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Evidence found and GRADE certainty

2,745 questions · 4,389 findings · 203 reviews · Oral Health

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No studies found 39 · 0.9%GRADE not reported 3,844 · 87.6%Very low 198 · 4.5%Low 137 · 3.1%Moderate 134 · 3.1%High 37 · 0.8%

Country-level unemployment rate vs Higher vs lower unemployment-rate categories

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

OHRQoL did not differ significantly across country-level unemployment-rate categories; no pooled estimate was reported in the text (ungraded).

1 finding from 1 review

Replacement of the defective restoration vs Repair of the defective restoration

Composite: Preference for replacement over repair - Scenario 1: partial loss or fracture of the restoration · 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 partial loss or fracture of the restoration, surveyed dentists most often preferred repair over replacement (pooled RR 0.72; p = 0.002); ungraded.

1 finding from 1 review

Cleft lip and/or palate (CL/P) vs Healthy controls without cleft

Clinical attachment level (CAL) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Clinical attachment level loss is greater in persons with orofacial cleft than in healthy controls (p<0.00001), but no pooled effect size was reported (ungraded).

1 finding from 1 review

Microinvasive techniques (resin infiltration, resin/GIC sealant, or glass ionomer varnish) vs Non-invasive measures (fluoride varnish/toothpaste, flossing, oral hygiene instruction, sham/standard of care)

Adverse events and periodontal/secondary outcomes (gingival bleeding, gingival bleeding index, visible plaque index) · Children and adults with non-cavitated proximal (interproximal) caries lesions in primary and/or permanent teeth (ages 3-45)

Only three trials reported secondary/adverse outcomes; no adverse events were attributed to microinvasive treatment and periodontal findings were mixed and not pooled (ungraded).

1 finding from 1 review

Partial pulpotomy (PP) with calcium hydroxide vs No comparator

Overall success (composite of clinical and radiographic success) · Adults aged 18 years or older with mature permanent teeth and carious pulp exposure

Partial pulpotomy with calcium hydroxide had a pooled success rate of 34.3%.

1 finding from 1 review

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

Risk of fragility fractures · Females aged over 50 years

In females over 50, fragility-fracture risk rose steeply from ~0.5 mg/L: RR 0.98 at 0.25, 1.00 at 0.45, and 1.26 (95% CI 1.10-1.46) at 1.0 mg/L drinking-water fluoride vs null; ungraded.

3 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 · Females over 50 years: drinking-water fluoride 0.45 mg/L vs null
    RR 1.00 [0.80, 1.24]
    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 · Females over 50 years: drinking-water fluoride 0.25 mg/L vs null
    RR 0.98 [0.83, 1.14]
    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 · Females over 50 years: drinking-water fluoride 1.0 mg/L vs null
    RR 1.26 [1.10, 1.46]
    Studies not reported
    GRADE not reported

Machine-learning algorithms for dental caries detection vs Dental expert / visual-tactile clinical assessment (reference standard)

Negative post-test probability · Dental images or diagnostic tests for dental caries detection

The negative post-test probability was 6%; certainty was not graded.

1 finding from 1 review

Intervention not reported

Amalgam: Preference for replacement over repair - Scenario 2: loss of dental hard substance adjacent to the restoration

The intervention led to higher amalgam: Preference for replacement over repair - Scenario 2: loss…; GRADE not reported.

1 finding from 1 review

Electronic cigarette use vs Non-smokers (non-users)

Oral microbiota composition (dysbiosis; increased periodontal/opportunistic pathogens) · Adult e-cigarette (ENDS) users (general oral health; predominantly natural dentition)

E-cigarette use is associated with oral microbiota dysbiosis and increased pathogenic bacteria compared with non-smokers (narrative synthesis; ungraded).

1 finding from 1 review

Self-assembling/remineralizing peptide (e.g., P11-4, PAA-PASP) vs Hydroxyapatite (e.g., nano-HAp)

Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)

In the Etch-and-Rinse adhesive + chemical ACAD protocol network, Peptide vs HAp showed no significant difference in 24 h bond strength (MD -0.288, 95% CI -7.988 to 7.411; Very Low certainty).

2 findings from 1 review

Gamified oral health interventions (mobile apps, serious games, augmented reality, game-based education) vs Non-digital gamified oral health interventions (card/board games, storytelling, printed aids)

Long-term behavior change and overall oral health outcomes · Children or adolescents

Digital gamified interventions appear more effective than non-digital alternatives for long-term behavior change and oral health outcomes, but the evidence is narrative and ungraded.

1 finding from 1 review
  • The Application of Gamification in Children's Oral Health Management: Systematic Review. 2025 All outcomes
    Long-term follow-up (sustained behavior change) · Schools, dental clinics, and mobile-app user-testing environments
    Digital-based interventions were more effective in fostering long-term behavior change compared with nondigital alternatives and consistently outperformed nondigital alternatives in improving oral health outcomes;…
    Studies not reported
    GRADE not reported

Gamified mobile health app vs Nongamified intervention

Regular use rate · Children or adolescents

One RCT reported a 72.4% regular-use rate with a gamified mobile health app versus 48.3% with a nongamified intervention; no GRADE assessment was reported.

1 finding from 1 review

Early childhood caries (ECC) vs Caries-free controls

Number of detected salivary bacterial genera · Young children with early childhood caries and caries-free controls

Fewer salivary bacterial genera were reported in the caries-affected group, without a comparative effect estimate or CI.

1 finding from 1 review

Early childhood caries (ECC) vs Caries-free controls

Relative abundance of dominant salivary microbial community (7 genera) · Young children with early childhood caries and caries-free controls

The reported multi-genus community had similar relative abundance in caries-affected and caries-free children, without a comparative effect estimate or CI.

1 finding from 1 review

Ion-releasing restorations (IRR): RMGIC, HVGIC, GIC, compomer/PMRC, giomer vs Composite resin (CR), including bulk-fill composite

Adequate marginal or tooth integrity · Children receiving dental restorations (aged 4-11 years; primary teeth; Class I/II/V cavities)

No significant difference between IRR and CR in marginal or tooth integrity (high certainty).

1 finding from 1 review