What do systematic reviews say?

Active rinse (zinc acetate + chlorhexidine + sodium fluoride), with or without tongue scraping vs Negative control rinse, with or without tongue scraping

• Interventions for managing halitosis 2019 · Cochrane All outcomes
  Ademovski 2012 (4-arm cross-over trial) compared an active rinse (with/without tongue scraping) versus a negative control rinse (with/without tongue scraping); OLT and VSC. The authors did not report the correlation…
  1 study
  GRADE not reported

Protease cysteine + actinidine tablets vs placebo (3 tablets/4 times a day

Protease cysteine + actinidine tablets showed no clear difference in volatile sulphur compounds (VSC), OralChroma compared with placebo tablets; GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  1 week
  MD -45.8 [-258.38, 166.78]
  1 study · 14 participants
  GRADE not reported

Lactobacillus beta lactoperoxidase (LPO) tablets vs placebo (3 tablets/4 times a day

• Interventions for managing halitosis 2019 · Cochrane All outcomes
  Nakano 2017 (2-arm trial) compared Lactobacillus beta LPO tablets versus placebo tablets (VSC by OralChroma). The trial did not report any usable data and hence could not be included in the analysis.
  1 study
  GRADE not reported

Polaprezinc vs Azulene oral rinse

Polaprezinc led to lower oral pain (severe, > 2 on 0-3 scale) compared with azulene oral rinse; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over RT period
  RR 0.36 [0.17, 0.77]
  1 study · 31 participants
  GRADE not reported

Polaprezinc vs Azulene oral rinse

Polaprezinc showed no clear difference in disability of oral intake compared with azulene oral rinse; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over RT period
  RR 0.31 [0.07, 1.31]
  1 study · 31 participants
  GRADE not reported

Epidermal growth factor (EGF), oral spray vs placebo

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Adverse events narratively reported; no serious events attributed to EGF (not GRADE-rated)
  2 studies
  GRADE not reported

Epidermal growth factor (EGF), oral spray vs placebo

Epidermal growth factor (EGF), oral spray showed no clear difference in interruptions to cancer treatment (radiotherapy breaks longer than… compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Radiotherapy to the head and neck
  RR 4.38 [0.25, 75.44]
  1 study · 113 participants
  GRADE not reported

Epidermal growth factor (EGF), oral spray vs placebo

Epidermal growth factor (EGF), oral spray showed no clear difference in normalcy of diet (total parenteral nutrition) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Chemoradiotherapy to the head and neck
  RR 1.03 [0.55, 1.94]
  1 study · 136 participants
  GRADE not reported

Intestinal trefoil factor (ITF), oral spray vs placebo

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Adverse events narratively reported (not GRADE-rated)
  1 study
  GRADE not reported

Oral cytology (e.g. OralCDx brush biopsy, CytID) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative)

The review found no eligible studies for this question.

• Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
  Oral cytology (e.g. brush biopsy) was added to the list of eligible index tests in this update; no eligible studies evaluated it (evidence gap).
  0 studies
  No studies found

Visual screening (oral visual inspection) by trained health workers vs No screening

• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  9 years (three cycles)
  The costs associated with the screening programme were reported after three cycles (nine years) (Subramanian 2009) (Additional Table 8). The benefit produced by a screen was 269.31 life-years saved per 100,000 for all…
  1 study
  GRADE not reported

Visual screening (oral visual inspection) by trained health workers vs No screening

The review found no eligible studies for this question.

• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  15-year follow-up
  No harms were reported.
  0 studies
  No studies found

Visual screening (oral visual inspection) by trained health workers vs No screening

Visual screening (oral visual inspection) by trained health workers led to lower stage at diagnosis (early-stage detection) compared with no screening; GRADE not reported.

• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  15-year follow-up
  RR 0.81 [0.70, 0.93]
  1 study · 523 participants
  GRADE not reported
• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  15-year follow-up · High-risk individuals (tobacco and/or alcohol users)
  RR 0.82 [0.71, 0.95]
  1 study · 486 participants
  GRADE not reported

Visual screening (oral visual inspection) by trained health workers vs No screening

The review found no eligible studies for this question.

• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  15-year follow-up
  Data on quality of life were not reported.
  0 studies
  No studies found

Visual screening (oral visual inspection) by trained health workers vs No screening

• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  15-year follow-up
  Across the four cycles (15 years), the reported sensitivity of the visual examination in detecting oral cancer was 67.4% (188/279). No information on the specificity or the positive predictive value of the programme…
  1 study
  GRADE not reported

Visual screening (oral visual inspection) by trained health workers vs No screening

• Screening programmes for the early detection and prevention of oral cancer 2013 · Cochrane All outcomes

  5-year survival
  A significantly higher five-year survival rate was reported in the screened group (55.5%) compared to the control (43.4%) (P value = 0.003).
  1 study · 523 participants
  GRADE not reported

More than 15 missing teeth vs 15 or fewer missing teeth

More than 15 missing teeth was associated with higher odds of oral cancer.

• Periodontitis and the risk of oral cancer: a meta-analysis of case-control studies. 2024 All outcomes

  Missing teeth >15
  OR 1.91 [1.01, 3.62]
  5 studies
  GRADE not reported

Intervention not reported

The intervention led to higher oral cancer (OC); GRADE not reported.

• Periodontitis and the risk of oral cancer: a meta-analysis of case-control studies. 2024 All outcomes

  Sensitivity analysis: excluding Moraes et al. [34]
  OR 2.63 [1.92, 3.62]
  7 studies
  GRADE not reported

Mouth self-examination (MSE) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative)

• Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
  Summary of findings 2 (no pooled analysis): specificity 1.00 (95% CI 1.00 to 1.00), 0.95 (95% CI 0.88 to 0.99), 0.44 (95% CI 0.20 to 0.70), and 0.54 (95% CI 0.37 to 0.69) across the 4 studies. Certainty VERY LOW.
  4 studies · 35059 participants
  Very low

Mouth self-examination (MSE) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative)

• Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
  Summary of findings 2 (no pooled analysis): sensitivity 0.18 (95% CI 0.13 to 0.24), 0.09 (95% CI 0.04 to 0.15), 0.43 (95% CI 0.24 to 0.63), and 0.33 (95% CI 0.10 to 0.65) across the 4 studies. Prevalence 0.6% to 63.6%.…
  4 studies · 35059 participants
  Very low