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Evidence found and GRADE certainty

36 questions · 57 findings · 11 reviews · Dental caries

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No studies found 5 · 8.8%GRADE not reported 40 · 70.2%Very low 4 · 7%Low 8 · 14%Moderate 0 · 0%High 0 · 0%

Breastfeeding for more than 24 months vs Not breastfed at the same age or breastfed for a shorter duration

Early childhood caries (ECC) - incidence/risk · Children with exclusively primary dentition (age ≤71 months)

Breastfeeding beyond 24 months is associated with an increased risk (incidence) of early childhood caries versus not breastfeeding at the same age (RR 2.44, 95% CI 1.97 to 3.02; low certainty).

1 finding from 1 review

Longer follow-up vs Shorter follow-up

Annual increment in DMFS (D3) · Children and adolescents with permanent dentition

Not adjusted meta-regression beta was 0.43 per additional follow-up year.

5 findings from 1 review
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Not adjusted
    Meta-regression beta per year of follow-up 0.43 [0.04, 0.83]
    22 studies · 11300 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for bitewings and age at baseline
    Meta-regression beta per year of follow-up 0.64 [0.31, 0.96]
    22 studies · 11300 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for bitewings age at baseline and baseline caries experience
    Meta-regression beta per year of follow-up 0.37 [0.04, 0.70]
    22 studies · 11300 participants
    GRADE not reported
Show 2 more findings
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for groups 1-4 including relevance of evidence and risk of bias
    Meta-regression beta per year of follow-up 0.46 [0.08, 0.83]
    22 studies · 11300 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for groups 1-3 including decade and preventive intervention
    Meta-regression beta per year of follow-up 0.36 [-0.02, 0.73]
    22 studies · 11300 participants
    GRADE not reported

Longer follow-up vs Shorter follow-up

Annual increment in DMFT (D3) · Children and adolescents with permanent dentition

Not adjusted meta-regression beta was 0.18 per additional follow-up year.

5 findings from 1 review
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Not adjusted
    Meta-regression beta per year of follow-up 0.18 [-0.04, 0.40]
    13 studies · 24753 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for bitewings and age at baseline
    Meta-regression beta per year of follow-up 0.18 [0.02, 0.35]
    13 studies · 24753 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for bitewings age at baseline and baseline caries experience
    Meta-regression beta per year of follow-up 0.23 [0.06, 0.40]
    13 studies · 24753 participants
    GRADE not reported
Show 2 more findings
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for groups 1-4 including relevance of evidence and risk of bias
    Meta-regression beta per year of follow-up -0.04 [-0.34, 0.26]
    13 studies · 24753 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for groups 1-3 including decade and preventive intervention
    Meta-regression beta per year of follow-up 0.07 [-0.24, 0.39]
    13 studies · 24753 participants
    GRADE not reported

Longer follow-up vs Shorter follow-up

Caries incidence rate per person-year at risk (D3) · Children and adolescents with permanent dentition

Adjusted for groups 1-4 including relevance of evidence and risk of bias meta-regression beta was -0.02 per additional follow-up year.

5 findings from 1 review
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for groups 1-4 including relevance of evidence and risk of bias
    Meta-regression beta per year of follow-up -0.02 [-0.05, 0.01]
    15 studies · 10768 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for bitewings age at baseline and baseline caries experience
    Meta-regression beta per year of follow-up 0.00 [-0.00, 0.01]
    15 studies · 10768 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for bitewings and age at baseline
    Meta-regression beta per year of follow-up 0.00 [-0.00, 0.01]
    15 studies · 10768 participants
    GRADE not reported
Show 2 more findings
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Adjusted for groups 1-3 including decade and preventive intervention
    Meta-regression beta per year of follow-up -0.00 [-0.02, 0.02]
    15 studies · 10768 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per additional year of follow-up · Western or comparable populations · Not adjusted
    Meta-regression beta per year of follow-up -0.00 [-0.01, 0.01]
    15 studies · 10768 participants
    GRADE not reported

