse effects · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Adverse effects (Berry 2011, CHX versus sodium bicarbonate versus water): no adverse events were reported associated with the interventions. | 1 study | Ungraded |
Chlorhexidine vs Ozonated water Incidence of VAP · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Chlorhexidine versus ozonated water (Hanifi 2017): some evidence of a benefit for ozonated water; single study, not replicated, interpret with caution. | 1 study | Ungraded |
Any antimicrobial mouthwash and/or nasal spray (alone or in combination), at any concentration, delivered to the patient or HCW before and/or after an AGP vs No treatment or saline or water COVID-19 viral content of aerosol · Patients without suspected or confirmed COVID-19 infection undergoing aerosol-generating procedures (AGPs), and the… Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking… (2020) · Cochrane | No data available (no included studies) | NR | No studies |
Rubber dam + HVE vs Cotton roll + HVE Reduction in level of contamination in aerosols (CFU) during restorative procedures at participant's chest · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -251.00 [-267.95, -234.05] | 1 study · 21 participants | Very low |
Toothbrushing (with or without antiseptics), as part of oral hygiene care vs No toothbrushing (with or without antiseptics) Duration of ICU stay · Critically ill adults receiving mechanical ventilation in ICU · Follow-up: mean 1 month Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | MD -1.89 [-3.52, -0.27] | 3 studies · 749 participants | Very low |
High-volume evacuation (HVE) vs Conventional dental suction (low-volume evacuator / saliva ejector) Reduction in level of contamination in aerosols (CFU) during ultrasonic scaling at 150 cm from mouth · People undergoing aerosol-generating procedures (AGPs) in a dental setting Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious… (2020) · Cochrane | MD -2.20 [-14.01, 9.61] | 1 study · 6 participants | Very low |
Povidone iodine rinse vs Saline rinse or placebo Adverse effects · Critically ill patients receiving mechanical ventilation in ICU Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia (2020) · Cochrane | Adverse effects (Seguin 2014): no evidence of a difference in acute respiratory distress syndrome (RR 11.00, 95% CI 0.62 to 195.61), agitation and/or hypertension (RR 0.48, 95% CI 0.12 to 1.86), epistaxis (RR 0.14, 95%… | 1 study | Ungraded |
Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs Usual care (no specific treatment) Calculus (long term) · Adults (mean age 30.9 years), level of ID unclear; setting day centre · Long term (>12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD -2.00 [-2.64, -1.36] | 1 study · 304 participants | Low |
Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush (self, carer or carer-assisted brushing) Plaque (medium term) · Children and adults with mixed levels of ID; setting home, residential, day care, school, mixed or not specified · Medium term (6 weeks to 12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | SMD 0.29 [-0.07, 0.65] | 2 studies · 120 participants | Low |
Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush (self, carer or carer-assisted brushing) Behaviour, attitude and self-efficacy (participant/carer preference) · Children and adults with mixed levels of ID; setting home, residential, day care, school, mixed or not specified · Long term (>12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Comparison 2.8 (reported; not GRADE-rated). One NRS (Bratel 1991, 23 participants), self-efficacy at 16 months: 10/12 people with ID using the electric toothbrush reported a preference for it, finding it easier to use… | 1 study · 23 participants | Ungraded |
Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush (self, carer or carer-assisted brushing) Gingival inflammation (short term) · Children and adults with mixed levels of ID; setting home, residential, day care, school, mixed or not specified · Short term (<6 weeks) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Electric vs manual toothbrush. Assorted gingival indices scale 0-4, 2-4 weeks; 252 participants (4 RCTs); Low. Four studies showed no significant differences for gingival inflammation short term; data could not be… | 4 studies · 252 participants | Low |
Oral hygiene interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention Dental caries levels of people with ID · People with intellectual disabilities (ID), living at home, in day care, in hospital or in a residential care setting;… Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | No studies measured dental caries levels. One RCT (Shaw 1991, Comparison 5) assessed DMFT at baseline only and did not report caries at any later time point. | 0 studies | No studies |
Toothpaste with a plaque-disclosing agent vs Conventional toothpaste Gingival inflammation (short term) · Children aged 7 to 13 years with Down syndrome (mild to moderate ID); setting residential · Short term (<6 weeks) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Toothpaste with a plaque-disclosing agent vs conventional toothpaste, children with Down syndrome. Ainamo & Bay Gingival Bleeding Index, mean 10 days; percent mean difference 18 (intervention) vs 8 (control), P<0.001… | 1 study · 40 participants | Very low |
Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs Usual care (no specific treatment) Gingival pocketing (long term) · Adults (mean age 30.9 years), level of ID unclear; setting day centre · Long term (>12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD -0.60 [-0.97, -0.23] | 1 study · 304 participants | Low |
Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs Usual care (no specific treatment) Plaque (long term) · Adults (mean age 30.9 years), level of ID unclear; setting day centre · Long term (>12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD -0.70 [-1.28, -0.12] | 1 study · 304 participants | Low |
Toothpaste with a plaque-disclosing agent vs Conventional toothpaste Plaque (short term) · Children aged 7 to 13 years with Down syndrome (mild to moderate ID); setting residential · Short term (<6 weeks) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Simplified Green & Vermillion Oral Hygiene Index (plaque), mean 10 days; percent mean difference 65 (intervention) vs 15 (control), P<0.0001 favouring the disclosing-agent toothpaste; 40 participants (SoF states 80,… | 1 study · 40 participants | Very low |
Oral hygiene care training of carers vs No training (or a placebo training session) of carers Plaque (medium term) · People with mixed levels of ID (age range unclear); setting residential · Medium term (6 weeks to 12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD -0.07 [-0.26, 0.13] | 2 studies · 99 participants | Low |
Oral hygiene interventions (mechanical plaque removal): knowledge-based, behavioural, or skills training for people with ID or their carers vs Usual care, no care, or a similar alternative intervention Any unintended (positive or negative) effects of the interventions · People with intellectual disabilities (ID), living at home, in day care, in hospital or in a residential care setting;… Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Adverse/unintended effects addressed narratively: 10 of 34 studies investigated or reported negative unintended or adverse effects (e.g. difficulty with the electric or 3-headed toothbrushes, being frightened by the… | 10 studies | Ungraded |
Electric toothbrush (self, carer or carer-assisted brushing) vs Manual toothbrush (self, carer or carer-assisted brushing) Gingival inflammation (medium term) · Children and adults with mixed levels of ID; setting home, residential, day care, school, mixed or not specified · Medium term (6 weeks to 12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD 0.02 [-0.06, 0.09] | 2 studies · 120 participants | Moderate |
Special manual toothbrush (self, carer or carer-assisted brushing) vs Conventional manual toothbrush (self, carer or carer-assisted brushing) Oral health assessment and oral bacteria levels (medium term) · Children and adults with mixed levels of ID; setting home, residential, day care, school, mixed or not specified · Medium term (6 weeks to 12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Comparison 1.5 (graded in the Effects of interventions text; not tabulated in the SoF). Single-use suction toothbrush vs standard manual toothbrush (both with a chemical agent), 90 days, Ferozali 2007: Total Oral… | 1 study · 22 participants | Very low |
Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID Plaque (short term) · Children and adults with mild to profound ID; setting residential or school · Short term (<6 weeks) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD -0.47 [-0.92, -0.02] | 1 study · 10 participants | Very low |
Scheduled dental recall intervals (1-, 3- or 6-monthly; oral hygiene instruction with or without scale and polish) plus daily supervised toothbrushing by carers vs Usual care (no specific treatment) Gingival bleeding (long term) · Adults (mean age 30.9 years), level of ID unclear; setting day centre · Long term (>12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | MD -0.20 [-0.86, 0.46] | 1 study · 304 participants | Low |
Oral hygiene training (toothbrushing routine) of people with ID vs No oral hygiene training of people with ID Behaviour, attitude and self-efficacy (toothbrushing behaviour) (medium and long term) · Children and adults with mild to profound ID; setting residential or school · Long term (>12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Behaviour, attitude and self-efficacy (steps achieved in a toothbrushing routine), 100 days to 19 months; 59 participants (4 NRS); Very Low. Results not in a format for meta-analysis: 3 NRS (56 participants) reported… | 4 studies · 59 participants | Very low |
Special manual toothbrush (self, carer or carer-assisted brushing) vs Conventional manual toothbrush (self, carer or carer-assisted brushing) Behaviour, attitude and self-efficacy (carer experience) (medium term) · Children and adults with mixed levels of ID; setting home, residential, day care, school, mixed or not specified · Medium term (6 weeks to 12 months) Oral hygiene interventions for people with intellectual disabilities (2019) · Cochrane | Comparison 1.6 (graded in the Effects of interventions text; not tabulated in the SoF). Bildt 2010, Superbrush vs conventional, 4 months, 18 participants (1 RCT): carer handling of toothbrush MD 0.50 (95% CI -0.35 to… | 1 study · 18 participants | Very low |