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
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
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Continent: South America
RR 6.20 [4.66, 8.25]
2 studies · 349 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Continent: Europe
RR 2.61 [1.54, 4.42]
6 studies · 1075 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Continent: Africa
RR 4.86 [3.79, 6.23]
2 studies · 339 participants
GRADE not reported
Show 6 more findings
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · HDI: High
RR 5.06 [4.22, 6.06]
7 studies · 1223 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · HDI: Low
RR 3.39 [2.18, 5.27]
2 studies · 350 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Continent: Asia
RR 4.38 [2.91, 6.61]
11 studies · 1917 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Overall (all 21 countries pooled)
RR 3.94 [2.93, 5.31]
21 studies · 3680 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · HDI: Medium
RR 7.13 [4.90, 10.35]
2 studies · 353 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · HDI: Very high
RR 2.99 [1.91, 4.67]
10 studies · 1754 participants
GRADE not reported
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
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Continent: Africa
RR 4.62 [3.64, 5.86]
2 studies · 339 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Overall (all 21 countries pooled)
RR 2.43 [1.87, 3.16]
21 studies · 3680 participants
GRADE not reported
Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational… 2025 All outcomesNot applicable (single time-point survey, June to October 2023) · Multinational (21 countries across Africa, Asia, Europe, South America); general dental practice · Continent: Europe
RR 3.07 [2.41, 3.89]
6 studies · 1075 participants
GRADE not reported
Show 2 more findings
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
Forearm fracture · European GWAS participants
The SVMR Weighted Median interval included the null.
3 findings from 1 review
OR 0.992 [0.945, 1.042]
490889 participants
GRADE not reported
OR 0.994 [0.948, 1.042]
490889 participants
GRADE not reported
OR 0.990 [0.950, 1.032]
490889 participants
GRADE not reported
Oral health-related quality of life · people aged 60 years and older living in the community
OHRQoL did not differ significantly by country-level periodontal disease prevalence; no pooled estimate was reported in the text (ungraded).
1 finding from 1 review
Oral health-related quality of life · people aged 60 years and older living in the community
Community-dwelling older adults in higher-income countries had better OHRQoL than those in lower-income countries (77.9, 95% CI 70.2 to 85.6 vs 66.9, 95% CI 56.7 to 77.0); the difference by income was statistically significant (ungraded).
2 findings from 1 review
MEAN 77.9 [70.2, 85.6]
Studies not reported
GRADE not reported
MEAN 66.9 [56.7, 77.0]
Studies not reported
GRADE not reported
Composite: Preference for replacement over repair - Scenario 4: marginal discoloration · Dentists managing a defective direct resin composite restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…
For a defective composite restoration with marginal discoloration, surveyed dentists most often preferred replacement over repair (pooled RR 1.97; p < 0.001); ungraded.
1 finding from 1 review
Oral health-related quality of life · people aged 60 years and older living in the community
Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded).
4 findings from 1 review
Show 1 more finding
MEAN 81.2 [75.3, 88.3]
Studies not reported
GRADE not reported
Osteoporosis with pathological fracture · European GWAS participants
The SVMR MR-Egger interval included the null.
3 findings from 1 review
OR 1.097 [0.598, 2.011]
376746 participants
GRADE not reported
OR 1.181 [0.748, 1.866]
376746 participants
GRADE not reported
OR 1.278 [0.921, 1.773]
376746 participants
GRADE not reported
Lumbar spine and pelvis fracture · European GWAS participants
The MVMR MR-Egger interval included the null.
1 finding from 1 review
OR 1.062 [0.991, 1.137]
490700 participants
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
Early childhood caries (ECC) · Children aged 0-5 years in North Africa
Paternal tertiary education was associated with lower odds of ECC (OR 0.381).
3 findings from 1 review
OR 0.381 [0.16, 0.91]
1 study
GRADE not reported
OR 0.083 [0.03, 0.21]
1 study
GRADE not reported
OR 0.797 [0.171, 0.650]
1 study
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
Odds of higher caries (DMFT) category · 12-year-old children across European countries (national/regional epidemiological surveys, 2011-2022)
Higher national income was strongly associated with lower odds of poor oral health (OR 0.10, 95% CI 0.03 to 0.37; about 90% lower odds); not GRADE-rated.
1 finding from 1 review
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
Lumbar spine and pelvis fracture · European-ancestry adults
Genetically predicted dental caries (DMFS) had no significant causal effect on fracture of lumbar spine and pelvis (multivariable MR, OR 0.968).
2 findings from 1 review
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
Composite: Preference for replacement over repair - Scenario 2: loss of dental hard substance adjacent to the restoration · Dentists managing a defective direct resin composite restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…
For a defective composite restoration with loss of dental hard substance adjacent to the restoration, surveyed dentists most often preferred repair over replacement (pooled RR 0.75; p = 0.004); ungraded.
1 finding from 1 review
Composite: Preference for replacement over repair - Scenario 5: open margin · Dentists managing a defective direct resin composite restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…
For a defective composite restoration with open margin, surveyed dentists most often preferred replacement over repair (pooled RR 3.93; p < 0.001); ungraded.
1 finding from 1 review