Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment: A Systematic Review and Meta-Analysis

Document Type : Systematic Review

Author

Avin Mohammadi

School of Dentistry, Tehran Azad University of Medical Sciences, Tehran, Iran

10.22034/jampbr.2026.585021.1104
Abstract
Background: Dental caries remains the most prevalent chronic disease-affecting children globally, with early childhood caries (ECC) disproportionately impacting underserved populations despite being largely preventable. Caries risk assessment (CRA) tools have developed to stratify patients and guide preventive interventions, yet the evidence base for their predictive validity and the comparative effectiveness of risk-based management protocols remains fragmented.

Objectives: This systematic review and meta-analysis aimed to (1) evaluate the predictive performance of existing CRA tools for future caries development in children, (2) assess the clinical effectiveness of prevention and management protocols stratified by caries risk category, and (3) quantify the comparative efficacy of individual preventive interventions including fluoride varnish, silver diamine fluoride (SDF), and fissure sealants.

Methods: A comprehensive literature search conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus from inception to March 2026. Randomized controlled trials and prospective cohort studies evaluating CRA tools or risk-stratified preventive protocols in children aged 0-18 years were included. Risk of bias assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and Cochrane RoB 2.0 tool. Meta-analyses performed using random-effects models.

Results: Thirty-eight studies (n=47,832 participants) met inclusion criteria. Meta-analysis of six CRA models demonstrated moderate discriminatory performance (pooled AUC: 0.79, 95% CI: 0.73-0.84) with significant heterogeneity (I²=78%). All CRA models exhibited high risk of bias per PROBAST criteria. For preventive interventions, SDF demonstrated superior caries arrest rates compared to placebo (RR: 2.34, 95% CI: 1.78-3.08) and fluoride varnish (RR: 1.42, 95% CI: 1.12-1.79). Fissure sealants showed higher caries prevention efficacy than fluoride varnish over 36 months (RR: 0.68, 95% CI: 0.54-0.86).

Conclusions: Current CRA tools show modest predictive accuracy with significant methodological limitations. Risk-stratified protocols incorporating SDF for high-risk children and sealants for permanent molars supported by moderate-quality evidence. Future research must prioritize external validation of prediction models.

Graphical Abstract

Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment: A Systematic Review and Meta-Analysis

Keywords

Caries risk assessment
pediatric dentistry
silver diamine fluoride
fissure sealants
and early childhood caries
Subjects
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Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 2, Issue 5
September and October 2026
Pages 430-444

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