Supplementary file for: Prevalence and factors associated with pulp stones

Supplementary file for: Prevalence and factors associated with pulp stones: a systematic review with meta-analysis and meta-regression. Pulp stones are radiopaque calcified masses located within the coronal or radicular pulp tissue, typically asymptomatic and detected incidentally on radiographic examination. Worldwide prevalence estimates vary widely, and methodological inconsistencies across studies hinder comprehensive understanding. Therefore, the present systematic review aimed to answer the following question: “What is the worldwide prevalence of pulp stones, and what factors are associated with their occurrence?” Aim: To systematically review and synthesize the evidence on the worldwide prevalence of pulp stones and to identify factors associated with their occurrence. Materials and methods: Six electronic databases were searched up to March 2024. Data extraction included participant demographics, diagnostic methods, tooth type, and the presence of systemic diseases. Risk of bias was assessed using the JBI checklist, and prevalence was pooled using random-effects meta-analyses at both the individual and tooth levels. Meta-regression was performed to explore potential sources of heterogeneity, and the certainty of evidence was assessed using GRADE. Results: Twenty-four studies comprising 10,738 individuals and 94,416 teeth met the inclusion criteria. Pulp stones were present in 46% of individuals and 20% of teeth, with substantial heterogeneity across studies. Meta-regression identified systemic conditions and tooth type as significant contributors to prevalence variability. Individuals with both cardiovascular and renal diseases exhibited a higher prevalence (β=0.31, p=0.04), whereas those with cardiovascular disease alone showed a lower prevalence (β=-0.33, p=0.04) compared with healthy participants (R2= 26.0). Risk of bias was moderate in most studies, and the overall certainty of evidence was very low. Conclusion: Pulp stones are highly prevalent and their occurrence can be influenced by systemic conditions and tooth-related factors. However, these findings are based on a very-low certainty of evidence, limited by study heterogeneity and methodological inconsistencies. (2026)