Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

229 questions · 612 findings · 24 reviews · Oral Health

No studies found 6 · 1%GRADE not reported 568 · 92.8%Very low 24 · 3.9%Low 10 · 1.6%Moderate 4 · 0.7%High 0 · 0%

Caries distribution assessment (individual, tooth and surface levels) vs None (descriptive prevalence review; subgroup analyses by urban/rural status, country and year)

Caries distribution (individual/tooth/surface level) · European adolescents aged 12–19 years

Caries distribution was skewed at individual, tooth and surface levels and too heterogeneous to meta-analyze (narrative synthesis of 11 studies; not GRADE-rated).

1 finding from 1 review

Monotherapy or dual antiretroviral therapy vs No antiretroviral medication (treatment-naive)

Oral candidiasis prevalence · Children and adolescents (<18 years) living with HIV (CLWH)

Oral candidiasis prevalence did not differ significantly between treatment-naive CLWH and those on monotherapy or dual therapy (very low certainty).

1 finding from 1 review

Silver diamine fluoride (SDF) vs Other methods (pooled: ART/glass ionomer cement, nano-silver fluoride, placebo)

Caries arrestment at the individual (patient) level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

Compared with other caries-management methods, SDF may increase caries arrestment at the individual level, but the pooled estimate is very imprecise (low certainty).

1 finding from 1 review

Silver diamine fluoride (SDF) vs Atraumatic restorative treatment (ART) with glass ionomer cement (GIC) or glass ionomer material

Caries arrestment at the individual (patient) level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

In one trial, SDF greatly increased individual-level caries arrestment versus ART/glass ionomer cement (OR 18.03); this subgroup was not separately GRADE-rated.

1 finding from 1 review

Silver diamine fluoride (SDF) vs Nano-silver fluoride (NSF; with or without green tea extract)

Caries arrestment at the individual (patient) level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

Pooling two trials, nano-silver fluoride achieved higher individual-level caries arrestment than SDF (OR 0.39 favoring the comparator; ungraded subgroup).

1 finding from 1 review

Silver diamine fluoride (SDF) vs Placebo, control, and/or other interventions

Caries arrestment at the individual (patient) level · Children and adults without systemic diseases affecting dental health

SDF showed a higher caries-arrestment proportion at the individual level, but the reported difference was not statistically significant.

1 finding from 1 review

Silver diamine fluoride (SDF) vs placebo control

Caries arrestment at the individual (patient) level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

Pooling two trials, SDF markedly increased individual-level caries arrestment versus placebo (OR 18.10; ungraded subgroup).

1 finding from 1 review

Dental caries assessment (WHO/clinical diagnostic criteria; caries = DMFT>0) vs Caries-free status

CA VI concentration · Individuals assessed for dental caries (mainly children aged 2-9 years; one study in adults aged 18-24 years)

Salivary CA VI concentration is significantly lower in individuals with dental caries than in caries-free individuals (SMD -0.672, 95% CI -1.011 to -0.332; not GRADE-rated).

1 finding from 1 review

Down syndrome vs Individuals without Down syndrome (healthy controls: siblings, schoolchildren or others)

Mean DMFT (decayed, missing, filled permanent teeth) · Individuals of all ages

Individuals with Down syndrome had a lower mean DMFT in permanent teeth than controls (pooled SMD -0.18, 95% CI -0.35 to -0.02; 6 studies; I2=20%); certainty of evidence not graded.

1 finding from 1 review

Down syndrome vs Individuals without Down syndrome (healthy controls: siblings, schoolchildren or others)

Dental caries · Individuals of all ages

Individuals with Down syndrome had a lower prevalence of dental caries than those without (pooled OR 0.36, 95% CI 0.22 to 0.57; 2 studies; I2=0%); certainty of evidence not graded.

1 finding from 1 review

Anorexia nervosa (as exposure; diagnosed by DSM-III/III-R/IV/V) vs Healthy controls

Percentage of bleeding on probing (BOP) · Patients with anorexia nervosa aged >=12 years (mean age ~18.4; entirely female in reported data), general community-dwelling population

Anorexia nervosa is associated with significantly increased bleeding on probing versus healthy controls (MD 16.57%, 95% CI 12.89 to 20.25; low certainty).

1 finding from 1 review

Cleft lip and/or palate (CL/P) vs Healthy controls without cleft

Gingival index (GI) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Persons with orofacial cleft have a higher gingival index than healthy controls (MD 0.15, 95% CI 0.11 to 0.19; low certainty).

1 finding from 1 review

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

Dental caries · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, children and adolescents with HIV on antiretroviral therapy had about twice the odds of dental caries versus HIV-negative peers (OR 2.04, 95% CI 1.21 to 3.42; very low certainty).

3 findings from 1 review

Dental caries (ECC/severe ECC) as exposure/grouping vs Caries-free controls

Relative abundance of S. mutans in saliva · Individuals assessed for dental caries, predominantly children with early childhood caries (ECC) or severe ECC (age about 1 to 4 years)

A few small studies report Streptococcus mutans relative abundance in caries versus caries-free children without pooling; the evidence is ungraded and not meta-analyzed.

1 finding from 1 review

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

Caries in primary teeth: dmft (3 years) · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, the dmft (primary dentition) index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 0.92, 95% CI -0.09 to 1.93; very low certainty).

2 findings from 1 review

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

Dental caries severity (dmfs index, primary dentition) · Children and adolescents (<18 years) living with HIV (CLWH)

In case-control studies, HIV+ children on ART had a significantly higher dmfs index than HIV-negative peers (MD 5.15, 95% CI 2.20 to 8.11; not separately GRADE-rated).

2 findings from 1 review

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

Dental caries in permanent teeth · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, the DMFT index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 0.60, 95% CI -0.53 to 1.72; very low certainty).

2 findings from 1 review

Cleft lip and/or palate (CL/P) vs Healthy controls without cleft

Clinical attachment level (CAL) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Clinical attachment level loss is greater in persons with orofacial cleft than in healthy controls (p<0.00001), but no pooled effect size was reported (ungraded).

1 finding from 1 review

Dental caries vs Caries-free status

Relative abundance of S. mutans in saliva · Systemically healthy individuals (children and adults, aged 40 months to 50 years) assessed for dental caries

The relative abundance of S. mutans in saliva is significantly higher in caries-active than caries-free individuals (pooled SMD 1.48, 95% CI 0.45 to 2.50), but heterogeneity is very high (I2=90%); ungraded.

1 finding from 1 review

Anorexia nervosa (as exposure; diagnosed by DSM-III/III-R/IV/V) vs Healthy controls

Salivary flow rate (stimulated) · Patients with anorexia nervosa aged >=12 years (mean age ~18.4; entirely female in reported data), general community-dwelling population

Stimulated salivary flow rate was significantly lower in anorexia nervosa patients than controls, but only unstimulated flow was meta-analyzed; this outcome is ungraded.

1 finding from 1 review