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Evidence found and GRADE certainty

122 questions · 185 findings · 7 reviews · Oral and maxillofacial surgery

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No studies found 0 · 0%GRADE not reported 175 · 94.6%Very low 0 · 0%Low 10 · 5.4%Moderate 0 · 0%High 0 · 0%

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

Forearm fracture · European-ancestry adults

Genetically predicted dental caries (DMFS) had no significant causal effect on fracture of forearm (multivariable MR, OR 0.973).

2 findings from 1 review

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

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 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: 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 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: 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 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: drinking-water fluoride 0.9 mg/L vs null
    RR 1.00 [0.79, 1.27]
    Studies not reported
    GRADE not reported

Genetically predicted DMFS (dental caries) vs Lower genetically predicted DMFS

Femur fracture · European GWAS participants

The SVMR MR-Egger interval included the null.

3 findings from 1 review

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Osteoporosis with pathological fracture · European-ancestry adults

Genetically predicted periodontitis had no causal effect on osteoporosis with pathological fracture (single-variable MR, OR 1.003).

2 findings from 1 review

Genetically predicted DMFS (dental caries) vs Lower genetically predicted DMFS

Lumbar spine and pelvis fracture · European GWAS participants

The SVMR Weighted Median interval included the null.

3 findings from 1 review

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

Postmenopausal osteoporosis with pathological fracture · Postmenopausal women (European ancestry)

In multivariable MR (adjusted for periodontitis), genetically predicted dental caries (DMFS) causally increased postmenopausal osteoporosis with pathological fracture (OR 1.422, moderate evidence).

2 findings from 1 review

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Lumbar spine and pelvis fracture · European-ancestry adults

Genetically predicted periodontitis had no causal effect on fracture of lumbar spine and pelvis (multivariable MR, OR 1.060).

2 findings from 1 review

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

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 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: 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 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: 0.20 mg/L vs null
    MD 0.02 [-0.02, 0.07]
    Studies not reported
    GRADE not reported

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

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

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

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

Femur fracture · European-ancestry adults

Genetically predicted periodontitis had no causal effect on fracture of femur (multivariable MR, OR 1.034).

2 findings 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