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Evidence found and GRADE certainty

148 questions · 167 findings · 18 reviews · Oral and maxillofacial surgery

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No studies found 26 · 15.6%GRADE not reported 113 · 67.7%Very low 9 · 5.4%Low 12 · 7.2%Moderate 4 · 2.4%High 3 · 1.8%

Oral celecoxib (COX-2 inhibitor) vs placebo

Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…

Oral celecoxib (COX-2 inhibitor) showed no clear difference in pain intensity (VAS) compared with placebo; GRADE not reported.

1 finding from 1 review

Oral celecoxib (COX-2 inhibitor) vs placebo

Adverse events (reported; mild, no withdrawals) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…
1 finding from 1 review

Oral clonazepam (benzodiazepine) vs placebo

Withdrawals due to adverse events · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…
1 finding from 1 review

Oral cyclobenzaprine (muscle relaxant) vs placebo

Jaw pain (VAS) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…

Oral cyclobenzaprine (muscle relaxant) showed no clear difference in jaw pain (VAS) compared with placebo; GRADE not reported.

1 finding from 1 review

Oral cyclobenzaprine (muscle relaxant) vs placebo

Adverse events (reported; mild, no withdrawals) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…
1 finding from 1 review

Oral glucosamine hydrochloride/chondroitin sulphate vs placebo

Pain on TMJ palpation (ordinal scale) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…

Oral glucosamine hydrochloride/chondroitin sulphate showed no clear difference in pain on TMJ palpation (ordinal scale) compared with placebo; GRADE not reported.

1 finding from 1 review

Oral glucosamine hydrochloride/chondroitin sulphate vs placebo

Total pain rating index (McGill Pain Questionnaire) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…

Oral glucosamine hydrochloride/chondroitin sulphate showed no clear difference in total pain rating index (McGill Pain Questionnaire) compared with placebo; GRADE not reported.

1 finding from 1 review

Oral glucosamine hydrochloride/chondroitin sulphate vs placebo

Withdrawals due to adverse events · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…
1 finding from 1 review

Oral glucosamine hydrochloride/chondroitin sulphate vs placebo

Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…

Oral glucosamine hydrochloride/chondroitin sulphate showed no clear difference in pain intensity (VAS) compared with placebo; GRADE not reported.

1 finding from 1 review

Reassurance / behavioral management (control of contributory factors)

Outcome not reported · Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

The review found no eligible studies for this question.

1 finding from 1 review

Oral paracetamol vs placebo

At least 50% reduction in pain · Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local…

Paracetamol (single oral dose, any dose or formulation; subgroups up… led to higher achieving at least 50% pain relief at 4 hours (using pain intensity… compared with placebo; GRADE not reported.

3 findings from 1 review

Oral paracetamol vs placebo

Patients with one or more adverse events · Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local…

Paracetamol (single oral dose, any dose or formulation; subgroups up… showed no clear difference in patients with one or more adverse events compared with placebo; GRADE not reported.

1 finding from 1 review

Oral paracetamol vs placebo

Participant‐reported pain relief of 50% or greater · Patients requiring surgical removal of a lower wisdom tooth or teeth, with baseline moderate to severe pain (surgery under local…

Paracetamol (single oral dose, any dose or formulation; subgroups up… led to higher achieving at least 50% pain relief at 6 hours (using pain relief… compared with placebo; GRADE not reported.

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

Genetically predicted periodontitis vs Lower genetically predicted periodontitis liability

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

Genetically predicted DMFS (dental caries) vs Reference (1-SD lower genetically predicted DMFS)

Femoral neck bone mineral density (FN-BMD) · European-ancestry adults

Genetically predicted dental caries (DMFS) had no causal effect on femoral neck BMD.

1 finding from 1 review

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

Orthodontic treatment with appliances inducing stable, permanent orthodontic tooth movement (splints worn 8 to 12 weeks and surgical interventions excluded) vs Control: no treatment, placebo, or reassurance

Adverse effects on oral health · Adults aged 18 years or older with clinically diagnosed TMD (exhibiting two or more of the listed signs and/or symptoms)

The review found no eligible studies for this question.

1 finding from 1 review

Pre-radiotherapy extraction of healthy molar teeth vs Conservative treatment (leaving the teeth in place during radiotherapy, with oral health education and disease prevention: oral hygiene, fluoride, diet advice)

Overall survival · Patients diagnosed with head and neck cancer planned to undergo any type of radiotherapy (external beam, intensity modulated,…

The review found no eligible studies for this question.

1 finding from 1 review