Early childhood caries (ECC) · Preschool children (<6 years)
Higher sugar consumption is associated with early childhood caries in children under 6 years: pooled OR 1.59 (95% CI 1.50 to 1.68) from 9 cohort studies with no heterogeneity (I2=0%); the body of evidence was not GRADE-rated (ungraded).
1 finding from 1 review
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
Caries experience (mean DMFT) · 12-year-old children across European countries (national/regional epidemiological surveys, 2011-2022)
Mean DMFT in 12-year-olds rises as national income falls: 0.90 (very high income), 2.38 (high income), 3.30 (middle income) (Figure 2); not GRADE-rated.
3 findings from 1 review
Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomesCross-sectional (survey data 2011-2022) · European countries stratified by World Bank GNI per capita (modified 3-category); test of group differences Q_b(2)=51.35, p<0.01 · Very high income (GNI >$25,000)
MEAN 0.90 [0.66, 1.15]
14 studies
GRADE not reported
Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomesCross-sectional (survey data 2011-2022) · European countries stratified by World Bank GNI per capita (modified 3-category); test of group differences Q_b(2)=51.35, p<0.01 · High income (GNI $15,001-25,000)
MEAN 2.38 [1.78, 2.97]
8 studies
GRADE not reported
Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomesCross-sectional (survey data 2011-2022) · European countries stratified by World Bank GNI per capita (modified 3-category); test of group differences Q_b(2)=51.35, p<0.01 · Middle income (GNI <=$15,000)
MEAN 3.30 [2.57, 4.03]
12 studies
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
Wrist fractures · general population
Wrist-fracture risk declined nearly linearly with increasing fluoride: RR 1.00 at 0.01 mg/L to 0.84 at 1.5 mg/L drinking-water fluoride 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 · Drinking-water fluoride 1.5 mg/L vs null
RR 0.84 [0.43, 1.65]
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 0.01 mg/L vs null
RR 1.00 [0.99, 1.01]
Studies not reported
GRADE not reported
Hip Fracture · general population
Overall hip-fracture risk showed little association with drinking-water fluoride and a nearly flat dose-response curve (narrow CI); no numeric RR reported in text; ungraded.
1 finding from 1 review
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
Oral health-related quality of life · Adolescents (10-19 years)
Higher family income / better socioeconomic status is associated with better OHRQoL in adolescents (narrative synthesis; no pooled estimate or GRADE rating).
1 finding from 1 review
Oral-health-related quality of life in adolescents: umbrella review. 2023 All outcomesCommunity/school/clinic settings; adolescents 10-19 years; included reviews conducted in multiple countries
Adolescents from families with higher incomes and higher levels of maternal education have better OHRQoL scores [34]. Worse oral health status, older age, female sex and worse socioeconomic status were significantly…
Studies not reported
GRADE not reported
Prostate cancer · Participants in observational studies
The meta-analysis of observational studies reported a OR of 0.99 (95% CI 0.87 to 1.12) for higher versus lower circulating vitamin D concentration.
1 finding from 1 review
Breast cancer · Participants in observational studies
The meta-analysis of observational studies reported a OR of 0.99 (95% CI 0.68 to 1.47) for higher versus lower circulating vitamin D concentration.
1 finding from 1 review
Spine bone mineral density · Females (all ages)
Among females in low-to-moderate-risk-of-bias studies, the reported spine-BMD estimate above 2.35 mg/L water fluoride was MD 0.07 g/cm2 (95% CI 0.11 to 0.24; ungraded).
2 findings from 1 review
Dental caries in children · Children (approx. 4-18 years)
Pooling studies that used BMI as a continuous variable showed no significant association between per-unit BMI and childhood dental caries (OR 1.01, 95% CI 0.99 to 1.03; I2=3.5%); ungraded.
3 findings from 1 review
Dental caries · Healthy children and adolescents in the United Arab Emirates
Higher snacking and soft-drink/sugar consumption were associated with more caries in most studies, though one study found no association with sweet-consumption frequency (narrative synthesis; not GRADE-rated).
1 finding from 1 review
Soft drink consumption (Khadri et al.: 0.31, 95% CI 0.14-0.47) and a high extent of snacking (Hashim et al.: high vs low snack level aRR 1.46, 95% CI 1.26-1.70; snacking >=3x vs once daily aRR 1.25, 1.00-1.57) were…
Studies not reported
GRADE not reported
Caries experience (mean DMFT) · 12-year-old children across European countries (national/regional epidemiological surveys, 2011-2022)
Countries with higher per-capita dental expenditure had lower mean DMFT (>$100: 0.96; $51-100: 2.14; $0-50: 3.06) (Figure 4); not GRADE-rated.
3 findings from 1 review
Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomesCross-sectional (survey data 2011-2022) · European countries stratified by OECD per-capita dental health-care expenditure (USD); test of group differences Q_b(2)=30.51, p<0.01; expenditure-stratified overall pooled DMFT 2.10 (95% CI 1.61-2.59), 32 countries · $0-50 per capita
MEAN 3.06 [2.32, 3.79]
14 studies
GRADE not reported
Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomesCross-sectional (survey data 2011-2022) · European countries stratified by OECD per-capita dental health-care expenditure (USD); test of group differences Q_b(2)=30.51, p<0.01; expenditure-stratified overall pooled DMFT 2.10 (95% CI 1.61-2.59), 32 countries · >$100 per capita
MEAN 0.96 [0.64, 1.28]
12 studies
GRADE not reported
Caries status in 12-year-old children, geographical location and socioeconomic conditions across European countries: A… 2025 All outcomesCross-sectional (survey data 2011-2022) · European countries stratified by OECD per-capita dental health-care expenditure (USD); test of group differences Q_b(2)=30.51, p<0.01; expenditure-stratified overall pooled DMFT 2.10 (95% CI 1.61-2.59), 32 countries · $51-100 per capita
MEAN 2.14 [1.40, 2.89]
6 studies
GRADE not reported
Prostate cancer · Adults (general population)
Meta-analysis of observational studies (higher vs lower 25(OH)D) for Prostate cancer: OR 1.04 (95% CI 0.98 to 1.09), not statistically significant. Umbrella review outcome-level evidence grade: Substantial effect unlikely.
1 finding from 1 review
Type 2 diabetes mellitus · Adults (general population)
Meta-analysis of observational studies (higher vs lower 25(OH)D) for Type 2 diabetes: OR 0.63 (95% CI 0.56 to 0.69), statistically significant. Umbrella review outcome-level evidence grade: Suggestive.
1 finding from 1 review
Sporadic colorectal adenoma recurrence · Adults (general population)
Meta-analysis of observational studies (higher vs lower 25(OH)D) for Sporadic colorectal adenoma recurrence: OR 0.87 (95% CI 0.57 to 1.33), not statistically significant. Umbrella review outcome-level evidence grade: No conclusion.
1 finding from 1 review