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Evidence found and GRADE certainty

1,954 questions · 2,335 findings · 149 reviews · Oral Health

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No studies found 436 · 18.7%GRADE not reported 1,370 · 58.7%Very low 254 · 10.9%Low 173 · 7.4%Moderate 80 · 3.4%High 22 · 0.9%

School-based supervised toothbrushing (STB) vs no intervention

Dental caries increment, DMFT/dmft (whole-tooth level) · Children in school or kindergarten settings (aged 3-14 years)

School-based supervised toothbrushing has no statistically significant effect on whole-tooth caries (DMFT/dmft SMD 0.05, 95% CI -0.27 to 0.37; ungraded).

1 finding from 1 review

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

Partial pulpotomy with immediate (same-visit) permanent restoration 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

Immediate permanent restoration was associated with a pooled success rate of 89.9%.

1 finding from 1 review

Secondary (passive/secondhand) smoking exposure during childhood vs No secondary smoking exposure

Early childhood caries (ECC) - incidence/risk · Preschool children aged <=71 months (caries outcome assessed at 3-6 years)

Children exposed to secondary smoking from infancy have a higher incidence of early childhood caries by age 3 (RR 1.45; low certainty).

1 finding from 1 review

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

Bleeding Index (BI) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Bleeding index is significantly higher in persons with orofacial cleft than in healthy controls (p<0.0001), but no pooled effect size was reported (ungraded).

1 finding from 1 review

Out-of-pocket health expenditure vs Lower vs higher out-of-pocket expenditure categories

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

Lower out-of-pocket health expenditure was associated with better OHRQoL (83.9, 95% CI 75.2 to 92.6 vs 67.5, 95% CI 58.5 to 76.5); the difference was statistically significant (ungraded).

2 findings from 1 review

Low periodontal-disease prevalence vs Not applicable

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

No statistically significant difference in OHRQoL was reported by periodontal-disease prevalence.

1 finding from 1 review

Dental caries vs Caries-free status

Prevalence (detection frequency) of S. mutans in plaque · Systemically healthy individuals (children and adults, aged 40 months to 50 years) assessed for dental caries

S. mutans prevalence in plaque is significantly higher in caries-active than caries-free individuals (pooled OR 2.58, 95% CI 1.65 to 4.02; I2=16%); ungraded.

1 finding from 1 review

Postbiotic toothpaste vs Fluoride toothpaste alone

Increased salivary pH · children aged 6‐12 years

Postbiotic toothpaste raises salivary pH in one pediatric RCT (ungraded).

1 finding from 1 review
  • Postbiotics and Dental Caries: A Systematic Review. 2025 All outcomes
    4 weeks · Clinical; salivary/plaque sampling
    Postbiotic toothpaste significantly increased salivary pH versus fluoride toothpaste in children (Basir 2022); postbiotics are also proposed to buffer acidic pH; no pooled estimate.
    1 study
    GRADE not reported

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

Probing pocket depth · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Persons with orofacial cleft have a greater probing pocket depth than healthy controls (MD 0.88, 95% CI 0.82 to 0.95; low certainty).

1 finding from 1 review

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

Retention [ · Children receiving dental restorations (aged 4-11 years; primary teeth; Class I/II/V cavities)

No significant difference between IRR and CR in restoration retention (high certainty).

1 finding from 1 review

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

Proper surface texture or luster · Children receiving dental restorations (aged 4-11 years; primary teeth; Class I/II/V cavities)

No significant difference between IRR and CR in surface texture or luster (high certainty).

1 finding from 1 review

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

Lumbar spine bone mineral density (BMD) · Females aged over 50 years

In females over 50, spine BMD showed an inverted U-shaped curve with a downward trend beginning at lower fluoride concentrations than in the overall analysis; no numeric MD reported in text; 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 · Females >50, spine BMD dose-response
    Inverted U-shaped curve with a downward trend starting at lower fluoride concentrations than the overall analysis (no numeric MD reported in text)
    Studies not reported
    GRADE not reported

Theory-based oral health education/promotion interventions (HBM, TPB, SCT, HAPA, TTM, PMT, SOC, PRECEDE-PROCEED, MI) vs Control (waitlist, routine/standard oral health education, or minimal intervention)

Plaque index (PI) / oral hygiene · school‐age children and adolescents

Theory-based interventions significantly reduced dental plaque (SMD -1.92; moderate certainty).

1 finding from 1 review