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Evidence found and GRADE certainty

2,745 questions · 4,389 findings · 203 reviews · Dental caries

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No studies found 39 · 0.9%GRADE not reported 3,844 · 87.6%Very low 198 · 4.5%Low 137 · 3.1%Moderate 134 · 3.1%High 37 · 0.8%

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

Electronic cigarette use vs Non-smokers

Interleukin-6 (IL-6) · Humans who use e-cigarettes (mostly adults, often with periodontal disease) assessed for oral proinflammatory markers

Meta-analysis suggests no significant effect of e-cigarette use on the salivary level of Interleukin-6 (IL-6) (6 studies), though heterogeneity was high (I2=95%) and the pooled estimate appears only in Figure 3D (unavailable); GCF data were limited (1 study(ies)) (ungraded).

1 finding from 1 review

AI systems for caries detection/segmentation on dental X-ray images (predominantly convolutional neural networks; also ANNs, DNNs, DCNN, FCNN, SVMs, decision trees, random forests; e.g. EfficientNet, ResNet, AlexNet) vs Human dentists / trained dental professionals or traditional radiographic interpretation (reference standard / reference models)

Specificity · Patients undergoing dental X-ray (radiographic) imaging for caries detection

Across 7 studies, AI showed high weighted-mean specificity (~87.9%) for caries detection, with very high heterogeneity (I2=96%); ungraded.

1 finding from 1 review

Dental treatments, care, and services (the decision context) vs No comparator

Dental fear (fear of treatment) as a factor of choice · (Potential) patients with freedom of choice regarding dental treatments, including parents and caregivers deciding for children or…

Dental fear was the second most frequently reported factor (N=64 articles), varying by country (ungraded).

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

Children with dental caries vs Children without dental caries

Mean corpuscular volume (MCV) · Children or adolescents

MCV tends to be lower in children with dental caries, but the pooled difference is not statistically significant (MD -1.96 fL, 95% CI -4.02 to 0.10; very low certainty).

1 finding from 1 review

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

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 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 · 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 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 · Males: drinking-water fluoride 0.57 mg/L vs null
    RR 0.83 [0.72, 0.97]
    7 studies
    GRADE not reported

Replacement of the defective restoration vs Repair of the defective restoration

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
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Replacement of the defective restoration vs Repair of the defective restoration

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
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Electronic cigarette use vs Non-smokers

IL-6 level · People who use electronic cigarettes

The review reports that GCF evidence was limited and may show a potential association.

3 findings from 1 review

Quantitative light-induced fluorescence (QLF) vs Reference standard (histology; some ICDAS/radiography)

Occlusal caries detection: sensitivity · Extracted human teeth (in vitro); permanent and primary teeth, occlusal surfaces

In vitro, QLF pooled sensitivity for occlusal caries detection was 0.83 (5 studies; ungraded).

3 findings from 1 review

Self-assembling/remineralizing peptide (e.g., P11-4, PAA-PASP) vs Calcium phosphate agent (e.g., CPP-ACP, Ca/P-PILP, niobophosphate)

Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)

In the Self-Etch adhesive + chemical ACAD protocol network, Peptide vs Calcium Phosphate showed no significant difference in 24 h bond strength (MD -0.009, 95% CI -4.076 to 4.058; Low certainty).

3 findings from 1 review

Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs HIV-negative individuals

Dental caries · Children and adolescents (<18 years) living with HIV (CLWH)

In cross-sectional studies, children and adolescents with HIV on antiretroviral therapy had about twice the odds of dental caries versus HIV-negative peers (OR 2.04, 95% CI 1.21 to 3.42; very low certainty).

3 findings from 1 review

Dental caries (ECC/severe ECC) as exposure/grouping vs Caries-free controls

Relative abundance of S. mutans in saliva · Individuals assessed for dental caries, predominantly children with early childhood caries (ECC) or severe ECC (age about 1 to 4 years)

A few small studies report Streptococcus mutans relative abundance in caries versus caries-free children without pooling; the evidence is ungraded and not meta-analyzed.

1 finding from 1 review

Hall technique vs placebo

Treatment success (caries lesion arrest or restoration survival) · Children (aged 3-11 y) with cavitated caries lesions in primary teeth

At 6 months, the Hall technique had significantly higher treatment success than placebo (OR 163.59; moderate certainty).

1 finding from 1 review

Not applicable (single-group prevalence) vs Not applicable (single-group prevalence)

Early childhood caries (ECC) · Children aged 0-5 years in North Africa

Pooled ECC prevalence in Tunisia was 38% (95% CI 24-51), significantly lower than Egypt and Sudan.

10 findings from 1 review
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Theory-based oral health education/promotion interventions (HBM, TPB, SCT, HAPA, TTM, PMT, SOC, PRECEDE-PROCEED, MI) vs Control (waitlist, routine/standard oral health education, or minimal intervention)

Self-efficacy related to oral health · school‐age children and adolescents

Theory-based educational interventions significantly improved oral health self-efficacy (SMD 1.49; low certainty), though between-study heterogeneity was very high.

1 finding from 1 review

HEMA/EGDMA-based desensitizer vs No biomimetic remineralization (control)

Immediate (24 h) resin-dentin bond strength (MPa) · Artificial caries-affected dentin (ACAD) in extracted permanent human teeth (in vitro)

In the Self-Etch adhesive + chemical ACAD protocol network, HEMA vs Control showed no significant difference in 24 h bond strength (MD 1.899, 95% CI -3.210 to 7.009; Low certainty).

1 finding from 1 review