What do systematic reviews say?

Potassium nitrate/dimethyl isosorbide/polycarboxylate cement (KNO3/DMI/PCa) vs Potassium nitrate/polycarboxylate cement (KNO3/PCa)

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  24 months
  Hodosh 2003 (Analysis 3.1): all 18 patients receiving KNO3/DMI/PCa responded favourably (0/18 developed clinical symptoms) versus 9/17 in the KNO3/PCa group; symptomatic teeth required endodontic therapy or extraction.…
  1 study · 35 participants
  GRADE not reported

Calcium hydroxide cement (Dycal) vs Zinc oxide and eugenol (ZOE)

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  12 months · Complete caries removal
  Analysis 2.2 (clinical symptoms at 12 months following complete caries removal, Dycal vs Cavitec). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth…
  1 study · 151 participants
  GRADE not reported

Calcium hydroxide (CH) vs Zinc oxide and eugenol (ZOE)

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  24 months
  Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…
  1 study · 275 participants
  GRADE not reported

Life (calcium hydroxide pulp-capping material) vs Zinc oxide and eugenol (ZOE)

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  12 months · Complete caries removal
  Analysis 2.2 (clinical symptoms at 12 months following complete caries removal, Life vs Cavitec). Fitzgerald 1991: 151 teeth in 55 patients (analysis at tooth level, not patient level); substantial attrition (11 teeth…
  1 study · 151 participants
  GRADE not reported

Potassium nitrate/dimethyl isosorbide/polycarboxylate cement (KNO3/DMI/PCa) vs Polycarboxylate cement (PCa) alone

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  24 months
  Hodosh 2003 (Analysis 3.1): all 18 patients receiving KNO3/DMI/PCa responded favourably (0/18 developed clinical symptoms) versus 10/12 in the PCa group. "The results in groups two and three were statistically…
  1 study · 30 participants
  GRADE not reported

Glycerrhetinic acid/antibiotic mixture vs Zinc oxide and eugenol (ZOE)

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  24 months
  Shovelton 1971 (Analysis 1.1): 275 teeth followed for 2 years (235 at 6 months, 160 at 12 months, 85 analysed at 24 months). Success rates 50% to 80%. Ledermix and calcium hydroxide had the highest success rates,…
  1 study · 275 participants
  GRADE not reported

Potassium nitrate/polycarboxylate cement (KNO3/PCa) vs Polycarboxylate cement (PCa) alone

• Pulp management for caries in adults: maintaining pulp vitality 2007 · Cochrane All outcomes

  24 months
  Hodosh 2003 (Analysis 3.1): 9/17 in the KNO3/PCa group and 10/12 in the PCa group developed clinical symptoms requiring endodontic therapy or extraction. No significance test reported for this specific contrast; no…
  1 study · 29 participants
  GRADE not reported

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Cavity liners may make little or no difference to restoration longevity (high success across groups; low certainty).

• Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth - a… 2025 All outcomes

  >=12 months · Dental clinical settings (multiple countries)
  No significant difference; high success in all groups
  8 studies · 889 participants
  Low

Higher drinking-water fluoride exposure vs Null / lowest drinking-water fluoride exposure (reference)

Non-linear positive dose-response: little change in overall fracture risk below ~1.5 mg/L drinking-water fluoride, with risk increasing above that threshold (RR 1.06, 1.19, 1.35 at 2.0, 3.0, 4.0 mg/L vs null); ungraded (4 studies).

• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride 1.2 mg/L vs null
  RR 1.00 [0.80, 1.24]
  4 studies
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride 4.0 mg/L vs null
  RR 1.35 [0.94, 1.95]
  4 studies
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride 3.0 mg/L vs null
  RR 1.19 [0.87, 1.64]
  4 studies
  GRADE not reported

Anorexia nervosa (as exposure; diagnosed by DSM-III/III-R/IV/V) vs Healthy controls

Anorexia nervosa is associated with significantly increased bleeding on probing versus healthy controls (MD 16.57%, 95% CI 12.89 to 20.25; low certainty).

• The influence of anorexia nervosa on oral health and related parameters potentially relevant to orthodontic treatment:… 2025 All outcomes

  Clinical dental/oral examination; case-control studies and controlled clinical trials in Europe (mainly Poland, Italy, France, Germany), Australia and the USA
  MD 16.57 [12.89, 20.25]
  2 studies · 326 participants
  Low

Higher drinking-water fluoride exposure vs Null / lowest drinking-water fluoride exposure (reference)

Femoral-fracture risk was mildly U-shaped: RR 0.86 at 0.5 mg/L rising to 1.06 at 1.8 mg/L drinking-water fluoride vs null; risk mostly below null across the range; ungraded.

• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride 1.8 mg/L vs null
  RR 1.06 [0.67, 1.69]
  Studies not reported
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride 0.5 mg/L vs null
  RR 0.86 [0.71, 1.05]
  Studies not reported
  GRADE not reported

Higher drinking-water fluoride exposure vs Null / lowest drinking-water fluoride exposure (reference)

Fragility-fracture risk overall was slightly U-shaped: RR 0.93 up to 0.9 mg/L, ~1.00 at 1.48 mg/L, 1.05 at 1.8 mg/L drinking-water fluoride vs null; ungraded.

• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride up to 0.9 mg/L vs null
  RR 0.93 [0.84, 1.02]
  Studies not reported
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Drinking-water fluoride 1.8 mg/L vs null
  RR 1.05 [0.82, 1.35]
  Studies not reported
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Sensitivity (excluding high risk-of-bias studies): 0.8-1.5 mg/L vs null
  RR 0.93 [0.72, 1.21]
  Studies not reported
  GRADE not reported

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

The evidence is very uncertain about the effect of cavity liners on treatment failure; no significant difference between lined and unlined (or differently lined) restorations was found (very low certainty).

• Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth - a… 2025 All outcomes

  >=12 months · Dental clinical settings (multiple countries)
  No significant difference; 96.5% of treated teeth remained vital
  12 studies · 1184 participants
  Very low

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

The evidence is very uncertain whether cavity liners reduce postoperative hypersensitivity; no significant difference was found overall (very low certainty).

• Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth - a… 2025 All outcomes

  7 days to 3 months · Dental clinical settings (multiple countries)
  No significant difference; minimal pain reported
  9 studies · 1000 participants
  Very low

Higher drinking-water fluoride exposure vs Null / lowest drinking-water fluoride exposure (reference)

Spine BMD showed an inverted U-shaped association with fluoride (peak ~0.6 mg/L); excluding high risk-of-bias studies gave small positive MDs (e.g., 0.05 g/cm2, 95% CI 0.01-0.10, up to 2.27 mg/L); ungraded.

• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Sensitivity (excluding high risk-of-bias studies): 1.27 to 2.27 mg/L vs null
  MD 0.05 [0.01, 0.10]
  Studies not reported
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Sensitivity (excluding high risk-of-bias studies): 0.60 mg/L vs null
  MD 0.06 [-0.02, 0.13]
  Studies not reported
  GRADE not reported
• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Both sexes, main dose-response
  Inverted U-shaped association in both males and females, highest value around 0.6 mg/L (no numeric MD reported in text for main analysis)
  Studies not reported
  GRADE not reported

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

Cavity liners may make little or no difference to tooth survival (99.4% survival across groups; low certainty).

• Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth - a… 2025 All outcomes

  >=12 months · Dental clinical settings (multiple countries)
  No significant difference; 99.4% survival in all groups
  12 studies · 1184 participants
  Low

Dental cavity liner (e.g. calcium hydroxide, glass ionomer, resin-modified glass ionomer, or flowable composite) placed under the restoration vs No cavity liner or a different liner material

No included study reported oral health-related quality of life (a planned outcome), so no evidence is available.

• Efficacy of different cavity liners compared to no cavity lining in managing deep caries in vital permanent teeth - a… 2025 All outcomes

  >=6 months · Dental clinical settings (multiple countries)
  no estimate extracted
  0 studies
  No studies found

Higher drinking-water fluoride exposure vs Null / lowest drinking-water fluoride exposure (reference)

Hip BMD increased with fluoride in both sexes (linearly in males, non-linearly above ~1.2 mg/L in females); no numeric MD reported in text for the main analysis; ungraded.

• The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomes

  Long-term / lifetime fluoride exposure · General population; 37 observational studies (1944-2024), predominantly North America (USA, Canada) and Northern Europe (Finland, Sweden), plus UK, Poland, Italy, Germany, China, Taiwan, South Korea, Ethiopia; exposure mainly community drinking-water fluoride · Both sexes, main dose-response
  Hip BMD increased in both sexes, linearly in males and non-linearly (starting above 1.2 mg/L) in females (no numeric MD reported in text for main analysis)
  Studies not reported
  GRADE not reported

Anorexia nervosa (as exposure; diagnosed by DSM-III/III-R/IV/V) vs Healthy controls

Stimulated salivary flow rate was significantly lower in anorexia nervosa patients than controls, but only unstimulated flow was meta-analyzed; this outcome is ungraded.

• The influence of anorexia nervosa on oral health and related parameters potentially relevant to orthodontic treatment:… 2025 All outcomes

  Clinical dental/oral examination; case-control studies and controlled clinical trials in Europe (mainly Poland, Italy, France, Germany), Australia and the USA
  Stimulated salivary flow rate significantly lower in anorexic patients (Paszynska 2015 Nov 1.20 vs 1.57 ml/min, p=0.005; Paszynska 2018 0.99 vs 1.45 ml/min, p<0.00001); reported narratively, not meta-analyzed
  2 studies · 126 participants
  GRADE not reported

Anorexia nervosa (as exposure; diagnosed by DSM-III/III-R/IV/V) vs Healthy controls

Anorexia nervosa is associated with significantly lower salivary pH than healthy controls (MD -0.39, 95% CI -0.54 to -0.24; low certainty).

• The influence of anorexia nervosa on oral health and related parameters potentially relevant to orthodontic treatment:… 2025 All outcomes

  Clinical dental/oral examination; case-control studies and controlled clinical trials in Europe (mainly Poland, Italy, France, Germany), Australia and the USA
  MD -0.39 [-0.54, -0.24]
  3 studies · 180 participants
  Low