# Pediatric dentistry systematic reviews using the GRADE approach: methodological study

## TL;DR

This study evaluates how often and how well systematic reviews in pediatric dentistry use the GRADE approach to assess evidence certainty.

## Contribution

The study quantifies GRADE usage in pediatric dentistry reviews and identifies common reasons for downgrading evidence certainty.

## Key findings

- Only 28% of pediatric dentistry reviews used the GRADE approach to assess evidence certainty.
- Most evidence outcomes had very low or low certainty, primarily due to risk of bias and imprecision.
- The methodological quality of the included reviews varied, with most fulfilling only moderate or low AMSTAR 2 criteria.

## Abstract

To assess the reporting of the certainty of the evidence using the GRADE approach in systematic reviews of interventions in pediatric dentistry.

The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in pediatric dentistry that reported the certainty of the evidence through the GRADE approach. Paired independent reviewers screened the studies, extracted data, and appraised the methodological quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. The certainty of the evidence was extracted for each outcome. A descriptive analysis was conducted.

Around 28% of pediatric dentistry reviews of interventions used the GRADE approach (n = 24). Twenty reviews reported 112 evidence outcomes from RCTs and 13 from NRSIs using GRADE evidence profile tables. The methodological quality was high (16.7%), moderate (12.5%), low (37.5%), and critically low (33.3%), fulfilling the majority of the AMSTAR 2 criteria. The certainty of the evidence for outcomes generated from RCTs and NRSIs was very low (40.2% and 84.6%), low (33.1% and 7.7%), moderate (17.8% and 7.7%), and high (9.8% and 0.0%). The main reasons to downgrade the certainty were due to (for RCTs and NRSIs, respectively): risk of bias (68.8% and 84.6%), imprecision (67.8% and 100.0%), inconsistency (18.8% and 23.1%), indirectness (17.8% and 0.0%), and publication bias (7.1% and 0.0%).

The proportion of systematic reviews assessing the certainty of the evidence using the GRADE approach was considered small, considering the total initial number of published pediatric dentistry reviews of intervention. The certainty of the evidence was mainly very low and low, and the main problems for downgrading the certainty of evidence were due to risk of bias and imprecision.

PROSPERO database #CRD42022365443.

The online version contains supplementary material available at 10.1186/s12903-024-04542-w.