Findings

What do systematic reviews say?

821 questions · 993 findings · 80 reviews · Dental caries

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No studies found 60 · 6%GRADE not reported 749 · 75.4%Very low 109 · 11%Low 41 · 4.1%Moderate 34 · 3.4%High 0 · 0%

Non-syndromic cleft lip and palate (CLP) status and its oral microbiota (exposure/grouping) vs Children and adolescents aged 0-18 years without CLP (controls)

Lactobacillus spp. salivary/plaque counts (cariogenic microbiota) · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)

A meta-analysis found no significant difference in mean Lactobacillus spp. levels between children with and without CLP, with high heterogeneity; the evidence is ungraded.

1 finding from 1 review

Characterization of the oral microbiota and the relationship of the oral microbiota with the dental and periodontal… 2024 All outcomes
Multiple countries; pediatric cleft/craniofacial care; saliva, dental plaque, subgingival plaque and nasal/oropharyngeal samples
For the outcome of the presence of Lactobacillus spp., there were no significant differences between patients with CLP and healthy patients, and the diversity of the studies led to high heterogeneity; however, the p…
Studies not reported
GRADE not reported

Non-syndromic cleft lip and palate (CLP) status and its oral microbiota (exposure/grouping) vs Children and adolescents aged 0-18 years without CLP (controls)

Streptococcus mutans count · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)

A meta-analysis of 2 studies found no difference in mean Streptococcus mutans levels between children with and without CLP, with very high heterogeneity; the evidence is ungraded.

1 finding from 1 review

Characterization of the oral microbiota and the relationship of the oral microbiota with the dental and periodontal… 2024 All outcomes
Multiple countries; pediatric cleft/craniofacial care; saliva, dental plaque, subgingival plaque and nasal/oropharyngeal samples
Two studies were analyzed that reported the outcome in means of the presence of Streptococcus mutans, and that there was no difference between the means for healthy patients and those with CLP. The results of these…
2 studies
GRADE not reported

Non-syndromic cleft lip and palate (CLP) status and its oral microbiota (exposure/grouping) vs Children and adolescents aged 0-18 years without CLP (controls)

Periodontal conditions (gingival inflammation, bleeding on probing, probing depth, clinical attachment loss) · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)

Narrative synthesis of 6 studies suggests children/adolescents with CLP have poorer periodontal status (higher gingival and plaque indices, deeper probing, more bleeding and attachment loss) and harbor periodontopathogens; no pooled estimate and the evidence is ungraded.

1 finding from 1 review

Characterization of the oral microbiota and the relationship of the oral microbiota with the dental and periodontal… 2024 All outcomes
Multiple countries; pediatric cleft/craniofacial care; saliva, dental plaque, subgingival plaque and nasal/oropharyngeal samples
Six studies (Ahluwalia, Rawashdeh, Funahashi, Perdikogianni, Quirynen, Costa) reported that patients with CLP had higher gingival index and biofilm/plaque index, deeper probing depth, more bleeding on probing and…
6 studies
GRADE not reported

Oral health education only (verbal, written, or audio-visual education) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Caries experience · Children (mean age newborn to ~5.2 years) and their parents/carers

Oral-health-education-only interventions showed at most a marginal effect on tooth-level caries (dmft SMD -0.11, 95% CI -0.21 to -0.00; 2 studies; not GRADE-rated).

1 finding from 1 review

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes
Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Oral health education only (vs comprehensive intervention)
SMD -0.11 [-0.21, 0.00]
2 studies
GRADE not reported

Oral health education only (verbal, written, or audio-visual education) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Caries experience at the surface level (dmfs/defs) · Children (mean age newborn to ~5.2 years) and their parents/carers

Oral-health-education-only interventions did not show a statistically significant effect on surface-level caries (dmfs SMD -0.20, 95% CI -0.43 to 0.03; 2 studies; not GRADE-rated).

1 finding from 1 review

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes
Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Oral health education only (vs comprehensive intervention)
SMD -0.20 [-0.43, 0.03]
2 studies
GRADE not reported

Community and caregiver oral health education plus media campaign vs Pre-intervention baseline (and sites that discontinued the prevention program)

Reduction in prevalence of baby bottle tooth decay (BBTD) · Alaska Native and American Indian Head Start children

Community and caregiver oral health education was associated with a significant ~25% overall reduction in baby bottle tooth decay among Head Start children (certainty not graded).

