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Evidence found and GRADE certainty

366 questions · 703 findings · 59 reviews · All outcomes

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No studies found 20 · 2.8%GRADE not reported 630 · 89.6%Very low 27 · 3.8%Low 12 · 1.7%Moderate 7 · 1%High 7 · 1%

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

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

Hip/femoral bone mineral density (BMD) · Females (all ages)

In females (low-to-moderate risk-of-bias studies), hip BMD rose monotonically above ~0.9 mg/L: MD 0.04 g/cm2 (95% CI -0.03-0.12) up to ~2.3 mg/L and 0.09 (-0.09-0.27) at 4.0 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: up to ~2.3 mg/L vs null
    MD 0.04 [-0.03, 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: 4.0 mg/L vs null
    MD 0.09 [-0.09, 0.27]
    Studies not reported
    GRADE not reported

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

Highest BMI category (overweight/obese) vs Lowest BMI category (normal weight/underweight)

Early childhood caries (ECC) · Children (approx. 4-18 years)

In the Region: Asian countries subgroup, the BMI (highest vs lowest)-childhood caries association was significant (OR 1.70, 95% CI 1.25 to 2.32; ungraded).

17 findings from 1 review
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ART sealant using high-viscosity glass ionomer (press-finger technique) vs No comparator

Caries-free sealed pits and fissures · Permanent teeth with sealed pits and fissures

The pooled caries-free rate was 85% at 6 years.

6 findings from 1 review
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ART sealant using high-viscosity glass ionomer (press-finger technique) vs No comparator

Retention of sealant (complete or partial retention) · Permanent teeth

The pooled retention rate was 75% at 1 year.

5 findings from 1 review
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Higher family income / socioeconomic status vs Lower income / worse socioeconomic status

Oral health-related quality of life · Adolescents (10-19 years)

Higher family income / better socioeconomic status is associated with better OHRQoL in adolescents (narrative synthesis; no pooled estimate or GRADE rating).

1 finding from 1 review
  • Oral-health-related quality of life in adolescents: umbrella review. 2023 All outcomes
    Community/school/clinic settings; adolescents 10-19 years; included reviews conducted in multiple countries
    Adolescents from families with higher incomes and higher levels of maternal education have better OHRQoL scores [34]. Worse oral health status, older age, female sex and worse socioeconomic status were significantly…
    Studies not reported
    GRADE not reported

Higher circulating 1,25-dihydroxyvitamin D (1,25(OH)2D) concentration vs Lower circulating 1,25-dihydroxyvitamin D (1,25(OH)2D) concentration

Prostate cancer · Participants in observational studies

The meta-analysis of observational studies reported a OR of 0.99 (95% CI 0.87 to 1.12) for higher versus lower circulating vitamin D concentration.

1 finding from 1 review

Higher circulating 1,25-dihydroxyvitamin D (1,25(OH)2D) concentration vs Lower circulating 1,25-dihydroxyvitamin D (1,25(OH)2D) concentration

Breast cancer · Participants in observational studies

The meta-analysis of observational studies reported a OR of 0.99 (95% CI 0.68 to 1.47) for higher versus lower circulating vitamin D concentration.

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

Higher BMI (continuous / per-unit increment) vs Lower BMI (continuous reference / per 1 kg/m2 decrement)

Dental caries in children · Children (approx. 4-18 years)

Pooling studies that used BMI as a continuous variable showed no significant association between per-unit BMI and childhood dental caries (OR 1.01, 95% CI 0.99 to 1.03; I2=3.5%); ungraded.

3 findings from 1 review

High-viscosity glass-ionomer ART restorations vs No comparator

Restoration survival · Permanent posterior teeth with single-surface cavities

The pooled survival rate was 93% at 2 years.

6 findings from 1 review
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High-viscosity glass-ionomer ART restorations vs No comparator

Restoration survival · Permanent posterior teeth with multiple-surface cavities

The pooled survival rate was 41% at 2 years.

3 findings from 1 review

High-viscosity glass-ionomer ART restorations vs No comparator

Restoration survival · Primary posterior teeth with single-surface cavities

The pooled survival rate was 95% at 1 year.

3 findings from 1 review

High-viscosity glass-ionomer ART restorations vs No comparator

Restoration survival · Primary posterior teeth with multiple-surface cavities

The pooled survival rate was 62% at 2 years.

3 findings from 1 review

Higher consumption of snacks / sugar / soft drinks vs Lower consumption

Dental caries · Healthy children and adolescents in the United Arab Emirates

Higher snacking and soft-drink/sugar consumption were associated with more caries in most studies, though one study found no association with sweet-consumption frequency (narrative synthesis; not GRADE-rated).

1 finding from 1 review

Higher per-capita expenditure on dental health care vs Lower per-capita expenditure on dental health care (USD bands: $0-50 / $51-100 / >$100)

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

High-viscosity GIC atraumatic restorative treatment vs No control

Restoration survival · Children with decayed primary molar teeth

Multi-surface ART restorations had a reported survival rate of 73% at 1 year.

4 findings from 1 review
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