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Evidence found and GRADE certainty

2,297 questions · 3,638 findings · 215 reviews · All outcomes

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No studies found 98 · 2.7%GRADE not reported 2,946 · 81%Very low 263 · 7.2%Low 158 · 4.3%Moderate 137 · 3.8%High 36 · 1%

Flavonoids (e.g., quercetin, proanthocyanidin) vs Fluoride agent (e.g., NaF/SDF/KF/CaF2)

Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)

In the Etch-and-Rinse adhesive + biological ACAD protocol network, Flavonoids vs Fluorine showed no significant difference in 24 h bond strength (MD 4.241, 95% CI -2.652 to 11.135; Moderate certainty).

2 findings from 1 review

Full pulpotomy vs Partial pulpotomy

Overall success (composite of clinical and radiographic success) · Adults aged 18 years or older with mature permanent teeth and carious pulp exposure

The three-study meta-analysis found no significant difference between full and partial pulpotomy after 1 year.

1 finding from 1 review

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

Gingival index (GI) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Persons with orofacial cleft have a higher gingival index than healthy controls (MD 0.15, 95% CI 0.11 to 0.19; low certainty).

1 finding from 1 review

Anticaries vaccine or antibody (DNA, recombinant protein, nanoparticle-adjuvanted, live-vector, plant-based, or passive IgY immunization) targeting S. mutans vs Control (unvaccinated / empty vector / PBS / placebo animals)

Streptococcus mutans colonization reduction (narrative; no CFU data reported) · Animal caries models (mice, rats, hamsters) challenged/colonized with Streptococcus mutans; one transgenic-plant antigen-expression system

Anticaries vaccines produced a sustained reduction in Streptococcus mutans colonization on teeth in animal models (ungraded narrative synthesis; no pooled estimate).

1 finding from 1 review

Obesity or overweight (higher BMI, mostly WHO BMI ≥25/≥30; 2 studies used waist circumference) vs Normal Weight or Non‐Obese

Dental caries · Adults (≥18 years)

After adjustment for confounders, obesity/overweight was not associated with dental caries (OR 1.00, 95% CI 0.89 to 1.12; ungraded).

9 findings from 1 review
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Ion-releasing restorations (IRR): RMGIC, HVGIC, GIC, compomer/PMRC, giomer vs Composite resin (CR), including bulk-fill composite

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

No significant difference between IRR and CR in marginal adaptation (high certainty).

1 finding from 1 review

Hall technique vs Sealing

Treatment success (caries lesion arrest or restoration survival) · Children (aged 3-11 y) with cavitated caries lesions in primary teeth

At 12 months, the Hall technique had significantly higher treatment success than sealing (OR 13.93; moderate certainty).

2 findings from 1 review

Mineral trioxide aggregate (MTA) vs Calcium hydroxide (CH)

Postoperative pain (patient-reported) · Vital permanent teeth (mature or immature) with deep or extremely deep caries and asymptomatic pulp or reversible pulpitis, undergoing…

The effect of material choice (MTA vs CaOH) on postoperative pain is unclear: two small studies used different methods and reported contradictory results, so no meta-analysis was performed (ungraded).

1 finding from 1 review

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

Electronic cigarette use vs Non-smokers

Interleukin-6 (IL-6) · Humans who use e-cigarettes (mostly adults, often with periodontal disease) assessed for oral proinflammatory markers

Meta-analysis suggests no significant effect of e-cigarette use on the salivary level of Interleukin-6 (IL-6) (6 studies), though heterogeneity was high (I2=95%) and the pooled estimate appears only in Figure 3D (unavailable); GCF data were limited (1 study(ies)) (ungraded).

1 finding from 1 review

AI systems for caries detection/segmentation on dental X-ray images (predominantly convolutional neural networks; also ANNs, DNNs, DCNN, FCNN, SVMs, decision trees, random forests; e.g. EfficientNet, ResNet, AlexNet) vs Human dentists / trained dental professionals or traditional radiographic interpretation (reference standard / reference models)

Specificity · Patients undergoing dental X-ray (radiographic) imaging for caries detection

Across 7 studies, AI showed high weighted-mean specificity (~87.9%) for caries detection, with very high heterogeneity (I2=96%); ungraded.

1 finding from 1 review

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

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

Children with dental caries vs Children without dental caries

Mean corpuscular volume (MCV) · Children or adolescents

MCV tends to be lower in children with dental caries, but the pooled difference is not statistically significant (MD -1.96 fL, 95% CI -4.02 to 0.10; very low certainty).

1 finding from 1 review

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

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 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 · 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 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 · Males: drinking-water fluoride 0.57 mg/L vs null
    RR 0.83 [0.72, 0.97]
    7 studies
    GRADE not reported

Replacement of the defective restoration vs Repair of the defective restoration

Amalgam: Preference for replacement over repair - Scenario 1: partial loss or fracture of the restoration · Dentists managing a defective direct amalgam restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…

Subgroup (Continent: South America): pooled preference was replacement over repair for a defective amalgam restoration with partial loss or fracture of the restoration (RR 6.20); significant continental variation, p = 0.04.

9 findings from 1 review
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Replacement of the defective restoration vs Repair of the defective restoration

Composite: Preference for replacement over repair - Scenario 3: secondary caries · Dentists managing a defective direct resin composite restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…

Subgroup (Continent: Africa): pooled preference was replacement over repair for a defective composite restoration with secondary caries (RR 4.62); significant continental variation, p < 0.001.

5 findings from 1 review
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