Gum health: midpalatal gingival recession · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
Open surgical exposure showed no clear difference in gum health: midpalatal gingival recession compared with closed surgical exposure; GRADE not reported.
1 finding from 1 review
Patient response: satisfaction with treatment (satisfactory vs unsatisfactory) · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
Open surgical exposure showed no clear difference in patient response: satisfaction with treatment (satisfactory vs… compared with closed surgical exposure; GRADE not reported.
1 finding from 1 review
Aesthetics: canine rated as abnormal tooth colour · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
Open surgical exposure showed no clear difference in aesthetics: canine rated as abnormal tooth colour compared with closed surgical exposure; GRADE not reported.
1 finding from 1 review
Success of surgery (eruption of the canine crown sufficient for orthodontic alignment, without repeated surgery) · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
Open surgical exposure showed no clear difference in success of surgery (eruption of the canine crown sufficient for… compared with closed surgical exposure (low certainty).
1 finding from 1 review
Treatment time: length of time in the operating theatre (first incision to final suture) · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
It is very uncertain whether open surgical exposure changes treatment time: length of time in the operating theatre (first… compared with closed surgical exposure (very low certainty).
1 finding from 1 review
Gum health: radiographic crestal bone level · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
Open surgical exposure showed no clear difference in gum health: radiographic crestal bone level compared with closed surgical exposure; GRADE not reported.
1 finding from 1 review
Aesthetics of the treated canine compared with the untreated contralateral canine · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
1 finding from 1 review
Clinical attachment level (CAL) · People with maxillary palatally displaced (impacted) canines, unilateral or bilateral (children/adolescents; mean ages 14.2 to 17.5 years)
Open surgical exposure showed no clear difference in gum health: clinical attachment level (CAL) compared with closed surgical exposure (low certainty).
1 finding from 1 review
Postoperative pain · Patients undergoing implant exposure (second-stage surgery)
Erbium:YAG laser (implant exposure) led to lower postoperative pain compared with flap elevation at implant exposure; GRADE not reported.
1 finding from 1 review
Biological complications · Patients undergoing implant exposure (second-stage surgery)
Erbium:YAG laser (implant exposure) showed no clear difference in biological complications compared with flap elevation at implant exposure; GRADE not reported.
1 finding from 1 review
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
The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomesLong-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 outcomesLong-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 outcomesLong-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
Show 1 more finding
The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomesLong-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 2.0 mg/L vs null
RR 1.06 [0.80, 1.41]
4 studies
GRADE not reported
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 outcomesLong-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 outcomesLong-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
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 outcomesLong-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 outcomesLong-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
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 outcomesLong-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 outcomesLong-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 outcomesLong-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 outcomesLong-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 outcomesLong-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
Lumbar spine bone mineral density (BMD) · general population
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.
4 findings from 1 review
Show 1 more finding
The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomesLong-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): above 2.27 mg/L vs null
MD 0.04 [-0.21, 0.30]
Studies not reported
GRADE not reported
Risk of fragility fractures · Females (all ages)
In females, fragility-fracture risk was U-shaped: lowest ~0.4 mg/L, rising above 0.9 mg/L (RR 0.84 at 0.34, 1.00 at 0.9, 1.13 at 1.1 mg/L 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 outcomesLong-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: drinking-water fluoride 1.1 mg/L vs null
RR 1.13 [0.93, 1.37]
Studies not reported
GRADE not reported
The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomesLong-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: drinking-water fluoride 0.34 mg/L vs null
RR 0.84 [0.67, 1.07]
Studies not reported
GRADE not reported
The association of fluoride exposure with bone density and fracture risk: a dose-response meta-analysis. 2025 All outcomesLong-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: drinking-water fluoride 0.9 mg/L vs null
RR 1.00 [0.79, 1.27]
Studies not reported
GRADE not reported
Lumbar spine bone mineral density (BMD) · Females (all ages)
In females (low-to-moderate risk-of-bias studies), spine BMD rose then plateaued ~0.5 mg/L: MD 0.02 g/cm2 (95% CI -0.02-0.07) at 0.20 mg/L and 0.06 (-0.01-0.12) across 0.7-2.35 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 outcomesLong-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: 0.7-2.35 mg/L vs null
MD 0.06 [-0.01, 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 outcomesLong-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: 0.20 mg/L vs null
MD 0.02 [-0.02, 0.07]
Studies not reported
GRADE not reported
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 outcomesLong-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 outcomesLong-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 outcomesLong-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
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
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 outcomesLong-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 outcomesLong-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