Primary prevention of dental caries: An evidence review

The purpose of this overview of reviews was to provide evidence to assist with the development of clinical guidelines on the primary prevention of dental caries in primary, permanent, and mixed dentition.

Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance in this process over time, where there is net demineralisation of tooth structure by organic acids formed from the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). 

The HRB found that, relative to all other types of interventions, and taking the volume of evidence for each intervention category into account, the evidence for caries prevention in primary dentition was strongest for fluoride supplements. The evidence for caries prevention in permanent dentition was strongest for fluoride mouth rinse, fluoride gels, and fluoride solutions. The evidence for caries prevention in mixed dentition was strongest for vitamin D and xylitol (although it is important to note that the volume of evidence in the mixed dentition category was generally very low). However, the overview also revealed a fragmented body of research, with a substantial proportion of single-trial outcomes and a low and very low degree of certainty in the evidence for the majority of the interventions. Following a systematic quality assessment, the methodological quality of the included systematic reviews was generally low. Further high-quality, adequately powered RCT research is required; in the meantime, conclusions may only be drawn narrowly, if at all, with respect to the most effective approaches by which to prevent dental caries using individual-based primary prevention interventions prior to the development of any dental decay/dental caries.  

Related files for download

• Supplementary appendices to Primary prevention of dental caries. An evidence review (PDF, 6 MB)