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Evidence found and GRADE certainty

4,315 questions · 23,557 findings · 2,311 reviews

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No studies found 4,183 · 17.8%GRADE not reported 3,930 · 16.7%Very low 5,371 · 22.8%Low 5,787 · 24.6%Moderate 3,320 · 14.1%High 966 · 4.1%

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Used a pea-sized amount of fluoride toothpaste or less vs Used more than a pea-sized amount

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether used a pea-sized amount of fluoride toothpaste or less changes fluorosis (percentage prevalence in permanent teeth) compared with used more than a pea-sized amount (very low certainty).

1 finding from 1 review

Teledentistry diagnosis using DSLR or smartphone extra-oral photographs vs Visual or clinical examination

Negative predictive value for dental caries diagnosis · Children and adults with primary or permanent dentition

Negative predictive values were reported in 10 of the 13 studies that reported sensitivity and specificity; no meta-analysis or GRADE rating was reported.

1 finding from 1 review

Started toothbrushing with fluoride toothpaste at or before 12 months (earlier start) vs Started after 12 months (later start)

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether started toothbrushing with fluoride toothpaste at or before 12… changes fluorosis (percentage prevalence in permanent teeth) compared with started after 12 months (later start) (very low certainty).

2 findings from 1 review

Started toothbrushing with fluoride toothpaste before 4 years (earlier start) vs Started after 4 years (later start)

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether started toothbrushing with fluoride toothpaste before 4 years… changes fluorosis (percentage prevalence in permanent teeth) compared with started after 4 years (later start) (very low certainty).

1 finding from 1 review

Fluoride toothpaste less than 1000 ppm (lower concentration) vs Fluoride toothpaste 1000 ppm or more (higher concentration)

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether fluoride toothpaste less than 1000 ppm (lower concentration) changes fluorosis (percentage prevalence in permanent teeth) compared with fluoride toothpaste 1000 ppm or more (higher concentration) (very low certainty).

2 findings from 1 review

Started toothbrushing with fluoride toothpaste before 24 months (earlier start) vs Started after 24 months (later start)

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether started toothbrushing with fluoride toothpaste before 24 months… changes fluorosis (percentage prevalence in permanent teeth) compared with started after 24 months (later start) (very low certainty).

1 finding from 1 review

Disability (developmental, intellectual, or sensory) vs Persons without disabilities

Dental caries prevalence and severity · Persons with disabilities (children and adults with autism, Down syndrome, cerebral palsy, hearing impairment, or multiple disabilities)…

Dental caries prevalence and severity are high among persons with disabilities in Saudi Arabia (60% to over 80%), and the one comparative autism study reported significantly higher caries than controls; synthesized narratively (ungraded).

1 finding from 1 review

Brushed less than twice per day vs Brushed twice or more per day

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether brushed less than twice per day changes fluorosis (percentage prevalence in permanent teeth) compared with brushed twice or more per day (very low certainty).

2 findings from 1 review

Started toothbrushing with fluoride toothpaste at or before 24 months (earlier start) vs Started after 24 months (later start)

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether started toothbrushing with fluoride toothpaste at or before 24… changes fluorosis (percentage prevalence in permanent teeth) compared with started after 24 months (later start) (very low certainty).

2 findings from 1 review

Overweight/obesity (combined) vs Normal Weight or Non‐Obese

Dental caries prevalence · Brazilian children/adolescents in permanent dentition (BMI classified by WHO 2006 Z-score)

A meta-analysis of 2 studies (permanent dentition, WHO 2006 Z-score) was rated very low certainty; the pooled effect was not shown in the article.

1 finding from 1 review

Farzanegan 2021 = Transbond XT + 1% chitosan + 1% TiO2 (co-intervention); Mollabashi 2022 = TiO2-only composite (1 wt%) vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control

Enamel demineralization / white spot lesion prevention (DIAGNOdent, enamel mineral content) · Patients undergoing fixed orthodontic (fixed appliance) treatment (adolescents and adults, ages 12 to 35)

Two small RCTs gave inconsistent results for TiO2-modified adhesives/composites on enamel demineralization (one favorable on DIAGNOdent, one no difference in mineral content); ungraded.

1 finding from 1 review

Obesity (Unclassified) vs Normal Weight or Non‐Obese

Dental caries prevalence · Brazilian children/adolescents in permanent dentition (BMI classified by CDC 2000 growth charts)

Normal-weight adolescents in the permanent dentition probably have greater odds of dental caries than obese peers (OR 2.53; moderate certainty).

1 finding from 1 review

Teledentistry (index test): dental caries diagnosis from photographs taken with DSLR or smartphone cameras; store-and-forward vs Visual or clinical examination

Positive predictive value · Children and adults with primary or permanent dentition undergoing dental caries assessment

Positive predictive value was reported in 10 studies and varied widely across studies (about 42% to 99%); no pooled estimate and certainty not graded.

1 finding from 1 review