What do systematic reviews say?

Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Non-histology reference standard (excavation, radiographs, separation)
  Specificity 0.86 [0.76, 0.92]
  Studies not reported
  GRADE not reported
• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · High prevalence of dentine caries (>= 35%)
  Specificity 0.75 [0.66, 0.82]
  Studies not reported
  GRADE not reported
• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Histology reference standard
  Specificity 0.76 [0.69, 0.81]
  Studies not reported
  GRADE not reported

Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Primary/mixed dentition
  Sensitivity 0.87 [0.80, 0.92]
  Studies not reported
  GRADE not reported
• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surface
  Sensitivity 0.87 [0.82, 0.90]
  Studies not reported
  GRADE not reported
• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Approximal surface
  Sensitivity 0.80 [0.60, 0.92]
  Studies not reported
  GRADE not reported

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Specificity 0.76 [0.67, 0.83]
  36 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• 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) · Permanent dentition
  Permanent dentition (4 studies): sensitivity ranged from 0.55 to 0.65.
  4 studies
  GRADE not reported
• 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) · Primary dentition
  Primary dentition (3 studies): sensitivity ranged from 0.91 to 0.93. No evidence of a difference in accuracy by dentition (removing accuracy covariate: Chi2=3.15, df=1, P=0.08).
  3 studies
  GRADE not reported

CarieScan Pro device vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  CarieScan Pro (3 studies, 244 tooth surfaces): sensitivity ranged from 0.55 to 0.91. No evidence of a difference in accuracy by device type (Chi2=0.05, df=1, P=0.82).
  3 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• 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) · Permanent dentition
  Permanent dentition (4 studies): specificity ranged from 0.73 to 1.00.
  4 studies
  GRADE not reported
• 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) · Primary dentition
  Primary dentition (3 studies): specificity ranged from 0 to 0.92.
  3 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  SoF findings (HSROC; no summary operating point reported): 'ECM: sensitivity from 0.61 to 0.98 ... CarieScan Pro: sensitivity from 0.55 to 0.91'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites…
  7 studies
  Very low

Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Study setting (in vitro vs in vivo)
  Pre-specified in vitro versus in vivo comparison was not completed because 49 of the 60 histology studies were in vitro; a sensitivity analysis removing the in vivo studies confirmed a minimal change to summary…
  Studies not reported
  GRADE not reported

Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  ECM (4 studies, 475 tooth surfaces): sensitivity ranged from 0.61 to 0.98 (0.61-0.65 in three studies; 0.98 in the most recent ECM IV study). No evidence of a difference in accuracy by device type (Chi2=0.05, df=1,…
  4 studies
  GRADE not reported

Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Smooth surface
  Smooth surfaces reported by 2 datasets (Nakagawa 2013; Shi 2000) but excluded from the surface meta-analysis owing to sparsity; no summary sensitivity or specificity estimated.
  2 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  SoF findings (HSROC; no summary operating point reported): 'ECM: specificity from 0.73 to 0.96 ... CarieScan Pro: specificity from 0 to 1.00'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites (no…
  7 studies
  Very low

Other visual classification systems (unspecified or unique systems, e.g. Nyvad, Downer, Lussi, UniViSS) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.81 [0.65, 0.91]
  16 studies
  GRADE not reported

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.88 [0.81, 0.92]
  36 studies
  GRADE not reported

Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Previously restored teeth (secondary caries)
  Only one study (Kim 2017) intentionally included restored teeth in its sample; the pre-specified secondary-caries subgroup analysis could not be performed, no summary estimate reported.
  1 study
  GRADE not reported

Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  ECM (4 studies, 475 tooth surfaces): specificity ranged from 0.73 to 0.96.
  4 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  Diagnostic odds ratio (DOR) 15.65 [1.43, 171.15]
  7 studies
  Very low

CarieScan Pro device vs Reference standard (histology, excavation, or enhanced visual examination)

• 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)
  CarieScan Pro (3 studies, 244 tooth surfaces): specificity ranged from 0 to 1.00.
  3 studies
  GRADE not reported

Other visual classification systems (unspecified or unique systems, e.g. Nyvad, Downer, Lussi, UniViSS) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Specificity 0.84 [0.73, 0.91]
  16 studies
  GRADE not reported

Capecitabine‐containing regimens vs non‐capecitabine‐containing regimens or no chemotherapy

Capecitabine‐containing regimens showed no clear difference in disease‐free survival (DFS)median compared with non‐capecitabine‐containing regimens or no chemotherapy (moderate certainty).

• Capecitabine for hormone receptor‐positive versus hormone receptor‐negative breast cancer 2021 · Cochrane Headline outcomes only
  HR 0.93 [0.86, 1.01]
  8 studies · 13547 participants
  Moderate

Capecitabine‐containing regimens vs non‐capecitabine‐containing regimens or no chemotherapy

Capecitabine‐containing regimens showed no clear difference in DFS: hormone receptor‐positivemedian compared with non‐capecitabine‐containing regimens or no chemotherapy (moderate certainty).

• Capecitabine for hormone receptor‐positive versus hormone receptor‐negative breast cancer 2021 · Cochrane Headline outcomes only
  HR 1.03 [0.91, 1.17]
  5 studies · 5604 participants
  Moderate