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
Femur fracture · European GWAS participants
The SVMR MR-Egger interval included the null.
3 findings from 1 review
OR 0.893 [0.678, 1.175]
489106 participants
GRADE not reported
OR 1.137 [0.976, 1.325]
489106 participants
GRADE not reported
OR 1.094 [0.884, 1.354]
489106 participants
GRADE not reported
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
Lumbar spine and pelvis fracture · European GWAS participants
The SVMR Weighted Median interval included the null.
3 findings from 1 review
OR 0.867 [0.691, 1.087]
490700 participants
GRADE not reported
OR 0.950 [0.808, 1.117]
490700 participants
GRADE not reported
OR 0.994 [0.729, 1.355]
490700 participants
GRADE not reported
Amalgam: Preference for replacement over repair - Scenario 2: loss of dental hard substance adjacent to the restoration · Dentists managing a defective direct amalgam restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…
For a defective amalgam restoration with loss of dental hard substance adjacent to the restoration, surveyed dentists most often preferred replacement over repair (pooled RR 4.70; p < 0.001); ungraded.
1 finding from 1 review
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
Amalgam: Preference for replacement over repair - Scenario 6: corrosion · Dentists managing a defective direct amalgam restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…
For a defective amalgam restoration with corrosion, surveyed dentists most often preferred replacement over repair (pooled RR 1.59; p < 0.001); ungraded.
1 finding from 1 review
Amalgam: Preference for replacement over repair - Scenario 4: marginal discoloration · Dentists managing a defective direct amalgam restoration (posterior occlusal Class I; standardized vignette of a 30-year-old,…
Subgroup (HDI: Very high): pooled preference was replacement over repair for a defective amalgam restoration with marginal discoloration (RR 6.48); significant HDI variation, p = 0.01.
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 · HDI: Very high
RR 6.48 [3.71, 11.31]
10 studies · 1754 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: High
RR 7.06 [5.14, 9.69]
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 3.58 [2.74, 4.69]
2 studies · 350 participants
GRADE not reported
Show 2 more findings
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
Lacunar stroke · European-ancestry adults
Genetically predicted periodontitis was associated with modestly higher odds of lacunar stroke (OR 1.24); ungraded MR, though the FDR-adjusted P was 0.064 for the primary IVW-FE method (ML-adjusted P 0.037).
1 finding from 1 review
OR 1.24 [1.03, 1.49]
Studies not reported
GRADE not reported
Oral health-related quality of life · people aged 60 years and older living in the community
Older adults in higher-HDI countries had better OHRQoL (high 79.9, 95% CI 74.4 to 85.5; very high 78.4, 95% CI 71.1 to 85.8) than those in medium-HDI countries (63.5, 95% CI 54.3 to 72.7); the difference by HDI was statistically significant (ungraded).
3 findings from 1 review
MEAN 79.9 [74.4, 85.5]
Studies not reported
GRADE not reported
MEAN 63.5 [54.3, 72.7]
Studies not reported
GRADE not reported
MEAN 78.4 [71.1, 85.8]
Studies not reported
GRADE not reported
Lumbar spine bone mineral density (BMD) · European GWAS participants
The MVMR IVW interval included zero.
1 finding from 1 review
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
Osteoporosis · European GWAS participants
The MVMR MR-Egger interval excluded the null.
1 finding from 1 review
OR 1.343 [1.015, 1.778]
483725 participants
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
Oral health-related quality of life · people aged 60 years and older living in the community
OHRQoL did not differ significantly across country-level unemployment-rate categories; no pooled estimate was reported in the text (ungraded).
1 finding from 1 review
Composite: Preference for replacement over repair - Scenario 1: partial loss or fracture of 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 partial loss or fracture of the restoration, surveyed dentists most often preferred repair over replacement (pooled RR 0.72; p = 0.002); ungraded.
1 finding from 1 review
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
Forearm fracture · European GWAS participants
The MVMR MR-Egger interval included the null.
1 finding from 1 review
OR 0.992 [0.950, 1.036]
490889 participants
GRADE not reported
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