What do systematic reviews say?

Self-assembling peptide P11-4 vs CPP-ACP

Self-assembling peptide P11-4 did not differ significantly from CPP-ACP (SMD -0.38, 95% CI -0.87 to 0.11; indirect evidence only); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.38 [-0.87, 0.11]
  Studies not reported
  GRADE not reported

CPP-ACP vs CPP-ACFP

CPP-ACP did not differ significantly from CPP-ACFP (SMD 0.25, 95% CI -0.24 to 0.73); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD 0.25 [-0.24, 0.73]
  2 studies
  GRADE not reported

Periodontal disease (periodontitis; clinical attachment loss >=4 mm) vs Adults without periodontal disease (healthy periodontal status; CAL <=3 mm)

Adults with periodontal disease had significantly higher odds of root caries than those without (pooled OR 1.38, 95% CI 1.25 to 1.53; 2 observational studies; low certainty).

• Is there an association between periodontal disease and root caries? A systematic review and meta-analysis. 2023 All outcomes

  Population-based dental surveys: England (Adult Dental Health Survey 2009) and China (4th National Oral Health Survey) for the two pooled studies; included studies from China, England, Japan, and Finland
  OR 1.38 [1.25, 1.53]
  2 studies · 7664 participants
  Low

Glass ionomer cement vs Resin composite restoration

Over 2 or more years in permanent teeth, GIC probably reduces secondary caries versus resin composite (RR 0.50, 95% CI 0.28-0.91; moderate certainty).

• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  2 or more years of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 0.50 [0.28, 0.91]
  14 studies · 1571 participants
  Moderate
• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  1 year of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 0.33 [0.10, 1.05]
  5 studies · 380 participants
  Low

Malocclusion vs No malocclusion

Malocclusions probably have a negative effect on OHRQoL in adolescents, after adjustment for confounders (moderate certainty).

• Malocclusions and quality of life among adolescents: a systematic review and meta-analysis. 2023 All outcomes

  Schools and dental clinics (multiple countries)
  Impaired OHRQoL, qualitative synthesis: relative effect not estimable across the 13 studies (13,864 participants); moderate quality of evidence (GRADE).
  13 studies · 13864 participants
  Moderate

Amalgam (AAG) vs Resin-modified glass ionomer cement (RMGIC)

Over 2 or more years in deciduous teeth, amalgam probably had a higher risk of secondary caries than RMGIC (RR 2.46, 95% CI 1.42-4.27; moderate certainty).

• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  2 or more years of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 2.46 [1.42, 4.27]
  8 studies · 1135 participants
  Moderate

Herbal mouthwash vs Blank control

Herbal mouthwash reduced several plaque-related indices, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  PI was significantly reduced compared to baseline [39; 48; 54; 58]; BBPI was significantly reduced compared to blank control [47]; TI and dental plaque amount were significantly reduced compared to baseline [45; 38].
  8 studies
  Very low

Intervention not reported

• Incidence and influential factors in pulp necrosis and periapical pathosis following indirect restorations: a… 2023 All outcomes

  Compound impression material
  Proportion 3.27
  1 study
  GRADE not reported

Giomer (GIONOMER) vs Resin-modified glass ionomer cement (RMGIC)

Over 2 or more years in deciduous teeth, the difference in secondary caries between giomer and RMGIC is uncertain (RR 1.66, 95% CI 0.49-5.61; low certainty).

• Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network… 2023 All outcomes

  2 or more years of follow-up · Restorative dentistry clinical settings; primary studies conducted across multiple countries
  RR 1.66 [0.49, 5.61]
  1 study · 38 participants
  Low

Gum chewing (sugar-free) vs No chewing gum

In elderly and medically compromised people with xerostomia, chewing sugar-free gum daily for two or more weeks produces a small but statistically significant increase in unstimulated whole salivary flow rate versus no gum (SMD 0.44, 95% CI 0.22 to 0.66); certainty of evidence was not formally graded.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  Gum chewed daily for >=2 weeks (2 to 12 weeks; multiple time points for Kim and Ozen) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  SMD 0.44 [0.22, 0.66]
  6 studies · 291 participants
  GRADE not reported

Biodentine vs Mineral trioxide aggregate (MTA)

MTA and Biodentine performed comparably for clinical and radiographic success (5 RCTs, not pooled; ungraded).

• Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A… 2023 All outcomes

  ≥6 months follow-up · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure
  Biodentine vs MTA was the second most frequent comparison (5 RCTs) for the primary outcome but was not pooled owing to substantial clinical/statistical heterogeneity; the panel of per-trial forest plots (Figure 8)…
  5 studies
  GRADE not reported

CPP-ACP vs Placebo or no active treatment

CPP-ACP did not differ significantly from control (SMD -0.18, 95% CI -0.49 to 0.14); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.18 [-0.49, 0.14]
  8 studies
  GRADE not reported

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

MTA increases clinical and radiographic success versus CH in mature teeth (moderate certainty).

• Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A… 2023 All outcomes

  1 to 3 years · Success after vital pulp therapy · Mature teeth
  OR 3.34 [1.81, 6.17]
  5 studies · 537 participants
  Moderate

Gum chewing (sugar-free) vs No chewing gum

Gum chewing was linked with improved self-reported xerostomia / dry mouth in most studies (12 of 17 positive, 5 no effect); heterogeneous instruments precluded meta-analysis.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  Various (single session to 3 months) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  Narrative vote-count: of 17 studies measuring self-reported xerostomia / dry mouth, 12 found a positive effect of gum chewing [18,19,21,23,24,25,26,27,30,31,38,40] and 5 detected no effect [17,29,33,34,37]. No study…
  17 studies
  GRADE not reported

Chlorhexidine mouthwash vs Blank control

Chlorhexidine mouthwash may reduce total bacteria colony counts versus blank control in the short term, but the evidence is very uncertain (very low certainty).

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  <=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  Colony count of total bacteria were significantly reduced compared to placebos according to two studies [34, 43].
  2 studies
  Very low

CPP-ACFP vs Placebo or no active treatment

CPP-ACFP versus control gave SMD -0.42 (95% CI -0.84 to 0.00); the review classed CPP-ACFP as statistically significant versus control although the reported CI upper limit is at the null (0.00); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.42 [-0.84, 0.00]
  5 studies
  GRADE not reported

Self-assembling peptide P11-4 vs CPP-ACFP

Self-assembling peptide P11-4 did not differ significantly from CPP-ACFP (SMD -0.13, 95% CI -0.68 to 0.42); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.13 [-0.68, 0.42]
  2 studies
  GRADE not reported

Herbal mouthwash vs Blank control

Herbal mouthwash reduced some gingival inflammation-related indices, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  CPI was significantly reduced compared to baseline [35]; SBI was significantly reduced while MGI was similar compared to baseline [45]; BOP was significantly reduced compared to blank control [39].
  3 studies
  Very low

Herbal mouthwash vs Blank control

Herbal mouthwash showed mixed effects on Mutans streptococci, with very low-certainty evidence.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  Colony count of MS was significantly reduced compared to baseline [48]; another study found an insignificant reduction compared to baseline [51].
  2 studies
  Very low

Mutans streptococci detected in plaque or saliva at baseline vs No mutans streptococci detected in plaque or saliva at baseline

Across the sample-based sensitivity analysis, mutans streptococci at baseline were associated with higher odds of developing caries.

• Is Mutans Streptococci count a risk predictor of Early Childhood Caries? A systematic review and meta-analysis. 2023 All outcomes

  6 months to 3.5 years · Japan; Finland; USA; Sweden; Singapore · Overall sample sensitivity analysis
  OR 4.04 [3.33, 4.90]
  12 studies · 3313 participants
  GRADE not reported