1 finding from 1 review

Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case… 2013 All outcomes
3 to 8 years · Head Start sites in Alaska (1) and the continental US (11); Alaska Native and American Indian communities
Percent reduction in BBTD prevalence 25
1 study
GRADE not reported

Behaviour change / oral health promotion interventions delivered by non-dental professionals and health workers (nurses, midwives, health visitors, community health workers) vs control (no intervention/usual care/isotonic exercise)

Caries experience at the surface level (dmfs/defs) · Children (mean age newborn to ~5.2 years) and their parents/carers

Behaviour change interventions delivered by non-dental health workers produced a small, statistically significant reduction in caries experience at the surface level (dmfs SMD -0.15, 95% CI -0.25 to -0.04; 12 studies); the review judged the overall evidence to be of low quality (not GRADE-rated).

1 finding from 1 review

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes
Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.)
SMD -0.15 [-0.25, -0.04]
12 studies
GRADE not reported

Behaviour change / oral health promotion interventions delivered by non-dental professionals and health workers (nurses, midwives, health visitors, community health workers) vs control (no intervention/usual care/isotonic exercise)

Caries experience · Children (mean age newborn to ~5.2 years) and their parents/carers

Behaviour change interventions delivered by non-dental health workers produced a small-to-moderate, statistically significant reduction in caries experience at the tooth level (dmft SMD -0.34, 95% CI -0.54 to -0.13; 6 studies); the review judged the overall evidence to be of low quality (not GRADE-rated).

1 finding from 1 review

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes
Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.)
SMD -0.34 [-0.54, -0.13]
6 studies
GRADE not reported

Primary school-based interventions (one or more of: school health policy, oral health education, healthy school environment, access to oral health services, community involvement) vs usual practice

Dental caries · Primary school children (aged 3-16 years) attending primary school in low- and middle-income countries (LMICs)

Among children aged 6-8 years, DMFT scores were significantly reduced (SMD -0.11); subgroup not separately GRADE-rated.

8 findings from 1 review

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Age 6-8 years
SMD -0.11 [-0.17, -0.04]
Studies not reported
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · <=3 intervention activities
SMD -0.58 [-1.62, 0.45]
Studies not reported
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
<2 years · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention duration <2 years
SMD 0.01 [-0.16, 0.18]
3 studies
GRADE not reported

Show 5 more findings

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Age 8-15 years
SMD -0.41 [-0.50, -0.32]
Studies not reported
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
>=2 years · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention duration >=2 years
SMD -0.49 [-0.79, -0.19]
4 studies
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean)
SMD -0.33 [-0.56, -0.10]
7 studies · 6766 participants
Very low
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean)
SMD -0.26 [-0.70, 0.18]
5 studies · 3506 participants
Very low
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · >3 intervention activities
SMD 0.02 [-0.13, 0.17]
Studies not reported
GRADE not reported

Primary school-based interventions (one or more of: school health policy, oral health education, healthy school environment, access to oral health services, community involvement) vs usual practice

Annual increment in DMFS (D3) · Primary school children (aged 3-16 years) attending primary school in low- and middle-income countries (LMICs)

Oral-health-education interventions significantly reduced net increment in DMFS (SMD -1.05); no significant subgroup difference vs other interventions (P=0.74).

5 findings from 1 review

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention type: oral health education
SMD -1.05 [-2.03, -0.08]
3 studies
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · WHO health-promoting-schools framework
SMD -0.57 [-1.56, 0.42]
2 studies
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Non-WHO-framework interventions
SMD -1.88 [-3.15, -0.60]
Studies not reported
GRADE not reported

Show 2 more findings

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention type: other (daily tooth brushing)
SMD -1.23 [-1.46, -1.00]
1 study
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean)
SMD -1.09 [-1.91, -0.27]
4 studies · 3755 participants
Very low

Primary school-based interventions (one or more of: school health policy, oral health education, healthy school environment, access to oral health services, community involvement) vs usual practice

Dental caries prevalence measured by dmft or DMFT/S score greater than one · Primary school children (aged 3-16 years) attending primary school in low- and middle-income countries (LMICs)

School-based interventions may reduce the prevalence of dental caries (RR 0.70, favouring intervention), but the certainty of evidence is very low.

3 findings from 1 review

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean)
RR 0.70 [0.53, 0.94]
4 studies · 2968 participants
Very low
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
<2 years · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention duration <2 years
RR 0.95 [0.75, 1.21]
2 studies
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
>=2 years · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Intervention duration >=2 years
RR 0.58 [0.40, 0.84]
2 studies
GRADE not reported

Primary school-based interventions (one or more of: school health policy, oral health education, healthy school environment, access to oral health services, community involvement) vs usual practice

Caries increment, tooth index D(M)FT · Primary school children (aged 3-16 years) attending primary school in low- and middle-income countries (LMICs)

Among children aged 5-8 years, net increment in DMFT was not significantly reduced (SMD -0.36); no significant subgroup difference by age.

