Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

288 questions · 349 findings · 41 reviews · Dental caries

No studies found 43 · 12.3%GRADE not reported 207 · 59.3%Very low 42 · 12%Low 32 · 9.2%Moderate 22 · 6.3%High 3 · 0.9%

Gum chewing (sugar-free) vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish

Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) · Adults and children (general population)

In a sensitivity analysis assuming a 0.95 baseline-to-endpoint correlation for the sugar-free gum arm, the effect remained significant (SMD -0.55, 95% CI -0.80 to -0.30; 13 trials, I2 73%); certainty not formally graded.

2 findings from 1 review

Xylitol-only sugar-free chewing gum vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish

Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) · Adults and children (general population)

Xylitol-only sugar-free gum significantly reduced Streptococcus mutans load versus pooled controls (SMD -0.46, 95% CI -0.64 to -0.28; 12 trials, I2 43%); certainty not formally graded.

1 finding from 1 review

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Salivary Lactobacilli counts · Patients with drooling (sialorrhea) due to neurological disease

Salivary Lactobacilli counts were unchanged in two studies but significantly increased in one study one month after BoNT (ungraded; no effect estimate reported).

1 finding from 1 review
  • Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes
    Before vs after BoNT injection (2018 study: significant Lactobacilli increase at 1 month; Wu 2011 and 2017 study no change) · Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
    No statistically significant changes in Lactobacilli CFU counts were reported by Wu et al. or by Tiigimae-Saar 2017. However, the 2018 study found that Lactobacilli CFU counts were significantly increased one month…
    3 studies
    GRADE not reported

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Salivary osmolality (hydration level) · Patients with drooling (sialorrhea) due to neurological disease

No included study reported salivary osmolality; this pre-planned outcome remains unassessed (no studies).

1 finding from 1 review

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Salivary S. mutans level · Patients with drooling (sialorrhea) due to neurological disease

BoNT injections were not associated with significant changes in salivary S. mutans counts across three studies (ungraded; no effect estimate reported).

1 finding from 1 review
  • Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes
    Before vs after BoNT injection · Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
    The RCT by Wu et al. reported no statistically significant changes in S. mutans CFU counts (p-values only). The studies of Tiigimae-Saar did not find statistically significant differences in S. mutans CFU counts either.
    3 studies
    GRADE not reported

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Salivary pH · Patients with drooling (sialorrhea) due to neurological disease

BoNT injections were not associated with significant changes in oral/salivary pH across three studies (ungraded; no effect estimate reported).

1 finding from 1 review
  • Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes
    Before vs after BoNT injection · Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
    Wu et al. did not observe significant differences in participants' oral pH before and after BoNT-A injections between the active and control groups. There were also no statistically significant differences regarding…
    3 studies
    GRADE not reported

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Development of >=1 new carious lesion (caries incidence) · Patients with drooling (sialorrhea) due to neurological disease

In one RCT, BoNT-B 2500 U was not associated with a statistically significant increase in new caries versus placebo (RR 2.4, 95% CI 0.48 to 11.80; not significant).

2 findings from 1 review

Intraglandular botulinum neurotoxin (BoNT) injection vs No BoNT (placebo or pre-treatment baseline)

Salivary buffering capacity · Patients with drooling (sialorrhea) due to neurological disease

Salivary buffering capacity did not decrease after BoNT; one of two quasi-experimental studies reported a significant increase (ungraded; no effect estimate reported).

1 finding from 1 review
  • Oral health effects of botulinum toxin treatment for drooling: a systematic review. 2020 All outcomes
    Before vs after BoNT injection (2018 study: significant buffering increase at 1 month; 2017 study no change) · Neurological-disease populations with drooling (e.g., cerebral palsy, Parkinson disease, adults with sialorrhea); specialist clinical care
    The quasi-experimental studies of Tiigimae-Saar found different results concerning the changes in buffering capacity. For the analysis carried out in 2017, no statistically significant change was observed. By contrast,…
    2 studies
    GRADE not reported

440 to 550 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, tooth index D(M)FT · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)

440 to 550 ppm F toothpaste showed no clear difference in caries increment, tooth index D(M)FT compared with non-fluoride (0 ppm F) placebo toothpaste (low certainty).

1 finding from 1 review

1000 or 1100 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, tooth index D(M)FT · Adults with mature permanent dentition (aged 18 to 93 years at study start)

1000 or 1100 ppm F toothpaste showed no clear difference in caries increment, tooth index DMFT compared with non-fluoride (0 ppm F) placebo toothpaste (low certainty).

1 finding from 1 review

12,500 ppm F (NaF/olaflur/dectaflur) amine fluoride gel vs Placebo gel

Number of participants with more severe DLs (severity of DLs) · Orthodontic patients of any age with fixed braces (new DLs assessed at debond)

The review found no eligible studies for this question.

1 finding from 1 review

1450 to 1500 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, tooth index D(M)FT · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)

1450 to 1500 ppm F toothpaste probably leads to lower caries increment, tooth index D(M)FT compared with non-fluoride (0 ppm F) placebo toothpaste (moderate certainty).

1 finding from 1 review

38% silver diamine fluoride vs placebo

Root carious lesions arrest · Older adults with root carious lesions (exposed root surfaces)

One review reported SDF may reduce progression of root caries, with no numeric result (ungraded).

3 findings from 1 review

2400 to 2800 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, tooth index D(M)FT · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)

2400 to 2800 ppm F toothpaste may leads to lower caries increment, tooth index D(M)FT compared with non-fluoride (0 ppm F) placebo toothpaste (low certainty).

1 finding from 1 review

1450 to 1500 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, surface index D(M)FS · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)

1450 to 1500 ppm F toothpaste probably leads to lower caries increment, surface index D(M)FS compared with non-fluoride (0 ppm F) placebo toothpaste (moderate certainty).

1 finding from 1 review

1700 to 2200 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, tooth index D(M)FT · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)

1700 to 2200 ppm F toothpaste may leads to lower caries increment, tooth index D(M)FT compared with non-fluoride (0 ppm F) placebo toothpaste (low certainty).

1 finding from 1 review

250 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste

Caries increment, surface index D(M)FS · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)

250 ppm F toothpaste may leads to lower caries increment, surface index D(M)FS compared with non-fluoride (0 ppm F) placebo toothpaste (low certainty).

1 finding from 1 review

38% silver diamine fluoride vs placebo

Root carious lesions prevention · Older adults with root carious lesions (exposed root surfaces)

38% silver diamine fluoride reduced root-caries increment (DMFRS/DFRS) versus placebo, MD −0.33 (95% CI −0.39 to −0.28) (ungraded).

3 findings from 1 review

10% CPP-ACP cream (+ 900-ppm NaF mouthrinse + 1,000-ppm NaF dentifrice) vs Placebo cream (+ 900-ppm NaF mouthrinse + 1,000-ppm NaF dentifrice)

Arrest or reversal of noncavitated facial/lingual carious lesions · Children and adults with noncavitated carious lesions on facial/lingual surfaces (primary and permanent teeth)

10% CPP-ACP cream (+ 900-ppm NaF mouthrinse + 1,000-ppm NaF dentifrice) may not differ from Placebo cream (+ 900-ppm NaF mouthrinse + 1,000-ppm NaF dentifrice) for arrest or reversal of facial/lingual carious lesions (RR 1.28, 95% CI 0.97 to 1.68; low certainty).

3 findings from 1 review