Systematic review of pediatric dental caries transition probabilities across 11 studies

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Frontiers in Medicine Published May 5, 2026 Medically reviewed May 5, 2026 Study authors: Xenia Teplitzky, Falk Schwendicke, Laura Neimane, Darja Gostilo, Jekaterina Gudkina, Shaju Jacob Pul… DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Note that pediatric caries transition patterns depend on model complexity and study limitations.

This systematic review examines transition probabilities between childhood dental health states across pediatric populations. The analysis incorporates data from 12 reports on 11 studies. The authors synthesize findings regarding how dental health states change over time within these specific cohorts.

The most common pattern observed was stability within the same health state. Progression and regression occurred less frequently in the reviewed literature. The review highlights that transition patterns are dependent on model complexity. Multi-state models reflect bidirectional transitions and potential lesion reactivation. In contrast, simpler two-state models reflect unidirectional onset.

The authors acknowledge several limitations that affect the interpretation of these results. These include bias, variability in lesion assessment, incomplete confounder adjustment, and restrictive modeling assumptions. The review offers supporting data for current model-based research on pediatric caries progression. No specific medications or adverse events were reported in the source material.

Practice relevance is limited to supporting existing research frameworks rather than providing new clinical guidelines. The evidence does not establish causality due to the observational nature of the underlying studies. Clinicians should interpret these findings with caution regarding the specific modeling assumptions used in the included reports.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Understanding the progression of dental caries in children, characterized by transitions between distinct health states, may benefit the development of prevention and disease modeling frameworks. This systematic review aimed to synthesize evidence on transition probabilities between childhood dental health states across diverse study designs and populations. Comprehensive searches of PubMed and Scopus (last searched September 2025) identified observational and modeling studies reporting discrete caries health states in children. Data were extracted on study design, health state definitions, transition parameters, and model characteristics, and methodological quality was appraised using established tools such as JBI checklists. This review was registered in PROSPERO (CRD420251135660) under the title “Distinct Progressive Health States and Associated Transition Probabilities in Pediatric Dental Caries: A Systematic Review”. The title was modified for clarity in the present manuscript. A total of 12 reports on 11 studies were included, comprising observational and modeling studies reporting transitions of teeth or surfaces across pediatric populations. Across studies, results were synthesized narratively, most showing that stability within the same health state was the most common pattern, while progression and regression occurred less frequently and were largely dependent on model complexity. Multi-state models capturing lesion depth and activity appear to reflect bidirectional transitions and potential lesion reactivation, whereas simpler two-state models tend to reflect unidirectional onset. Methodological limitations, including bias, variability in lesion assessment, incomplete confounder adjustment, and restrictive modeling assumptions, reduced the robustness and comparability of the evidence. Nevertheless, this review offers supporting data for current model-based research on pediatric caries progression within the scope of this review, highlighting patterns, sources of variability, and the need for harmonized health state definitions, standardized assessment procedures, and transparent reporting to improve future modeling and evidence-based prevention strategies. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251135660, PROSPERO CRD420251135660.