Daily chewing gum for 2 weeks or longer vs No gum chewing or control

Salivary flow rate (unstimulated) · Elderly (>60 years) and medically compromised adults with xerostomia / dry mouth

codex

1 finding from 1 review

Partial pulpotomy with one-unit longer follow-up vs Partial pulpotomy with one-unit shorter follow-up

Overall success (composite of clinical and radiographic success) · Adults aged 18 years or older with mature permanent teeth and carious pulp exposure

In the high-risk-study-excluded sensitivity meta-regression, longer follow-up was associated with lower success.

1 finding from 1 review

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Annual decline in percentage of caries-free participants (permanent dentition, D3) · Children and adolescents (permanent dentition, D3, up to 21 y), Western or comparable populations

For low baseline caries experience, the annual decline in caries-free participants ranged 4.3% to 10.2% (9 studies; ungraded).

4 findings from 1 review
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Annual (studies with >=3 y follow-up) · Western Europe, North America, Australia, New Zealand (or comparable Western populations) · Baseline caries experience: low
    4.3% to 10.2%
    9 studies · 4811 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Annual (studies with >=3 y follow-up) · Western Europe, North America, Australia, New Zealand (or comparable Western populations)
    0.8% to 10.2%
    18 studies · 12017 participants
    GRADE not reported
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Annual (studies with >=3 y follow-up) · Western Europe, North America, Australia, New Zealand (or comparable Western populations) · Baseline caries experience: high
    0.8% to 2.2%
    2 studies · 5029 participants
    GRADE not reported
Show 1 more finding
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Annual (studies with >=3 y follow-up) · Western Europe, North America, Australia, New Zealand (or comparable Western populations) · Baseline caries experience: moderate
    3.7% to 8.3%
    4 studies · 928 participants
    GRADE not reported

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Annual increment in DMFT (permanent dentition) · Children and adolescents (permanent dentition, D3, up to 21 y), Western or comparable populations

In the permanent dentition, the annual DMFT increment ranged from 0.06 to 0.73 across 14 studies, and was higher where baseline caries experience was higher (descriptive range; ungraded).

4 findings from 1 review
Show 1 more finding
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per year of follow-up · Western Europe, North America, Australia, New Zealand (or comparable Western populations) · Baseline caries experience: moderate
    0.24 to 0.73
    6 studies · 16705 participants
    GRADE not reported

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Caries development in permanent teeth · Children and adolescents (permanent dentition, D3, up to 21 y), Western or comparable populations

In the permanent dentition, the annual DMFS increment ranged from 0.07 to 1.77 across 26 studies, and was higher where baseline caries experience was higher (descriptive range; ungraded).

4 findings from 1 review
Show 1 more finding
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per year of follow-up · Western Europe, North America, Australia, New Zealand (or comparable Western populations) · Baseline caries experience: low
    0.07 to 0.53
    8 studies · 3735 participants
    GRADE not reported

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Dental caries: dmfs increment (primary teeth) · Children (primary dentition, d3), Western or comparable populations

In the primary dentition, the annual dmfs increment ranged from -1.0 to 1.0 across 7 studies; values were inconsistent because of tooth exfoliation and could not be pooled (ungraded).

1 finding from 1 review

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Annual decline in percentage of caries-free children (primary dentition, d3) · Children (primary dentition, d3), Western or comparable populations

In the primary dentition, the annual decline in the percentage of caries-free children ranged from 3.8% to 12.2% across 6 studies (descriptive range, no pooled estimate; ungraded).

1 finding from 1 review

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Caries incidence rate (first D3 lesion) per person-year at risk (permanent dentition) · Children and adolescents (permanent dentition, D3, up to 21 y), Western or comparable populations

In the permanent dentition, the pooled caries incidence rate was 0.11 per person-year at risk (95% CI 0.09 to 0.13; random-effects meta-analysis of 15 studies), i.e., about 11 of every 100 caries-free persons develop dentine caries each year (ungraded).

