Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

131 questions · 215 findings · 26 reviews · All outcomes

No studies found 0 · 0%GRADE not reported 190 · 88.4%Very low 3 · 1.4%Low 8 · 3.7%Moderate 7 · 3.3%High 7 · 3.3%

Higher drinking-water fluoride exposure vs Lower water fluoride concentration (concurrent control)

Adverse effects: dental fluorosis · Populations of all ages (mostly children) exposed to drinking water with differing fluoride concentrations

Higher water fluoride concentration (fluoridated water; natural or… may leads to higher dental fluorosis of any level (all severities) compared with lower water fluoride concentration (concurrent control) (low certainty).

1 finding from 1 review

Obesity or overweight (higher BMI, mostly WHO BMI ≥25/≥30; 2 studies used waist circumference) vs Normal Weight or Non‐Obese

Dental caries · Adults (≥18 years)

After adjustment for confounders, obesity/overweight was not associated with dental caries (OR 1.00, 95% CI 0.89 to 1.12; ungraded).

9 findings from 1 review
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Granulocyte-macrophage colony-stimulating factor (GM-CSF), higher dose (1260 to 12,600 micrograms) vs Granulocyte-macrophage colony-stimulating factor (GM-CSF), lower dose (12.6 to 126 micrograms)

Oral mucositis (severe) · breast cancer patients undergoing chemotherapy

Granulocyte-macrophage colony-stimulating factor (GM-CSF), higher… led to higher oral mucositis (severe) compared with granulocyte-macrophage colony-stimulating factor (GM-CSF), lower…; GRADE not reported.

1 finding from 1 review

Higher JIA disease activity/severity (e.g., high JADAS/activity scores, polyarticular RF-negative subtype, active disease, anti-TNFalpha or cyclosporine medication) vs Lower JIA disease activity / inactive or milder JIA

Prevalence and severity of oral and TMJ diseases/conditions (periodontal status and dental caries) · Children and adolescents with juvenile idiopathic arthritis (JIA)

Some studies suggested greater JIA disease activity/severity (and certain medications) was associated with worse periodontal and caries outcomes, but small samples meant no solid conclusion could be drawn (ungraded).

1 finding from 1 review

Western/Northern Europe (UN M49 region) vs Eastern/Southern Europe (UN M49 geographical categorization)

Odds of higher caries (DMFT) category · 12-year-old children across European countries (national/regional epidemiological surveys, 2011-2022)

In the adjusted ordinal model geographical location was not independently significant for DMFT category (OR 0.57, 95% CI 0.24 to 1.35); not GRADE-rated.

1 finding from 1 review

Very high Human Development Index (HDI >=0.800) vs High Human Development Index (HDI 0.700-0.799)

Odds of higher caries (DMFT) category · 12-year-old children across European countries (national/regional epidemiological surveys, 2011-2022)

HDI was not independently associated with DMFT category in the adjusted model (OR 1.82, 95% CI 0.32 to 10.47); not GRADE-rated.

1 finding from 1 review

Maternal education attainment vs Children without dental caries

Dental caries (association with secondary/higher maternal education) · Children (deciduous and/or permanent dentition) in low- and middle-income countries

Secondary/higher maternal education showed no significant association with dental caries (OR 0.96, 95% CI 0.64 to 1.44; 7 studies; not GRADE-rated).

1 finding from 1 review

Maternal education attainment vs Not applicable (single-group prevalence)

Secondary/higher maternal education prevalence (among children with caries) · Children with dental caries (deciduous and/or permanent dentition) in low- and middle-income countries

About 45% of children with caries in LMICs had mothers with secondary or higher education (pooled prevalence 0.450, 95% CI 0.330 to 0.572; 7 studies; not GRADE-rated).

