What do systematic reviews say?

1,183 questions · 1,283 findings · 30 reviews · Oral medicine and oral cancer

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No studies found 164 · 12.8%GRADE not reported 802 · 62.5%Very low 209 · 16.3%Low 71 · 5.5%Moderate 36 · 2.8%High 1 · 0.1%

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)

Specificity for detection of oral cavity cancer/OPMD · Apparently healthy adults not reporting symptoms of OPMD or OSCC, attending an organised screening or surveillance programme, or screened…

1 finding from 1 review

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

Visual examination (VE) 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)

Specificity for detection of oral cavity cancer/OPMD · Apparently healthy adults not reporting symptoms of OPMD or OSCC, attending an organised screening or surveillance programme, or screened…

1 finding from 1 review

Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
Summary of findings 1 (no pooled analysis): for the 7 low-prevalence studies specificity ranged from 0.94 (95% CI 0.88 to 0.97) to 0.99 (95% CI 0.98 to 1.00); for the 3 higher-prevalence studies specificity ranged from…
10 studies · 25568 participants
Low

Combined index tests (e.g. vital staining plus light-based detection or cytology) vs Surgical or punch biopsy with histological assessment

Sensitivity · Adults (aged 16 years or over) presenting to primary or secondary care with clinically evident suspicious or innocuous oral lesions

1 finding from 1 review

Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident… 2021 · Cochrane All outcomes
Sensitivity 0.78 [0.45, 0.94]
9 studies
Very low

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

Locoregional control · People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
Locoregional control reported in 12 studies; not pooled. Olasz 2000 RR 0.50 (0.26 to 0.96); Prevost 2005 RR 1.48 (1.04 to 2.11); Molinari 1982 RR 0.35 (0.19 to 0.66).
12 studies
GRADE not reported

Concomitant (concurrent) chemoradiotherapy vs Radiotherapy alone

Overall survival, adjuvant concomitant chemoradiotherapy vs post-surgery radiotherapy alone · People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer

Concomitant (concurrent) chemoradiotherapy probably leads to lower overall survival, concurrent chemoradiotherapy vs radiotherapy alone… compared with radiotherapy alone (non-resectable tumours) (moderate certainty).

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
HR 0.74 [0.67, 0.83]
24 studies · 2852 participants
Moderate

Light-based detection and/or oral spectroscopy (e.g. ViziLite, VELscope, Microlux DL, Identafi 3000) vs Surgical or punch biopsy with histological assessment

Sensitivity · Adults (aged 16 years or over) presenting to primary or secondary care with clinically evident suspicious or innocuous oral lesions

1 finding from 1 review

Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident… 2021 · Cochrane All outcomes
Sensitivity 0.87 [0.78, 0.93]
23 studies
Low

COE with vital rinsing (toluidine blue/tolonium chloride) vs Conventional oral examination (COE) alone

Sensitivity (COE alone arm) · Oral cavity cancer or potentially malignant disorder symptom-free individuals with tobacco habits

1 finding from 1 review

Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
Sensitivity 0.50 [0.12, 0.88]
1 study · 3895 participants
Moderate

COE with vital rinsing (toluidine blue/tolonium chloride) vs Conventional oral examination (COE) alone

Sensitivity · Oral cavity cancer or potentially malignant disorder symptom-free individuals with tobacco habits

1 finding from 1 review

Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
Sensitivity 0.40 [0.05, 0.85]
1 study · 4080 participants
Moderate

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)

Sensitivity for detection of oral cavity cancer/OPMD · Apparently healthy adults not reporting symptoms of OPMD or OSCC, attending an organised screening or surveillance programme, or screened…

1 finding from 1 review

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

Visual examination (VE) 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)

Sensitivity for detection of oral cavity cancer/OPMD · Apparently healthy adults not reporting symptoms of OPMD or OSCC, attending an organised screening or surveillance programme, or screened…

1 finding from 1 review

Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy… 2021 · Cochrane All outcomes
Summary of findings 1 (no pooled analysis): for the 7 studies with low prevalence (<=10%) sensitivity ranged from 0.50 (95% CI 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00); for the 3 higher-prevalence studies…
10 studies · 25568 participants
Low

Fluticasone propionate spray vs Betamethasone sodium phosphate mouthwash

Pain / clinical response (not analysable) · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
Hegarty 2002: cross-over data not suitable for quantitative analysis
1 study
GRADE not reported

Topical triamcinolone acetonide vs pimecrolimus 1%

Adverse effects · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

Topical triamcinolone acetonide showed no clear difference in adverse effects compared with topical pimecrolimus; GRADE not reported.

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
end of treatment
RR 0.21 [0.01, 4.10]
1 study · 35 participants
GRADE not reported

Clobetasol propionate plus miconazole (adjunctive antifungal) vs Clobetasol propionate plus placebo

Candidosis (adverse effect) · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
Lodi 2007: 5 cases of candidosis among 15 participants without antifungal vs 0 with adjunctive miconazole (low-certainty)
1 study · 35 participants
Low

Topical triamcinolone acetonide vs Topical tacrolimus

Adverse effects · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

Topical triamcinolone acetonide may leads to lower adverse effects compared with topical tacrolimus (low certainty).

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
3-8 weeks
RR 0.47 [0.22, 0.99]
2 studies · 58 participants
Low

Topical triamcinolone acetonide vs Topical curcumin

Pain (mean score) · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

Topical triamcinolone acetonide may leads to lower pain (mean score) compared with topical curcumin (low certainty).

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
MD -0.64 [-1.19, -0.10]
2 studies · 100 participants
Low

Topical clobetasol propionate vs Topical ciclosporin

Pain resolution · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

It is very uncertain whether topical clobetasol propionate changes pain resolution compared with topical ciclosporin (very low certainty).

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
3-8 weeks
RR 2.11 [0.76, 5.86]
1 study · 39 participants
Very low

Topical clobetasol propionate vs Topical tacrolimus

Pain (mean VAS score) · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

Topical clobetasol propionate showed no clear difference in pain (mean VAS score) compared with topical tacrolimus; GRADE not reported.

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
end of treatment
MD 0.08 [-0.33, 0.49]
1 study · 68 participants
GRADE not reported

Topical clobetasol propionate vs Topical tacrolimus

Clinical resolution · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

It is very uncertain whether topical clobetasol propionate changes clinical resolution compared with topical tacrolimus (very low certainty).

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
3-8 weeks
RR 0.61 [0.38, 0.99]
2 studies · 52 participants
Very low

Oral prednisone plus curcuminoids (adjunctive) vs Oral prednisone plus placebo

Reduction in pain · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
Chainani-Wu 2007: no difference between adjunctive curcuminoids and placebo (recruitment stopped after interim analysis)
1 study · 28 participants
GRADE not reported

Topical triamcinolone acetonide vs Intralesional BCG-polysaccharide nucleic acid (BCG-PSN)

Pain (mean score) · People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment

Topical triamcinolone acetonide showed no clear difference in pain (mean score) compared with intralesional BCG-polysaccharide nucleic acid (BCG-PSN); GRADE not reported.

1 finding from 1 review

Interventions for treating oral lichen planus: corticosteroid therapies 2020 · Cochrane All outcomes
MD 0.59 [-0.15, 1.33]
1 study · 53 participants
GRADE not reported