What do systematic reviews say?

Surgery vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: not reported.
  0 studies
  No studies found

Probiotic mouthwash (e.g., Lactobacillus-based) vs Blank control

Probiotic mouthwash has inconsistent effects on Mutans streptococci colony counts versus blank control; 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 MS was significantly reduced compared to blank control [53]. Colony count of MS was insignificantly increased compared to baseline [33].
  2 studies
  Very low

Chlorhexidine mouthwash vs Placebo mouthwash

Chlorhexidine mouthwash probably reduces the Gingival Index versus placebo in the short term (WMD -0.45, 95% CI -0.70 to -0.20; 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)
  WMD -0.45 [-0.70, -0.20]
  3 studies · 98 participants
  Low

Herbal mouthwash vs Blank control

Herbal mouthwash reduced several plaque-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
  PI was significantly reduced compared to baseline [39; 48; 54; 58]; BBPI was significantly reduced compared to blank control [47]; TI and dental plaque amount were significantly reduced compared to baseline [45; 38].
  8 studies
  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

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

Intervention not reported

• Strategies to integrate oral health into primary care: a systematic review. 2023 All outcomes
  3 of 3 studies reported favourable outcomes
  3 studies
  GRADE not reported

Herbal mouthwash vs Blank control

Herbal mouthwash showed mixed effects on Mutans streptococci, with very low-certainty evidence.

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

  ≤ 3 months
  Colony count of MS was significantly reduced compared to baseline [48]; another study found an insignificant reduction compared to baseline [51].
  2 studies
  Very low

Antiretroviral therapy (any, including cART) vs No antiretroviral medication (treatment-naive)

Evidence on salivary IgA in CLWH on versus off ART was divergent and inconclusive (very low certainty).

• Impact of Antiretroviral Therapy on Oral Health among Children Living with HIV: A Systematic Review and Meta-Analysis. 2022 All outcomes

  Hospitals and AIDS outpatient centres in India, Brazil, and several Asian countries
  Two studies gave divergent results: Subramaniam (2015) reported higher SIgA in children on ART for more than 3 years than pre-ART (8.6 (SD 2.9) vs 6.2 (SD 1.7) mg/dL; p < 0.001), whereas Pomarico (2009) found lower…
  2 studies
  Very low

Intervention not reported

• A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum on Plaque Quantity in the Oral Cavity. 2022 All outcomes
  No adverse events reported
  8 studies
  GRADE not reported

Combined antiretroviral therapy (cART) vs Monotherapy or dual antiretroviral therapy

No significant difference in dental caries/severity between ART regimens (very low certainty).

• Impact of Antiretroviral Therapy on Oral Health among Children Living with HIV: A Systematic Review and Meta-Analysis. 2022 All outcomes

  Hospitals and AIDS outpatient centres in India, Brazil, and several Asian countries
  No significant difference in dental caries/severity between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 2 study(ies).
  2 studies
  Very low

Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs Healthy HIV-negative controls

No eligible studies reported Kaposi's sarcoma.

• Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review… 2022 All outcomes

  Cross-sectional (case-control; single time point) · HIV pediatric/ART clinics, AIDS centers, and hospitals in Brazil, India, Saudi Arabia, and West Africa (Cote d'Ivoire, Mali, Senegal)
  Planned WHO stage 4 outcome; no eligible studies (Table 2 lists 'None').
  0 studies
  No studies found

Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs Healthy HIV-negative controls

No significant difference in total salivary IgA between CLWH and healthy controls, though anti-Candida SIgA was higher in HIV groups; narrative only.

• Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review… 2022 All outcomes

  Cross-sectional (case-control; single time point) · HIV pediatric/ART clinics, AIDS centers, and hospitals in Brazil, India, Saudi Arabia, and West Africa (Cote d'Ivoire, Mali, Senegal)
  Pomarico 2009 reported no significant difference in total SIgA among HIV-ART, HIV-HAART, and healthy children, but significantly higher anti-Candida albicans SIgA in the two HIV groups; no effect estimate pooled.
  1 study
  GRADE not reported

Antiretroviral therapy (any, including cART) vs No antiretroviral medication (treatment-naive)

No significant difference in linear gingival erythema between CLWH with and without ART (very low certainty).

• Impact of Antiretroviral Therapy on Oral Health among Children Living with HIV: A Systematic Review and Meta-Analysis. 2022 All outcomes

  Hospitals and AIDS outpatient centres in India, Brazil, and several Asian countries
  OR 1.29 [0.58, 2.88]
  Studies not reported
  Very low

Traditional screening (referral card given if the inspecting dentist judges the child needs to see a dentist) vs No screening

The review found no eligible studies for this question.

• School dental screening programmes for oral health 2022 · Cochrane All outcomes
  Proportion of children with treated/untreated caries: Not reported (Summary of findings 1).
  0 studies
  No studies found

Criteria-based screening (dentist refers using pre-established criteria) vs Traditional screening

It is very uncertain whether criteria-based screening (dentist refers using pre-established… changes dental attendance compared with traditional screening (very low certainty).

• School dental screening programmes for oral health 2022 · Cochrane All outcomes

  3 to 4 months
  RR 1.01 [0.94, 1.08]
  2 studies · 5316 participants
  Very low

Traditional screening (referral card given if the inspecting dentist judges the child needs to see a dentist) vs No screening

The review found no eligible studies for this question.

• School dental screening programmes for oral health 2022 · Cochrane All outcomes
  No studies measured developmental defects of enamel (by any validated index).
  0 studies
  No studies found

Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs Healthy HIV-negative controls

One study found significantly higher ulcerative stomatitis among CLWH on ART (OR 28.59, 95% CI 1.67 to 490.32), though the estimate is very imprecise.

• Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review… 2022 All outcomes

  Cross-sectional (case-control; single time point) · HIV pediatric/ART clinics, AIDS centers, and hospitals in Brazil, India, Saudi Arabia, and West Africa (Cote d'Ivoire, Mali, Senegal)
  OR 28.59 [1.67, 490.32]
  1 study · 190 participants
  GRADE not reported

Consumption of xylitol chewing gum by women (mothers) vs No chewing gum

Xylitol sugar-free gum significantly reduced plaque quantity versus no-gum/control (SMD -0.743, 95% CI -1.148 to -0.338), with high heterogeneity (I2 = 86.0%; ungraded).

• A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum on Plaque Quantity in the Oral Cavity. 2022 All outcomes

  End of study (last reported time point; study durations 4 days to 2 years) · Community, residential care homes, and schools; predominantly adults
  SMD -0.743 [-1.148, -0.338]
  7 studies
  GRADE not reported

Traditional screening (referral card given if the inspecting dentist judges the child needs to see a dentist) vs No screening

• School dental screening programmes for oral health 2022 · Cochrane All outcomes
  Milsom 2006 reported the prevalence of trauma to the permanent incisor teeth as a dichotomous outcome (reduction from baseline yes/no); we were unable to include this data in a meta-analysis.
  1 study
  GRADE not reported