1 finding from 1 review

Video modelling acclimatisation for LA vs Oral hygiene video

Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: anxiety/pain experience (VAS, higher scores indicate worsened anxiety) · Children and adolescents having dental treatment under local anaesthetic without general anaesthesia

Video modelling acclimatisation for LA may leads to lower self- or observational assessment of intraoperative… compared with oral hygiene video (low certainty).

1 finding from 1 review

Chlorhexidine varnish (10% and 40%) vs placebo or no treatment

Caries increment in permanent teeth · Children and adolescents below 18 years at study start (included studies: children from birth to 15 years), with mixed, permanent or…

It is very uncertain whether chlorhexidine varnish (10% and 40%) changes caries increment in permanent dentition (DMFS; higher values… compared with placebo or no treatment (very low certainty).

1 finding from 1 review

A 10-minute film followed by the same 30-minute one-to-one hygienist instruction on sugar consumption and dental health, plus oral hygiene, fluoride and regular visits (a multi-intervention) vs No special instructions (control)

Mean sugar consumption (self-reported, 1 to 5 scale; higher score = more positive behaviour) · Adults newly registered at a group dental practice in a suburban Dutch village, the Netherlands
1 finding from 1 review

30 minutes of one-to-one instruction by a dental hygienist covering the relationship between sugar consumption and dental health, plus oral hygiene, fluoride and regular dental visits (a multi-intervention) vs No special instructions (control)

Mean sugar consumption (self-reported, 1 to 5 scale; higher score = more positive behaviour) · Adults newly registered at a group dental practice in a suburban Dutch village, the Netherlands
1 finding from 1 review

Lower unemployment rate vs Higher unemployment rate (low <=5% / medium >5-10% / high >10%)

Caries experience (mean DMFT) · 12-year-old children across European countries (national/regional epidemiological surveys, 2011-2022)

Mean DMFT tended to increase with unemployment rate (low 1.23, medium 2.08, high 2.38; ANOVA p<.05); descriptive country-level means only, not meta-analyzed or GRADE-rated.

3 findings from 1 review

Country-level income (World Bank income classification) vs Higher- vs lower-income country categories

Oral health-related quality of life · people aged 60 years and older living in the community

Community-dwelling older adults in higher-income countries had better OHRQoL than those in lower-income countries (77.9, 95% CI 70.2 to 85.6 vs 66.9, 95% CI 56.7 to 77.0); the difference by income was statistically significant (ungraded).

2 findings from 1 review

Country-level income inequality (Gini index) vs Lower vs higher income inequality categories

Oral health-related quality of life · people aged 60 years and older living in the community

Older adults in countries with relative income equality (low Gini index) had markedly higher OHRQoL (91.3, 95% CI 90.0 to 92.6) than those in less equal countries; the difference by Gini index was statistically significant (ungraded).

4 findings from 1 review
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Human Development Index (HDI) vs Higher vs lower HDI categories

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

Country-level unemployment rate vs Higher vs lower unemployment-rate categories

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

Health expenditure per capita vs Higher vs lower per-capita health expenditure categories

Oral health-related quality of life · people aged 60 years and older living in the community

OHRQoL did not differ significantly across per-capita health-expenditure categories; no pooled estimate was reported in the text (ungraded).

1 finding from 1 review

Out-of-pocket health expenditure vs Lower vs higher out-of-pocket expenditure categories

Oral health-related quality of life · people aged 60 years and older living in the community

Lower out-of-pocket health expenditure was associated with better OHRQoL (83.9, 95% CI 75.2 to 92.6 vs 67.5, 95% CI 58.5 to 76.5); the difference was statistically significant (ungraded).

2 findings from 1 review

Fluoride toothpaste less than 1000 ppm (lower concentration) vs Fluoride toothpaste 1000 ppm or more (higher concentration)

Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years

It is very uncertain whether fluoride toothpaste less than 1000 ppm (lower concentration) changes fluorosis (percentage prevalence in permanent teeth) compared with fluoride toothpaste 1000 ppm or more (higher concentration) (very low certainty).

2 findings from 1 review