Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

821 questions · 993 findings · 80 reviews · Dental caries

No studies found 60 · 6%GRADE not reported 749 · 75.4%Very low 109 · 11%Low 41 · 4.1%Moderate 34 · 3.4%High 0 · 0%

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

Dental caries · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…

Package of oral health education/promotion including oral hygiene… showed no clear difference in dmfs index score compared with standard care (low certainty).

2 findings from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

Child dental attendance · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…
1 finding from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

Adverse events for mother or child · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…
1 finding from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

Child plaque (any plaque visible on any teeth) · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…

Package of oral health education/promotion including oral hygiene… led to lower child plaque (any plaque visible on any teeth) compared with standard care; GRADE not reported.

1 finding from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

d1-4 efs · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…
1 finding from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

Child microbiological presence (any mutans streptococci colonisation) · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…

Package of oral health education/promotion including oral hygiene… showed no clear difference in child microbiological presence (mutans streptococci colonisation) compared with standard care; GRADE not reported.

1 finding from 1 review

Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs usual care

SiC30 index score · For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years…

Package of oral health education/promotion including oral hygiene… led to lower siC30 index score compared with standard care; GRADE not reported.

1 finding from 1 review

Oral health education/promotion (oral hygiene advice plus diet and feeding practice advice) combined with clinical treatment for mother's dentition (basic restorative and preventive; 1 trial included CHX varnish application) vs usual care

Mother microbiological presence (high-level mutans streptococci / lactobacilli) · For interventions, pregnant women and mothers of infants in the first year of life; for outcomes, children up to 6 years of age

Oral health education/promotion (oral hygiene advice plus diet and… showed no clear difference in mother microbiological presence (high-level mutans streptococci /… compared with standard care; GRADE not reported.

1 finding from 1 review

Oral health education/promotion (oral hygiene advice plus diet and feeding practice advice) combined with clinical treatment for mother's dentition (basic restorative and preventive; 1 trial included CHX varnish application) vs usual care

Dental caries · For interventions, pregnant women and mothers of infants in the first year of life; for outcomes, children up to 6 years of age

The review found no eligible studies for this question.

2 findings from 1 review

Oral health education/promotion (oral hygiene advice plus diet and feeding practice advice) combined with clinical treatment for mother's dentition (basic restorative and preventive; 1 trial included CHX varnish application) vs usual care

Caries presence in primary teeth · For interventions, pregnant women and mothers of infants in the first year of life; for outcomes, children up to 6 years of age

It is very uncertain whether oral health education/promotion (oral hygiene advice plus diet and… changes caries presence in primary teeth compared with standard care (very low certainty).

1 finding from 1 review

Dental caries vs Adolescents without dental caries

Negative oral-health impact on daily performance (OIDP or Child-OIDP) · Adolescents (10-19 years)

In the Child-OIDP subgroup, dental caries is associated with a worse oral-health impact: PR 1.66 (95% CI 1.19 to 2.31) from 6 studies (I2=96%); ungraded, and not statistically different from the OIDP subgroup (p=0.96).

