Progressive health states and transition probabilities in pediatric dental caries: a systematic review of current evidence and research gaps

Introduction – 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. Methods – 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. Results – 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. Discussion – 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. Systematic Review Registration – https://www.crd.york.ac.uk/PROSPERO/view/CRD420251135660, PROSPERO CRD420251135660.