3 findings from 1 review

Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Age 5-8 years
SMD -0.36 [-0.76, 0.04]
5 studies
GRADE not reported
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean)
SMD -0.34 [-0.69, 0.02]
5 studies · 5492 participants
Very low
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income… 2022 All outcomes
Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Primary schools in low- and middle-income countries (Southeast Asia, Africa, the Americas, Europe, eastern Mediterranean) · Age 9-12 years
SMD -0.20 [-0.44, 0.04]
1 study
GRADE not reported

Comprehensive oral health intervention (oral health education plus additional support: motivational interviewing, toothbrush/toothpaste provision, community engagement, and/or fluoride varnish/sealant application) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Caries experience at the surface level (dmfs/defs) · Children (mean age newborn to ~5.2 years) and their parents/carers

Comprehensive interventions produced a small, statistically significant reduction in surface-level caries (dmfs SMD -0.14, 95% CI -0.26 to -0.02; 10 studies; not GRADE-rated).

1 finding from 1 review

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes
Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Comprehensive intervention (vs oral health education only)
SMD -0.14 [-0.26, -0.02]
10 studies
GRADE not reported

Comprehensive oral health intervention (oral health education plus additional support: motivational interviewing, toothbrush/toothpaste provision, community engagement, and/or fluoride varnish/sealant application) delivered by non-dental health workers vs control (no intervention/usual care/isotonic exercise)

Caries experience · Children (mean age newborn to ~5.2 years) and their parents/carers

Comprehensive interventions produced a statistically significant reduction in tooth-level caries (dmft SMD -0.47, 95% CI -0.84 to -0.10; 4 studies; not GRADE-rated), though heterogeneity was very high.

1 finding from 1 review

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's… 2022 All outcomes
Primary care and community settings; interventions delivered by non-dental health workers (multiple countries: Australia, Brazil, Canada, India, UK, USA, etc.) · Comprehensive intervention (vs oral health education only)
SMD -0.47 [-0.84, -0.10]
4 studies
GRADE not reported

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)

Barriers and facilitators to implementation of the integration strategy (qualitative) · People of all ages and abilities served through primary care and related settings (children, pregnant women, older adults in…

Key barriers to implementing integration strategies were time/staff/resource constraints and lack of organisational support, while facilitators were professionals' knowledge and attitudes and supportive governance/leadership (qualitative; 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
The most commonly studied qualitative outcomes were barriers and facilitators related to the strategy implementation process. Reported barriers were time and staff constraints, resource limitations and lack of…
15 studies
GRADE not reported

Intervention not reported

Oral hygiene improvement

1 finding from 1 review

The Application of Gamification in Children's Oral Health Management: Systematic Review. 2025 All outcomes
Gamified group (reminder sticker book, rewards and visual aids)
Narrative (P value) Significant improvement in oral hygiene in gamified group (P<.001)
1 study
GRADE not reported

Intervention not reported

Oral health-related quality of life (OHRQoL sum score, transformed 0-100)

1 finding from 1 review

Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Overall (pooled across all studies)
MEAN 77.0
45 studies
GRADE not reported

Country-level periodontal disease prevalence (Global Burden of Disease) vs Low vs high periodontal disease prevalence

Oral health-related quality of life · people aged 60 years and older living in the community

OHRQoL did not differ significantly by country-level periodontal disease prevalence; no pooled estimate was reported in the text (ungraded).

1 finding from 1 review

Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · Across periodontal disease prevalence categories
No statistically significant difference in OHRQoL based on periodontal disease prevalence (Fig. 4b).
Studies not reported
GRADE not reported

Country-level income (World Bank income classification) vs Higher- vs lower-income country categories

Oral health-related quality of life · people aged 60 years and older living in the community

Community-dwelling older adults in higher-income countries had better OHRQoL than those in lower-income countries (77.9, 95% CI 70.2 to 85.6 vs 66.9, 95% CI 56.7 to 77.0); the difference by income was statistically significant (ungraded).

2 findings from 1 review

Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · High-middle to high income
MEAN 77.9 [70.2, 85.6]
Studies not reported
GRADE not reported
Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · Low-middle income
MEAN 66.9 [56.7, 77.0]
Studies not reported
GRADE not reported

Country-level income inequality (Gini index) vs Lower vs higher income inequality categories

Oral health-related quality of life · people aged 60 years and older living in the community

Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded).

4 findings from 1 review

Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · Relative equality (Gini index 0.21 to 0.30)
MEAN 91.3 [90.0, 92.6]
Studies not reported
GRADE not reported
Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · High inequality
MEAN 75.3 [67.1, 83.6]
Studies not reported
GRADE not reported
Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · Adequate equality
MEAN 75.4 [70.1, 82.7]
Studies not reported
GRADE not reported

Show 1 more finding

Association between oral health-related quality of life and structural determinants of health among elderly… 2025 All outcomes
Community-dwelling older adults across 25 countries · Severe inequality
MEAN 81.2 [75.3, 88.3]
Studies not reported
GRADE not reported