Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

2,745 questions · 4,389 findings · 203 reviews · Oral Health

No studies found 39 · 0.9%GRADE not reported 3,844 · 87.6%Very low 198 · 4.5%Low 137 · 3.1%Moderate 134 · 3.1%High 37 · 0.8%

Indirect restorations (crowns, fixed partial dentures, inlays/onlays/veneers) vs None (single-group incidence)

Pulp necrosis · Vital teeth restored with indirect restorations

Pulp necrosis incidence among treated by prosthodontists was 1.87% (subgroup analysis; not GRADE-rated).

23 findings from 1 review
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Resin infiltration vs CPP-ACFP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration did not differ significantly from CPP-ACFP (SMD -0.52, 95% CI -1.16 to 0.12; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Access to oral healthcare (referral pathways, documentation processes, operating efficiencies, staffing, visits for oral health issues, uptake of fluoride varnish/other preventive treatment, and visits to an oral health professional) · People of all ages and abilities served through primary care and related settings (children, pregnant women, older adults in…

Most strategies to integrate oral health into primary care were associated with improved access to oral healthcare (19 studies, narrative synthesis; ungraded).

1 finding from 1 review
  • Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes
    Primary care, community, school, and aged-care/residential/nursing-home settings
    Access to oral healthcare was the primary outcome most studied (n=19). Most studies reported results favouring the integration strategy, including improvements in referral pathways, documentation processes, operating…
    19 studies
    GRADE not reported

Mutans streptococci present in oral samples at baseline vs Mutans streptococci absent in oral samples at baseline

Development of any (cavitated or non-cavitated) carious lesion · Children younger than 6 years with caries-free primary dentition (no cavitated or non-cavitated lesions at baseline)

Preschool children with mutans streptococci at baseline probably have about four times higher odds of developing early childhood caries (OR 4.13; moderate certainty).

10 findings from 1 review
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P11-4 + fluoride varnish vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

P11-4 plus fluoride varnish was significantly better than CPP-ACP (SMD -0.78, 95% CI -1.33 to -0.24; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Multivariable caries prediction model vs Additional prediction model(s)

Coronal caries increment · Individuals of all ages

The review reported this model performance without meta-analysis.

168 findings from 1 review
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ACTIVA bioactive restorative material vs Glass ionomer cement (GIC)

Secondary caries · Patients requiring dental restoration; permanent teeth

Over 1 year in permanent teeth, the effect of ACTIVA versus GIC on secondary caries is very uncertain (RR 22.80, 95% CI 0.89-584.17; very low certainty).

1 finding from 1 review

Tooth location

Pulp necrosis · Vital teeth

One study reported a 7.1% incidence in mandibular posterior teeth.

8 findings from 1 review
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Edentulism (complete or partial missing teeth) vs Individuals without edentulism

Oral health-related quality of life · Indian elderly

One study found edentulism did not affect OHRQoL (dichotomous); ungraded.

3 findings from 1 review

Safe housing / favorable household conditions vs Unsafe housing / poor household conditions

Oral health-related quality of life · Adolescents (10-19 years)

Safe housing and favorable household conditions are associated with better OHRQoL in adolescents (narrative synthesis; no pooled estimate or GRADE rating).

1 finding from 1 review
  • Oral-health-related quality of life in adolescents: umbrella review. 2023 All outcomes
    Community/school/clinic settings; adolescents 10-19 years; included reviews conducted in multiple countries
    having parents who can provide dental care and safe housing are positive predictors for OHRQoL. Socioeconomic factors related to the area of residence, satisfaction with oral health and dental care were shown to be…
    Studies not reported
    GRADE not reported

Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

Plaque · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)

In randomized trials, clear aligners probably reduce plaque accumulation versus fixed appliances, though the subgroup estimate is imprecise and its CI crosses no effect (SMD -1.79, 95% CI -3.63 to 0.04; moderate certainty).

6 findings from 1 review
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Carious dentin vs Sound dentin

Cathepsin K (CT-K) presence/activity · Human ex vivo carious dentin (mostly coronal), natural caries lesions

Cathepsin K may be increased in carious dentin (one study), but no certainty rating was assigned (ungraded).

1 finding from 1 review

Resin infiltration vs Fluoride varnish

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Resin infiltration was significantly better than fluoride varnish (SMD -0.70, 95% CI -1.18 to -0.21); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in permanent teeth undergoing pulpotomy

The effect of MTA versus CH after pulpotomy is uncertain (low certainty).

1 finding from 1 review

38% SDF (indirect pulp capping) vs Resin-modified glass ionomer cement (RMGIC)

Restoration color, marginal staining and luster (esthetics) · Children with deep occlusal caries in young permanent first molars (indirect pulp capping)

RMGIC gave significantly better restoration esthetics than SDF, which caused black staining (p=0.03; ungraded).

1 finding from 1 review

Multivariable caries prediction model vs Alternative prediction model(s) within the same study, or no formal comparator (models compared descriptively; no between-model statistical test)

Predictive performance for root caries increment (negative likelihood ratio, LR-) · Older adults (aged 52-95; mean 52-73) at risk of root caries increment

The single root-caries validation study (Hayes 2017) showed LR- of 0.34-0.41, above the useful rule-out threshold; no pooled estimate; ungraded.

2 findings from 1 review

Platelet-rich fibrin (PRF) graft vs Mineral trioxide aggregate (MTA)

Overall success (composite of clinical and radiographic success) · Patients with carious pulp exposure in immature permanent teeth undergoing pulpotomy

The two trials of PRF versus MTA for success gave contradictory results and were not pooled (ungraded).

1 finding from 1 review

38% silver diamine fluoride vs Atraumatic restorative treatment (ART)

Caries/restoration status in permanent molars · Children with dental caries in permanent (first) molars

SDF gave significantly better caries/restoration outcomes than ART over 9 months in children's permanent molars (p=0.004; ungraded).

1 finding from 1 review