What do systematic reviews say?

Supraomohyoid neck dissection vs Modified radical neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: reported but not usable (variable follow-up) (Guo 2014).
  1 study
  GRADE not reported

Elective neck dissection (at time of primary tumour resection) vs Therapeutic (delayed) neck dissection

Elective neck dissection (at time of primary tumour resection) probably leads to lower mortality (overall survival) compared with therapeutic (delayed) neck dissection (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.64 [0.50, 0.83]
  4 studies · 883 participants
  Moderate

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

Sentinel node biopsy (neck dissection only if biopsy positive) showed no clear difference in disease-free survival (new disease, progression, and mortality) compared with elective neck dissection (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.98 [0.90, 1.07]
  1 study · 279 participants
  Low

Superselective neck dissection vs Elective selective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: data not presented usably and inconsistent; Pandey 2018 no difference (3/12 vs 3/20); Rastogi 2018 lower recurrence with superselective (Kaplan-Meier P<0.05); 72 participants (2 RCTs).
  2 studies · 72 participants
  Very low

Elective neck dissection (at time of primary tumour resection) vs Therapeutic (delayed) neck dissection

Elective neck dissection (at time of primary tumour resection) probably leads to lower disease-free survival (new disease, progression, and mortality) compared with therapeutic (delayed) neck dissection (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.56 [0.45, 0.70]
  5 studies · 954 participants
  Moderate

Surgery plus radiotherapy vs Radiotherapy alone

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: severe acute effects in both groups (subcutaneous fibrosis, telangiectasia, moderate-to-severe oedema, xerostomia, trismus, dysphagia); subcutaneous fibrosis more prevalent with surgery + radiotherapy…
  1 study · 35 participants
  Very low

Surgery plus radiotherapy vs Chemotherapy (chemoradiotherapy)

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  oral cavity
  Locoregional recurrence: reported difference between groups not statistically significant (P=0.355), but no useable data; 32 participants (1 RCT, Iyer 2015).
  1 study · 32 participants
  Very low

PET-CT following chemoradiotherapy (neck dissection only if no/incomplete response) vs Planned neck dissection before or after chemoradiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: 22 surgical complications in the PET-CT group vs 83 in the planned-surgery group (Mehanna 2017).
  1 study · 564 participants
  Very low

PET-CT following chemoradiotherapy (neck dissection only if no/incomplete response) vs Planned neck dissection before or after chemoradiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Disease-free survival: outcome not reported in a usable way (Mehanna 2017: disease-specific and other-cause mortality did not differ, P=0.80 and 0.41).
  1 study
  GRADE not reported

Elective radical (comprehensive) neck dissection vs Elective selective neck dissection

It is very uncertain whether elective radical (comprehensive) neck dissection changes disease-free survival (new disease, progression, and mortality) compared with elective selective neck dissection (very low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  5 years
  HR 0.57 [0.29, 1.11]
  1 study · 104 participants
  Very low

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

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).

• 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)

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).

• 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

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)

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).

• 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)

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.

• 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

Chemotherapy regimen A (+/- locoregional treatment) vs Chemotherapy regimen B (+/- locoregional treatment)

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  Induction cisplatin+5-FU+docetaxel vs cisplatin+5-FU: disease-free survival HR 0.72 (95% CI 0.57 to 0.91, P = 0.006; Vermorken 2007). Prior to concurrent chemoradiation: Posner 2007 HR 0.71 (0.56 to 0.90, P = 0.005).…
  2 studies
  GRADE not reported

Induction chemotherapy plus locoregional treatment (radiotherapy and/or surgery) vs Locoregional treatment (radiotherapy and/or surgery) alone

Induction chemotherapy plus locoregional treatment (radiotherapy… showed no clear difference in overall survival, induction cisplatin + 5-fluorouracil + docetaxel… compared with locoregional treatment (radiotherapy and/or surgery) alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 1.08 [0.80, 1.44]
  3 studies · 760 participants
  Low

Induction chemotherapy plus locoregional treatment (radiotherapy and/or surgery) vs Locoregional treatment (radiotherapy and/or surgery) alone

Induction chemotherapy plus locoregional treatment (radiotherapy… led to lower locoregional control, induction cisplatin + 5-fluorouracil +… compared with locoregional treatment (radiotherapy and/or surgery) alone; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  RR 0.80 [0.64, 0.99]
  3 studies
  GRADE not reported

Non-selective carious tissue removal and conventional restoration (CR) vs Selective carious tissue removal (selective excavation, SE)

It is very uncertain whether non-selective carious tissue removal and conventional restoration (CR) changes failure of therapy compared with selective carious tissue removal (selective excavation, SE) (very low certainty).

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  12 months · Cavitated but not deep lesions, primary dentition
  OR 0.62 [0.21, 1.88]
  2 studies · 204 participants
  Very low
• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  12-18 months · Deep lesions, permanent dentition
  OR 11.32 [1.97, 65.02]
  2 studies · 179 participants
  Very low
• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  6-36 months · Deep lesions, primary dentition
  OR 4.43 [1.04, 18.77]
  4 studies · 265 participants
  Very low

Chemotherapy (any regimen; added to, or compared with, locoregional treatment) vs Locoregional treatment and/or an alternative chemotherapy regimen

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  Quality of life was a planned (protocol) outcome but no included trial provided usable quality-of-life data; the protocol was modified to report only survival/response outcomes.
  0 studies
  No studies found

Sealing using sealant materials vs Selective carious tissue removal (selective excavation, SE)

It is very uncertain whether sealing using sealant materials changes failure of therapy compared with selective carious tissue removal (selective excavation, SE) (very low certainty).

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  18-24 months · Cavitated lesions, primary dentition
  OR 3.11 [0.11, 85.52]
  2 studies · 82 participants
  Very low