What do systematic reviews say?

Biodentine vs Mineral trioxide aggregate (MTA)

MTA and Biodentine performed comparably for clinical and radiographic success (5 RCTs, not pooled; ungraded).

• Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A… 2023 All outcomes

  ≥6 months follow-up · Dental/endodontic clinical settings across multiple countries (university, hospital, specialist and general dental practice); permanent teeth with carious pulp exposure
  Biodentine vs MTA was the second most frequent comparison (5 RCTs) for the primary outcome but was not pooled owing to substantial clinical/statistical heterogeneity; the panel of per-trial forest plots (Figure 8)…
  5 studies
  GRADE not reported

Intervention not reported

• A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth. 2023 All outcomes

  Mendiratta 2021 (intellectually disabled, India)
  Caries arrest rate (%) 94.5 vs 90.1 (p=0.405, NS)
  1 study
  GRADE not reported

CPP-ACP vs Placebo or no active treatment

CPP-ACP did not differ significantly from control (SMD -0.18, 95% CI -0.49 to 0.14); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.18 [-0.49, 0.14]
  8 studies
  GRADE not reported

Early childhood caries / severe early childhood caries vs Caries-free controls

One Nepalese cross-sectional study found no significant association between severe ECC and malnutrition risk in children under 6 (mean difference 0.13, p=0.609); ungraded.

• The bi-directional relationship between growth stunting and early childhood caries: a rapid review. 2023 All outcomes

  Nepal · Zahid et al. 2020 (Nepal; children 6 months-6 years)
  MD 0.13 [-0.64, 0.38]
  1 study · 273 participants
  GRADE not reported

Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)

MTA increases clinical and radiographic success versus CH in mature teeth (moderate certainty).

• Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A… 2023 All outcomes

  1 to 3 years · Success after vital pulp therapy · Mature teeth
  OR 3.34 [1.81, 6.17]
  5 studies · 537 participants
  Moderate

Carious dentin vs Sound dentin

Cathepsin B may be increased in carious dentin compared with sound dentin (very low certainty).

• Presence of host and bacterial-derived collagenolytic proteases in carious dentin: a systematic review of ex vivo… 2023 All outcomes
  no estimate extracted
  2 studies · 22 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 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

Gum chewing (sugar-free) vs No chewing gum

Gum chewing was linked with improved self-reported xerostomia / dry mouth in most studies (12 of 17 positive, 5 no effect); heterogeneous instruments precluded meta-analysis.

• The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: a… 2023 All outcomes

  Various (single session to 3 months) · Haemodialysis units, elderly / geriatric care, cancer and palliative care, and xerostomia / hyposalivation clinics (studies from multiple countries)
  Narrative vote-count: of 17 studies measuring self-reported xerostomia / dry mouth, 12 found a positive effect of gum chewing [18,19,21,23,24,25,26,27,30,31,38,40] and 5 detected no effect [17,29,33,34,37]. No study…
  17 studies
  GRADE not reported

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

Chlorhexidine mouthwash vs Blank control

Chlorhexidine mouthwash may reduce total bacteria colony counts versus blank control in the short term, but the evidence is very uncertain (very low certainty).

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  <=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  Colony count of total bacteria were significantly reduced compared to placebos according to two studies [34, 43].
  2 studies
  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

CPP-ACFP vs Placebo or no active treatment

CPP-ACFP versus control gave SMD -0.42 (95% CI -0.84 to 0.00); the review classed CPP-ACFP as statistically significant versus control although the reported CI upper limit is at the null (0.00); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.42 [-0.84, 0.00]
  5 studies
  GRADE not reported

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

Strategies to integrate oral health into primary care (e.g., training/education of non-dental primary care professionals, policy/financing and health-insurance changes, colocation of dental and medical services, interprofessional and community-health-worker collaboration, teledentistry, integrated oral health assessment tools, school-based activities) vs No integration / usual care (or pre-integration baseline; many included studies uncontrolled)

Most studies reported improved oral disease outcomes with integration strategies (8 of 9 studies improved, 1 no change; 9 studies, narrative synthesis; ungraded).

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes

  Primary care, community, school, and aged-care/residential/nursing-home settings
  Nine studies reported oral disease outcomes, seven of which measured change in dental caries estimates. Eight of the nine studies reported improved oral disease outcomes; one (Vichayanrat 2012) reported no change in…
  9 studies
  GRADE not reported

Fibre-reinforced composite fixed (bonded) retainer vs Multistrand / spiral wire fixed (bonded) retainer

The review found no eligible studies for this question.

• Retention procedures for stabilising tooth position after treatment with orthodontic braces 2023 · Cochrane All outcomes

  12 months · lower arch
  No RCTs at 12-month follow-up; 1 RCT at 6 months: higher gingival inflammation with fibre-reinforced composite (MD 0.59, 95% CI 0.13 to 1.05; very low-certainty)
  0 studies
  No studies found

Self-assembling peptide P11-4 vs CPP-ACFP

Self-assembling peptide P11-4 did not differ significantly from CPP-ACFP (SMD -0.13, 95% CI -0.68 to 0.42); certainty of evidence not assessed (no GRADE).

• Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. 2023 All outcomes

  RCTs (clinical and in vitro); predominantly children and adolescents; orthodontic and non-orthodontic white spot lesions, early caries lesions, and artificial lesions
  SMD -0.13 [-0.68, 0.42]
  2 studies
  GRADE not reported

Light-emitting diode (LED) photobiomodulation vs Conventional orthodontic appliance treatment

The review found no eligible studies for this question.

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Harms and side effects | Not reported. None of the included studies assessed harms arising during the LED intervention.
  Studies not reported
  No studies found

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

Herbal mouthwash vs Blank control

Herbal mouthwash reduced some gingival inflammation-related indices, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  CPI was significantly reduced compared to baseline [35]; SBI was significantly reduced while MGI was similar compared to baseline [45]; BOP was significantly reduced compared to blank control [39].
  3 studies
  Very low