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What do systematic reviews say?

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Evidence found and GRADE certainty

2,066 questions · 3,346 findings · 178 reviews · Dental caries

No studies found 48 · 1.4%GRADE not reported 2,789 · 83.4%Very low 208 · 6.2%Low 129 · 3.9%Moderate 136 · 4.1%High 36 · 1.1%

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Positive LR for detecting all (initial and advanced) occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the conventional (all-studies) meta-analysis, the positive lr of radiographic detection for all (initial and advanced) occlusal caries was 1.74 (95% CI 1.3 to 2.4) (ungraded).

3 findings from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Negative LR for detecting all (initial and advanced) occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the conventional (all-studies) meta-analysis, the negative lr of radiographic detection for all (initial and advanced) occlusal caries was 0.79 (95% CI 0.65 to 0.96) (ungraded).

3 findings from 1 review

Fluoride gel (topically applied; operator- or self-applied; any fluoride agent/concentration; frequency at least once a year) vs no treatment

Caries increment in permanent teeth · Children or adolescents

The NMR reported a difference between fluoride in gel and no treatment at every displayed randomisation year; no GRADE assessment was reported.

1 finding from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Sensitivity for detecting advanced proximal caries · Proximal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Egypt, pooled sensitivity of radiographic detection for advanced proximal caries was 44.4% (95% CI 38 to 51) (ungraded).

3 findings from 1 review

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Positive LR for detecting advanced occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the conventional (all-studies) meta-analysis, the positive lr of visual detection for advanced occlusal caries was 7.09 (95% CI 5.6 to 8.9) (ungraded).

3 findings from 1 review

Silver diamine fluoride twice annually vs Other network treatments

Caries lesion arrestment · Primary teeth with dentin caries lesions on occlusal and smooth surfaces

Silver diamine fluoride twice annually ranked first for caries lesion arrestment in the occlusal- and smooth-surface network (moderate certainty).

1 finding from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Specificity for detecting advanced occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Germany, pooled specificity of radiographic detection for advanced occlusal caries was 91.4% (95% CI 88 to 94) (ungraded).

3 findings from 1 review

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Negative LR for detecting advanced occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Germany, the negative lr of visual detection for advanced occlusal caries was 0.58 (95% CI 0.5 to 0.7) (ungraded).

3 findings from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Specificity for detecting all (initial and advanced) occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Germany, pooled specificity of radiographic detection for all (initial and advanced) occlusal caries was 84.8% (95% CI 77 to 90) (ungraded).

3 findings from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Specificity for detecting all (initial and advanced) proximal caries · Proximal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Germany, pooled specificity of radiographic detection for all (initial and advanced) proximal caries was 91.7% (95% CI 90 to 93) (ungraded).

3 findings from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Positive LR for detecting advanced occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Germany, the positive lr of radiographic detection for advanced occlusal caries was 5.87 (95% CI 4.3 to 8.0) (ungraded).

3 findings from 1 review

Artesunate vs Quinine

Death · Patients with severe malaria

The fixed-effect NMR reported a difference between artesunate and quinine at every displayed average age; no GRADE assessment was reported.

2 findings from 1 review

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (often histological; also invasive opening)

Advanced occlusal carious lesions · Permanent molar surfaces in diagnostic accuracy studies (mostly in vitro; clinical)

Pooled specificity for visual detection of advanced occlusal lesions was 0.849 (95% CI 0.82 to 0.89).

2 findings from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Positive LR for detecting all (initial and advanced) proximal caries · Proximal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the conventional (all-studies) meta-analysis, the positive lr of radiographic detection for all (initial and advanced) proximal caries was 4.3 (95% CI 3.4 to 5.5) (ungraded).

3 findings from 1 review

Visual caries detection (ICDAS visual/visual-tactile inspection) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

NPV for detecting all (initial and advanced) occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the Egyptian public health clinic setting, the negative predictive value of visual detection for all (initial and advanced) occlusal caries was 97.4% at an assumed prevalence of 12.9% (ungraded).

2 findings from 1 review

Hall technique vs Other network treatments

Treatment success rate · Primary teeth with dentin caries lesions on occlusoproximal surfaces

The Hall technique ranked first for treatment success in the occlusoproximal-surface network (low certainty).

1 finding from 1 review

Radiographic caries detection (bitewing radiography) vs Reference standard (histological validation or cavity/lesion opening; advanced = cavitated/dentin-involved lesions, all = enamel-confined initial lesions also counted)

Sensitivity for detecting advanced occlusal caries · Occlusal surfaces of permanent molars (demonstrated in 12-14 year-olds; underlying diagnostic accuracy studies, mostly in vitro)

In the meta-analysis tailored to Egypt, pooled sensitivity of radiographic detection for advanced occlusal caries was 54.2% (95% CI 47 to 61) (ungraded).

3 findings from 1 review

Fluoride varnish vs Fluoride in dentifrice

Caries increment, surface index D(M)FS · Children or adolescents

The illustrative network meta-regression estimated an SMD for caries increment for fluoride in varnish versus fluoride in dentifrice across randomization year; the review did not state whether the difference was significant and certainty was not graded.

1 finding from 1 review