What do systematic reviews say?

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

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

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

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

Non-selective carious tissue removal and conventional restoration (CR) vs Stepwise carious tissue removal (SW)

Non-selective carious tissue removal and conventional restoration (CR) probably leads to higher failure of therapy compared with stepwise carious tissue removal (SW) (moderate certainty).

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

  6-60 months · Deep lesions, permanent dentition
  OR 2.06 [1.34, 3.17]
  3 studies · 398 participants
  Moderate
• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  12 months · Deep lesions, primary dentition
  OR 2.43 [0.65, 9.12]
  1 study · 63 participants
  Very low

Selective carious tissue removal (selective excavation, SE) vs Stepwise carious tissue removal (SW)

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

  Permanent and primary dentition
  Cost-effectiveness reported narratively: SE found more cost-effective than SW in permanent (Labib 2019) and primary teeth (Elhennawy 2021); not GRADE-rated.
  2 studies
  GRADE not reported

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

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

  Cavitated lesions, primary dentition
  Lesion progression reported narratively: Dias 2018 1/27 sealed vs 1/21 SE at 24 months; Hesse 2014 0/17 sealed vs 0/17 SE at 18 months; not pooled and not GRADE-rated.
  2 studies
  GRADE not reported

Selective carious tissue removal (selective excavation, SE) vs Stepwise carious tissue removal (SW)

Selective carious tissue removal (selective excavation, SE) probably leads to higher failure of therapy compared with stepwise carious tissue removal (SW) (moderate certainty).

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

  12-60 months · Deep lesions, permanent dentition
  OR 2.25 [1.33, 3.82]
  3 studies · 371 participants
  Moderate
• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  12-24 months · Deep lesions, primary dentition
  OR 2.05 [0.49, 8.62]
  2 studies · 126 participants
  Very low

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

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

  Cavitated but not deep lesions, primary dentition
  Lesion progression reported narratively: Ribeiro 1999 found 6/24 lesions progressed after 12 months; not pooled and not GRADE-rated.
  1 study
  GRADE not reported

Sealing using sealant materials vs Non-selective carious tissue removal and conventional restoration (CR)

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

  Non-cavitated lesions, primary dentition
  Lesion progression reported narratively: Borges 2012a found 3/26 sealed lesions progressed after 1 year (split-mouth); not pooled and not GRADE-rated.
  1 study
  GRADE not reported

Sealing using sealant materials vs no treatment

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

  Non-cavitated lesions, permanent dentition
  Lesion progression reported narratively: da Silveira 2012 found 3/27 lesions progressed after 1 year; not pooled and not GRADE-rated.
  1 study
  GRADE not reported

Non-selective carious tissue removal and conventional restoration (CR) vs Non-restorative cavity control (NRCC)

It is very uncertain whether non-selective carious tissue removal and conventional restoration (CR) changes failure of therapy compared with non-restorative cavity control (NRCC) (very low certainty).

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

  30 months · Cavitated lesions, primary dentition
  OR 1.16 [0.5, 2.71]
  1 study · 102 participants
  Very low

Sealing using sealant materials vs Non-selective carious tissue removal and conventional restoration (CR)

It is very uncertain whether sealing using sealant materials changes failure of therapy compared with non-selective carious tissue removal and conventional restoration (CR) (very low certainty).

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

  48 months · Cavitated lesions, permanent dentition
  OR 5.0 [0.51, 49.27]
  1 study · 41 participants
  Very low

Sealing using sealant materials vs no treatment

It is very uncertain whether sealing using sealant materials changes failure of therapy compared with no treatment (very low certainty).

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

  12 months · Non-cavitated lesions, permanent dentition
  OR 0.05 [0.0, 2.71]
  2 studies · 103 participants
  Very low

Glass ionomer sealant (with fluoride gel plus dentifrice) vs Fluoride gel plus fluoride toothpaste/dentifrice (non-invasive control)

Glass ionomer sealant (with fluoride gel plus dentifrice) showed no clear difference in caries (lesion) progression (radiographic) compared with fluoride gel plus fluoride toothpaste/dentifrice (non-invasive…; GRADE not reported.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 36 months (radiographic follow-up) · Glass ionomer sealant
  OR 0.13 [0.01, 2.52]
  1 study
  GRADE not reported