What do systematic reviews say?

Resin infiltration vs P11-4 + fluoride varnish

Resin infiltration and P11-4 plus fluoride varnish did not differ significantly (SMD 0.01, 95% CI -0.62 to 0.65; indirect evidence only); 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 0.01 [-0.62, 0.65]
  Studies not reported
  GRADE not reported

Self-assembling peptide P11-4 vs Fluoride varnish

Self-assembling peptide P11-4 did not differ significantly from fluoride varnish (SMD -0.31, 95% CI -0.71 to 0.09); 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 -0.31 [-0.71, 0.09]
  5 studies
  GRADE not reported

Sealing (resin sealant, glass ionomer cement, or polyurethane tape) vs Non-invasive / control treatment

Sealing probably reduces the odds of proximal lesion progression compared with placebo (OR 0.27, 95% CI 0.18 to 0.42; moderate certainty).

• Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis. 2021 All outcomes

  Longest available follow-up
  OR 0.27 [0.18, 0.42]
  7 studies · 320 participants
  Moderate

Resin infiltration vs Fluoride varnish

Resin infiltration produced significantly greater optical improvement than fluoride varnish (MD 4.76, 95% CI 0.74 to 8.78; moderate certainty).

• Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a… 2021 All outcomes

  3 to 6 months
  MD 4.76 [0.74, 8.78]
  3 studies · 212 participants
  Moderate
• Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a… 2021 All outcomes

  3 to 6 months · Mild lesions, DIAGNOdent score <=14 (Ciftci et al. 2018; Giray et al. 2018)
  MD 3.65 [0.82, 6.48]
  2 studies · 172 participants
  GRADE not reported
• Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a… 2021 All outcomes

  3 to 6 months · Severe lesions, DIAGNOdent score >14 (Gozetici et al. 2019)
  MD 13.15 [3.98, 22.32]
  1 study · 40 participants
  GRADE not reported

Gum chewing (sugar-free) vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish

In a sensitivity analysis assuming a 0.95 baseline-to-endpoint correlation for the sugar-free gum arm, the effect remained significant (SMD -0.55, 95% CI -0.80 to -0.30; 13 trials, I2 73%); certainty not formally graded.

• A systematic review and meta-analysis of the role of sugar-free chewing gum on Streptococcus mutans. 2021 All outcomes

  Final/end-of-study time point (follow-up 2 weeks to 18 months) · Schools, kindergartens, universities and community settings; adults and children; multiple countries · Sensitivity analysis: baseline-to-endpoint correlation 0.95 for SFG arm
  SMD -0.55 [-0.80, -0.30]
  13 studies · 1335 participants
  GRADE not reported
• A systematic review and meta-analysis of the role of sugar-free chewing gum on Streptococcus mutans. 2021 All outcomes

  Final/end-of-study time point (follow-up 2 weeks to 18 months) · Schools, kindergartens, universities and community settings; adults and children; multiple countries · Overall (vs all controls)
  SMD -0.42 [-0.60, -0.25]
  13 studies · 1335 participants
  GRADE not reported

Xylitol-only sugar-free chewing gum vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish

Xylitol-only sugar-free gum significantly reduced Streptococcus mutans load versus pooled controls (SMD -0.46, 95% CI -0.64 to -0.28; 12 trials, I2 43%); certainty not formally graded.

• A systematic review and meta-analysis of the role of sugar-free chewing gum on Streptococcus mutans. 2021 All outcomes

  Final/end-of-study time point (follow-up 2 weeks to 18 months) · Schools, kindergartens, universities and community settings; adults and children; multiple countries · Overall (vs all controls)
  SMD -0.46 [-0.64, -0.28]
  12 studies · 1295 participants
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

The review found no eligible studies for this question.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes
  None of the studies reported on participant or operator perception
  0 studies
  No studies found

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

The review found no eligible studies for this question.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes
  None of the studies reported on costs for micro-invasive treatment or non-invasive control
  0 studies
  No studies found

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

Micro-invasive treatment (proximal sealing or resin infiltration):… probably leads to lower caries (lesion) progression measured by pairwise reading of… compared with non-invasive measures (e.g. fluoride varnish, flossing/oral hygiene… (moderate certainty).

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

  18 to 36 months (radiographic follow-up)
  OR 0.31 [0.18, 0.53]
  4 studies
  Moderate
• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 36 months (radiographic follow-up)
  OR 0.24 [0.14, 0.41]
  7 studies · 365 participants
  Moderate
• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes

  12 to 18 months (radiographic follow-up)
  OR 0.18 [0.06, 0.50]
  3 studies
  Moderate

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

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

  1 to 3 years
  The four studies that measured adverse events reported no adverse events after micro-invasive treatment (no events in either arm)
  4 studies
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

The review found no eligible studies for this question.

• Micro‐invasive interventions for managing proximal dental decay in primary and permanent teeth 2015 · Cochrane All outcomes
  No studies reported on caries measured as change in decayed, missing and filled (DMF/dmf) figures at surface, tooth or whole mouth level
  0 studies
  No studies found

Resin infiltration vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)

Resin infiltration led to lower caries (lesion) progression (radiographic) compared with fluoride varnish, sham/placebo, or flossing advice (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) · Resin infiltration
  OR 0.19 [0.08, 0.46]
  2 studies
  GRADE not reported

Micro-invasive treatment (proximal sealing or resin infiltration): resin sealant, glass ionomer sealant, polyurethane/adhesive patch, or resin infiltration vs Non-invasive / control treatment

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

  3 years
  One study (Alkilzy 2011, sealant patch) reported material deficiency: 10% total and 23% partial loss of proximal sealants after three years; 53% maintained perfect margins and none had open margins. No studies reported…
  1 study
  GRADE not reported

SDF applied biannually (every 6 months) vs Other non/minimally-invasive treatment (ART or 5% NaF varnish)

Biannual SDF application significantly arrested caries (pooled ES 0.39, 95% CI 0.19-0.60; ungraded).

• Silver Diamine Fluoride (SDF) Efficacy in Arresting Cavitated Caries Lesions in Primary Molars: A Systematic Review… 2022 All outcomes

  Follow-up up to 12 months (biannual application) · Pediatric dental care in hospital, community/school and outpatient settings (Saudi Arabia, China, India, Brazil, Spain) · SDF application frequency: biannual (every 6 months)
  ES 0.39 [0.19, 0.60]
  2 studies · 381 participants
  GRADE not reported