Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

606 questions · 682 findings · 77 reviews

No studies found 99 · 14.5%GRADE not reported 215 · 31.5%Very low 197 · 28.9%Low 102 · 15%Moderate 48 · 7%High 21 · 3.1%

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

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 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 1.5 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 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 0.01 mg/L vs null
    RR 1.00 [0.99, 1.01]
    Studies not reported
    GRADE not reported

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

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
  • 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 · Overall dose-response (0 to highest exposure)
    Curve indicated little association and was nearly flat, with a comparatively narrow 95% confidence band (no numeric RR reported in text)
    Studies not reported
    GRADE not reported

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

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
  • 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 >50, spine BMD dose-response
    Inverted U-shaped curve with a downward trend starting at lower fluoride concentrations than the overall analysis (no numeric MD reported in text)
    Studies not reported
    GRADE not reported

Restricted partial pulpotomy (pulp removal 2-3 mm from exposure site only) vs Extended partial pulpotomy (pulp removal 2-3 mm from entire pulp chamber with complete deroofing)

Overall success (composite of clinical and radiographic success) · Adults (18-45 y) with mature permanent molars, carious exposure and symptomatic irreversible pulpitis

Restricting the lateral extent of partial pulpotomy gives success equivalent to more extensive amputation (97.6% vs 97.5%, p>0.05; ungraded, single trial).

1 finding from 1 review

Restricted partial pulpotomy (pulp removal 2-3 mm from exposure site only) vs Extended partial pulpotomy (pulp removal 2-3 mm from entire pulp chamber with complete deroofing)

Postoperative pain and analgesic intake · Adults (18-45 y) with mature permanent molars, carious exposure and symptomatic irreversible pulpitis

Restricted partial pulpotomy causes less early postoperative pain and analgesic use than extended amputation (p<0.05; ungraded, single trial).

1 finding from 1 review

Postnatal passive tobacco exposure (secondhand/household smoke in infancy) vs No passive tobacco exposure (non-exposed children)

Caries presence in primary teeth · Young children with primary (deciduous) dentition (aged 1 to 6 years at study start)

Postnatal (infancy) tobacco exposure is associated with higher odds of caries in primary dentition (pooled OR 1.72, 95% CI 1.45 to 2.05; 13 studies; high heterogeneity I2=83%); certainty not graded.

1 finding from 1 review

Postnatal passive tobacco exposure (secondhand/household smoke in infancy) vs No passive tobacco exposure (non-exposed children)

Dental caries in permanent teeth · Children and adolescents with permanent dentition

Postnatal (infancy) tobacco exposure is associated with higher odds of caries in permanent dentition (pooled OR 1.30, 95% CI 1.25 to 1.34; 9 studies; no heterogeneity); certainty not graded.

1 finding from 1 review