5 findings from 1 review
  • Impact of dental caries on the quality of life of adolescents: A systematic review and meta-analysis. 2025 All outcomes
    Cross-sectional (concurrent exposure and outcome); oral impacts recalled over the prior 6 months · School-based (17/20 studies), plus household and secondary-data surveys; low-, middle- and high-income countries (Brazil, Thailand, Tanzania, Saudi Arabia, Sri Lanka, Zambia, Iran, Serbia, Nepal, India, South Africa, China) · Instrument subgroup: Child-OIDP
    PR 1.66 [1.19, 2.31]
    6 studies
    GRADE not reported
  • Impact of dental caries on the quality of life of adolescents: A systematic review and meta-analysis. 2025 All outcomes
    Cross-sectional (concurrent exposure and outcome); oral impacts recalled over the prior 6 months · School-based (17/20 studies), plus household and secondary-data surveys; low-, middle- and high-income countries (Brazil, Thailand, Tanzania, Saudi Arabia, Sri Lanka, Zambia, Iran, Serbia, Nepal, India, South Africa, China) · Instrument subgroup: OIDP (all 3 studies)
    PR 1.68 [0.89, 3.17]
    3 studies
    GRADE not reported
  • Impact of dental caries on the quality of life of adolescents: A systematic review and meta-analysis. 2025 All outcomes
    Cross-sectional (concurrent exposure and outcome); oral impacts recalled over the prior 6 months · School-based (17/20 studies), plus household and secondary-data surveys; low-, middle- and high-income countries (Brazil, Thailand, Tanzania, Saudi Arabia, Sri Lanka, Zambia, Iran, Serbia, Nepal, India, South Africa, China) · Instrument subgroup: OIDP, sensitivity analysis excluding Krisdapong et al.
    PR 1.21 [1.15, 1.28]
    2 studies
    GRADE not reported
Show 2 more findings
  • Impact of dental caries on the quality of life of adolescents: A systematic review and meta-analysis. 2025 All outcomes
    Cross-sectional (concurrent exposure and outcome); oral impacts recalled over the prior 6 months · School-based (17/20 studies), plus household and secondary-data surveys; low-, middle- and high-income countries (Brazil, Thailand, Tanzania, Saudi Arabia, Sri Lanka, Zambia, Iran, Serbia, Nepal, India, South Africa, China) · Overall (all meta-analyzed studies pooled; both instruments and both caries definitions)
    PR 1.52 [1.15, 2.01]
    9 studies
    GRADE not reported
  • Impact of dental caries on the quality of life of adolescents: A systematic review and meta-analysis. 2025 All outcomes
    Cross-sectional (concurrent exposure and outcome); oral impacts recalled over the prior 6 months · School-based (17/20 studies), plus household and secondary-data surveys; low-, middle- and high-income countries (Brazil, Thailand, Tanzania, Saudi Arabia, Sri Lanka, Zambia, Iran, Serbia, Nepal, India, South Africa, China) · Caries-definition subgroup: presence of dental caries
    PR 1.19 [0.77, 1.84]
    3 studies
    GRADE not reported

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

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

Oral health-related quality of life · Patients with deep caries lesions in mature or immature permanent (posterior) teeth, with no symptoms or reversible pulpitis

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

1 finding from 1 review

Inactivated-bacteria tablets vs Placebo, fluoride toothpaste, or standard post-filling care (varies by trial)

Improved caries prognosis via restored oral microbiota · Patients after dental filling

Adjuvant postbiotics after dental filling improve caries prognosis by restoring the oral microbiota in one RCT (ungraded).

1 finding from 1 review
  • Postbiotics and Dental Caries: A Systematic Review. 2025 All outcomes
    14 days · Clinical; salivary/plaque sampling
    One RCT reported that adjuvant postbiotic tablets after dental filling improved caries prognosis by restoring oral microbiota diversity, structure and function and reducing potentially pathogenic bacteria (Liu 2024);…
    1 study
    GRADE not reported

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Femoral neck bone mineral density (FN-BMD) · European-ancestry adults

Genetically predicted periodontitis had no causal effect on femoral neck BMD.

1 finding from 1 review

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

Femoral neck bone mineral density (FN-BMD) · European-ancestry adults

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

1 finding from 1 review

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

Hip/femoral bone mineral density (BMD) · general population

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.

1 finding 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 · 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

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

Hip/femoral bone mineral density (BMD) · Females (all ages)

In females (low-to-moderate risk-of-bias studies), hip BMD rose monotonically above ~0.9 mg/L: MD 0.04 g/cm2 (95% CI -0.03-0.12) up to ~2.3 mg/L and 0.09 (-0.09-0.27) at 4.0 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 · Females, low-to-moderate risk-of-bias studies: up to ~2.3 mg/L vs null
    MD 0.04 [-0.03, 0.12]
    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, low-to-moderate risk-of-bias studies: 4.0 mg/L vs null
    MD 0.09 [-0.09, 0.27]
    Studies not reported
    GRADE not reported

Dental caries vs Caries-free status

Oral microbial community composition and diversity (other caries-associated taxa; alpha- and beta-diversity) · Systemically healthy individuals (children and adults, aged 40 months to 50 years) assessed for dental caries

No oral microbial taxon other than S. mutans was consistently associated with caries; alpha-diversity mostly did not differ between caries-active and caries-free groups and beta-diversity findings were mixed (ungraded, narrative).

1 finding from 1 review
  • Streptococcus mutans and Caries: A Systematic Review and Meta-Analysis. 2025 All outcomes
    Cross-sectional · Clinical oral-microbiome studies; saliva and/or supragingival plaque samples; 7 countries; DNA/RNA-based sequencing or microarray
    Narrative synthesis (no pooled estimate): no bacterial genus or species other than S. mutans was consistently (reported in more than 2 studies) associated with caries-active status (Table 3; 15 of 19 studies for…
    Studies not reported
    GRADE not reported