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Evidence found and GRADE certainty

516 questions · 950 findings · 74 reviews · Dental caries

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No studies found 35 · 3.7%GRADE not reported 831 · 87.5%Very low 38 · 4%Low 26 · 2.7%Moderate 13 · 1.4%High 7 · 0.7%

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Osteoporosis · European GWAS participants

The SVMR MR-Egger interval included the null.

4 findings from 1 review
Show 1 more finding

Replacement of the defective restoration vs Repair of the defective restoration

Amalgam: Preference for replacement over repair - Scenario 8: disruption of occlusal integrity · Dentists managing a defective direct amalgam restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…

For a defective amalgam restoration with disruption of occlusal integrity, surveyed dentists most often preferred replacement over repair (pooled RR 1.70; p < 0.001); ungraded.

1 finding from 1 review

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Osteoporosis with pathological fracture · European GWAS participants

The SVMR Weighted Median interval included the null.

3 findings from 1 review

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

Fracture · general population

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).

4 findings from 1 review
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Genetically predicted DMFS (dental caries) vs Reference (1-SD lower genetically predicted DMFS)

Osteoporosis with pathological fracture · European-ancestry adults

In multivariable MR, genetically predicted dental caries (DMFS) had no significant causal effect on osteoporosis with pathological fracture (OR 1.279, not significant).

2 findings from 1 review

Genetically predicted DMFS (dental caries) vs Lower genetically predicted DMFS

Postmenopausal osteoporosis with pathological fracture · European GWAS participants

The SVMR Maximum Likelihood interval included the null.

3 findings from 1 review

Genetically predicted DMFS (dental caries) vs Reference (1-SD lower genetically predicted DMFS)

Osteoporosis · European-ancestry adults

In multivariable MR (adjusted for periodontitis), higher genetically predicted dental caries (DMFS) causally increased osteoporosis risk (OR 1.165, moderate evidence).

2 findings from 1 review

Genetically predicted DMFS (dental caries) vs Reference (1-SD lower genetically predicted DMFS)

Bone mineral density in forearm · European-ancestry adults

Genetically predicted dental caries (DMFS) had no causal effect on forearm BMD.

1 finding from 1 review

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

Risk of femoral fractures · general population

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.

2 findings from 1 review
  • 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)

Risk of fragility fractures · Male participants

In males (7 studies), fragility-fracture risk generally decreased with increasing fluoride: RR 0.83 (95% CI 0.72-0.97) at 0.57 mg/L to 0.87 (0.48-1.58) at 1.8 mg/L vs null; ungraded.

2 findings from 1 review
  • 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 · Males: drinking-water fluoride 1.8 mg/L vs null
    RR 0.87 [0.48, 1.58]
    7 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 · Males: drinking-water fluoride 0.57 mg/L vs null
    RR 0.83 [0.72, 0.97]
    7 studies
    GRADE not reported

Replacement of the defective restoration vs Repair of the defective restoration

Amalgam: Preference for replacement over repair - Scenario 1: partial loss or fracture of the restoration · Dentists managing a defective direct amalgam restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…

Subgroup (Continent: South America): pooled preference was replacement over repair for a defective amalgam restoration with partial loss or fracture of the restoration (RR 6.20); significant continental variation, p = 0.04.

9 findings from 1 review
Show 6 more findings

Replacement of the defective restoration vs Repair of the defective restoration

Composite: Preference for replacement over repair - Scenario 3: secondary caries · Dentists managing a defective direct resin composite restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…

Subgroup (Continent: Africa): pooled preference was replacement over repair for a defective composite restoration with secondary caries (RR 4.62); significant continental variation, p < 0.001.

5 findings from 1 review
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Higher drinking-water fluoride exposure vs Null / lowest drinking-water fluoride exposure (reference)

Risk of fragility fractures · general population

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.

5 findings from 1 review
  • 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
Show 2 more findings
  • 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 1.48 mg/L vs null
    RR 1.00 [0.82, 1.21]
    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): 1.8 mg/L vs null
    RR 0.95 [0.70, 1.29]
    Studies not reported
    GRADE not reported

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Forearm fracture · European GWAS participants

The SVMR Weighted Median interval included the null.

3 findings from 1 review

Country-level periodontal disease prevalence (Global Burden of Disease) vs Low vs high periodontal disease prevalence

Oral health-related quality of life · people aged 60 years and older living in the community

OHRQoL did not differ significantly by country-level periodontal disease prevalence; no pooled estimate was reported in the text (ungraded).

1 finding from 1 review

Country-level income (World Bank income classification) vs Higher- vs lower-income country categories

Oral health-related quality of life · people aged 60 years and older living in the community

Community-dwelling older adults in higher-income countries had better OHRQoL than those in lower-income countries (77.9, 95% CI 70.2 to 85.6 vs 66.9, 95% CI 56.7 to 77.0); the difference by income was statistically significant (ungraded).

2 findings from 1 review

Replacement of the defective restoration vs Repair of the defective restoration

Composite: Preference for replacement over repair - Scenario 4: marginal discoloration · Dentists managing a defective direct resin composite restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…

For a defective composite restoration with marginal discoloration, surveyed dentists most often preferred replacement over repair (pooled RR 1.97; p < 0.001); ungraded.

1 finding from 1 review

Country-level income inequality (Gini index) vs Lower vs higher income inequality categories

Oral health-related quality of life · people aged 60 years and older living in the community

Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded).

4 findings from 1 review
Show 1 more finding

Genetically predicted DMFS (dental caries) vs Lower genetically predicted DMFS

Osteoporosis with pathological fracture · European GWAS participants

The SVMR MR-Egger interval included the null.

3 findings from 1 review