1 finding from 1 review
  • Caries Progression Rates Revisited: A Systematic Review. 2019 All outcomes
    Per person-year at risk · Western Europe, North America, Australia, New Zealand (or comparable Western populations)
    Incidence rate (per person-year at risk) 0.11 [0.09, 0.13]
    15 studies · 10768 participants
    GRADE not reported

Longitudinal follow-up over time (natural caries progression; no assigned intervention) vs Within-cohort change from baseline to follow-up (>=3 y)

Annual increment in dmft (primary dentition) · Children (primary dentition, d3), Western or comparable populations

In the primary dentition, the annual dmft increment ranged from -0.3 to 0.3 across 4 studies; values were inconsistent because of tooth exfoliation and could not be pooled (ungraded).

1 finding from 1 review

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Restoration longevity · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

Cavity liners may make little or no difference to restoration longevity (high success across groups; low certainty).

1 finding from 1 review

Gamified oral health interventions (mobile apps, serious games, augmented reality, game-based education) vs Non-digital gamified oral health interventions (card/board games, storytelling, printed aids)

Long-term behavior change and overall oral health outcomes · Children or adolescents

Digital gamified interventions appear more effective than non-digital alternatives for long-term behavior change and oral health outcomes, but the evidence is narrative and ungraded.

1 finding from 1 review
  • The Application of Gamification in Children's Oral Health Management: Systematic Review. 2025 All outcomes
    Long-term follow-up (sustained behavior change) · Schools, dental clinics, and mobile-app user-testing environments
    Digital-based interventions were more effective in fostering long-term behavior change compared with nondigital alternatives and consistently outperformed nondigital alternatives in improving oral health outcomes;…
    Studies not reported
    GRADE not reported

Resin composite restorations containing antibacterial agents vs Non-antibacterial containing composite restorations

Restoration survival · Adults and adolescents in any age group with restorations in the permanent dentition and children with restorations in the primary dentition

The review found no eligible studies for this question.

1 finding from 1 review

Direct resin composite veneer vs Indirect resin composite veneer

Restoration failure · Patients with permanent anterior teeth with intrinsic staining suitable for laminate veneer restorations
1 finding from 1 review
  • Direct versus indirect veneer restorations for intrinsic dental stains 2004 · Cochrane All outcomes
    2 years
    Meijering 1998 (data by restoration, not pooled; no statistical analysis possible). Failures over 2-year follow-up: direct resin composite (n=69) 4 absolute and 14 relative failures; indirect resin composite (n=54) 7…
    1 study · 123 participants
    GRADE not reported

Indirect veneer with no incisal edge reduction vs Indirect veneer with incisal edge reduction (1.5 mm plus short palatal bevel)

Restoration longevity · Patients receiving indirect laminate veneer restorations on permanent anterior teeth
1 finding from 1 review

Direct resin composite veneer vs Porcelain (indirect) veneer

Restoration failure · Patients with permanent anterior teeth with intrinsic staining suitable for laminate veneer restorations
1 finding from 1 review
  • Direct versus indirect veneer restorations for intrinsic dental stains 2004 · Cochrane All outcomes
    2 years
    Meijering 1998 (data by restoration, not pooled; no statistical analysis possible). Failures over 2-year follow-up: direct resin composite (n=69) 4 absolute and 14 relative failures; porcelain (n=56) 0 absolute and 3…
    1 study · 125 participants
    GRADE not reported

Ceramic inlays (all types) vs Gold inlay

Failure rate (longevity) at 5 years · Adults who require restorative treatment in posterior teeth

Ceramic inlays (all types) showed no clear difference in failure rate (longevity) at 5 years compared with gold inlay; GRADE not reported.

1 finding from 1 review