Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

1,692 questions · 2,586 findings · 180 reviews · Dental caries

No studies found 194 · 7.5%GRADE not reported 1,937 · 74.9%Very low 248 · 9.6%Low 136 · 5.3%Moderate 52 · 2%High 19 · 0.7%

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

Outcome not reported · Samples with a low (<15%) prevalence of caries into dentine (d3/D3); target condition = non-cavitated enamel caries.

The review found no eligible studies for this question.

1 finding from 1 review
  • Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    No eligible studies. 'No studies reported the inclusion of a low prevalence (0% to 14%) of d3/D3 of tooth surfaces'; all included studies reported d3/D3 prevalence of 15% or above, so the planned low-prevalence…
    0 studies
    No studies found

Fibre-optic transillumination (FOTI) vs Histological validation (in vitro) or direct visual examination after tooth separation / bioptical cavity preparation (in vivo)

detection of proximal caries · Permanent posterior teeth, proximal surfaces (in vitro extracted teeth and in vivo patients)

For fibre-optic transillumination (FOTI), studies were identified (in vitro N=4, in vivo N=3) but none had sufficiently low risk of bias and adequate reporting to be pooled; no meta-analytic estimate could be derived.

1 finding from 1 review

Transillumination and optical coherence tomography devices (all illumination devices combined: NIR, OCT, and FOTI/DIFOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

Oral health knowledge, attitudes and practices assessment vs None (descriptive prevalence review; subgroup analyses by urban/rural status, country and year)

Mother self-reported oral health behaviours and attitudes · Mothers and caregivers of children in the United Arab Emirates

Mothers and caregivers often had adequate knowledge/attitudes but improper oral-health practices and low dental-service use, associated with education and occupation (narrative synthesis; not GRADE-rated).

1 finding from 1 review

Dental plaque assessment (plaque score/index) vs None (descriptive prevalence review; subgroup analyses by urban/rural status, country and year)

Plaque · Children in the United Arab Emirates (Ajman, Sharjah)

Dental plaque levels were high and associated with frequent snacking and less frequent tooth brushing, and higher plaque was linked to more caries (narrative synthesis; not GRADE-rated).

1 finding from 1 review

Electrical conductance (e.g. electronic caries monitor, ECM) vs Reference standard: histology or enhanced visual-tactile examination

Outcome not reported · Adults presenting asymptomatically or suspected of having root caries (in vivo); extracted teeth of adults (in vitro)

The review found no eligible studies for this question.

1 finding from 1 review
  • Electrical conductance was a pre-specified eligible index test but no diagnostic test accuracy study of electrical conductance was included. A study evaluating the electronic caries monitor (ECM) (Wicht 2002) was…
    0 studies
    No studies found

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

VistaProof (Durr Dental; blue fluorescence, 405 nm) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic accuracy (sensitivity and specificity) for 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
  • Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    Analysed as a separate index test (coupled forest plot and SROC plot, Figure 24 / Figure 25; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 18 datasets, 2402 tooth sites.
    17 studies
    GRADE not reported

Laser fluorescence (DIAGNOdent 2190/pen) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic accuracy (sensitivity and specificity) for 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
  • Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 34 datasets, 6842 tooth sites.
    32 studies
    GRADE not reported

Laser fluorescence (LF; DIAGNOdent) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic accuracy (sensitivity and specificity) for 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
  • Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 46 datasets, 7316 tooth sites.
    45 studies
    GRADE not reported

Red fluorescence devices (DIAGNOdent, DIAGNOdent pen, MidWest; excitation wavelength >655 nm) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic odds ratio (DOR) for 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

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

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: Histology or excavation reference standard (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

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

Spectra caries detection device (Air Techniques; blue fluorescence) vs Reference standard (histology, excavation, or enhanced visual examination)

Diagnostic accuracy (sensitivity and specificity) for 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
  • Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies)
    The Spectra caries detection device fits into the blue fluorescence category but no studies provided data for inclusion in the meta-analysis (Markowitz 2015).
    1 study
    GRADE not reported

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: Permanent/mixed dentition (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

Laser fluorescence (LF; DIAGNOdent) vs Reference standard: histology (in vitro studies) or visual-tactile examination (in vivo studies)

Specificity · Adults presenting asymptomatically or suspected of having root caries (in vivo studies); extracted teeth of adults (in vitro studies). 2…
1 finding from 1 review
  • 4 studies (4997 root surfaces) investigated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. 2 studies evaluated tests on in vivo primary…
    4 studies
    Very low

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

Canary System (Quantum Dental Technologies; red fluorescence, scale 0-100) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation

Outcome not reported · Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of…

The review found no eligible studies for this question.

1 finding from 1 review

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

Sensitivity at fixed upper-quartile specificity 0.90 (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