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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 parental education (tertiary) vs Lower parental education (reference)

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

Paternal tertiary education was associated with lower odds of ECC (OR 0.381).

3 findings from 1 review

Secondary (passive/secondhand) smoking exposure during childhood vs No secondary smoking exposure

Caries prevalence (early childhood caries) · Preschool children aged <=71 months (caries outcome assessed at 3-6 years)

Preschool children exposed to secondary smoking have higher odds of caries prevalence (OR 1.77), but the cross-sectional evidence is very uncertain (very low certainty).

2 findings from 1 review

Partial pulpotomy with tri-calcium silicate material (MTA or Biodentine) vs No comparator

Overall success (composite of clinical and radiographic success) · Adults aged 18 years or older with mature permanent teeth and carious pulp exposure

Partial pulpotomy with MTA or Biodentine had a pooled success rate of 86.8%.

1 finding from 1 review

Postbiotics from Lactobacillus spp. (cell-free supernatants, biosurfactants, lipoteichoic acid, bacterial lysates) vs No prior SDF application (untreated dentin control)

Downregulation of S. mutans virulence/biofilm gene expression (gtfB, gtfC, ftf) · Cariogenic bacteria (mainly Streptococcus mutans reference strains) and oral biofilms in vitro

Postbiotics reduce expression of S. mutans biofilm/virulence genes (gtfB, gtfC, ftf) in vitro (ungraded narrative synthesis).

1 finding from 1 review
  • Postbiotics and Dental Caries: A Systematic Review. 2025 All outcomes
    Exposure 24 h to 7 days · Laboratory (in vitro)
    Postbiotics downregulated expression of S. mutans virulence and exopolysaccharide-synthesis genes (e.g., gtfB, gtfC, gtfD, ftf) in 10 in vitro studies; no pooled estimate.
    8 studies
    GRADE not reported

All dental health care expenditure strata vs No comparator

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

The overall pooled mean DMFT was 2.10 across all dental health care expenditure strata.

1 finding from 1 review

Brushing vs Brushing less than daily

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

Brushing twice daily was associated with lower odds of ECC (OR 0.033).

2 findings from 1 review

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

Lumbar spine bone mineral density (BMD) · general population

Spine BMD showed an inverted U-shaped association with fluoride (peak ~0.6 mg/L); excluding high risk-of-bias studies gave small positive MDs (e.g., 0.05 g/cm2, 95% CI 0.01-0.10, up to 2.27 mg/L); ungraded.

4 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 · Sensitivity (excluding high risk-of-bias studies): 1.27 to 2.27 mg/L vs null
    MD 0.05 [0.01, 0.10]
    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 · Sensitivity (excluding high risk-of-bias studies): 0.60 mg/L vs null
    MD 0.06 [-0.02, 0.13]
    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 · Both sexes, main dose-response
    Inverted U-shaped association in both males and females, highest value around 0.6 mg/L (no numeric MD reported in text for main analysis)
    Studies not reported
    GRADE not reported
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  • 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 · Sensitivity (excluding high risk-of-bias studies): above 2.27 mg/L vs null
    MD 0.04 [-0.21, 0.30]
    Studies not reported
    GRADE not reported

Higher national income (GNI per capita) vs Lower national income (GNI categories: middle <=$15,000 / high $15,001-25,000 / very high >$25,000)

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

Higher national income was strongly associated with lower odds of poor oral health (OR 0.10, 95% CI 0.03 to 0.37; about 90% lower odds); not GRADE-rated.

1 finding from 1 review

Intervention not reported

Composite: Preference for replacement over repair - Scenario 8: disruption of occlusal integrity

The intervention led to lower composite: Preference for replacement over repair - Scenario 8:…; GRADE not reported.

1 finding from 1 review

Intervention not reported

Composite: Preference for replacement over repair - Scenario 1: partial loss or fracture of the restoration

The intervention led to lower composite: Preference for replacement over repair - Scenario 1:…; GRADE not reported.

1 finding from 1 review

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)

Oral health attitudes (1-7 scale) · school‐age children and adolescents

Theory-based interventions significantly improved oral health attitude (SMD 9.32; low certainty); the very large effect warrants cautious interpretation.

1 finding from 1 review

Sugar consumption (higher sugar intake) vs No sugar consumption (lower/no intake)

Early childhood caries (ECC) · Preschool children (<6 years)

Higher sugar consumption is associated with early childhood caries in children under 6 years: pooled OR 1.59 (95% CI 1.50 to 1.68) from 9 cohort studies with no heterogeneity (I2=0%); the body of evidence was not GRADE-rated (ungraded).

1 finding from 1 review

Quantitative light-induced fluorescence (QLF) vs Reference standard (bitewing radiography, ADA classification, ICDAS II)

Proximal caries detection: specificity · Patients (in vivo); permanent and primary teeth, proximal (approximal) surfaces

In vivo, QLF pooled specificity for proximal caries in permanent teeth was 0.81 (3 studies; ungraded).

2 findings from 1 review

Ion-releasing restorations (IRR): RMGIC, HVGIC, GIC, compomer/PMRC, giomer vs Composite resin (CR), including bulk-fill composite

Integrity of contact point · Children receiving dental restorations (aged 4-11 years; primary teeth; Class I/II/V cavities)

No significant difference between IRR and CR in integrity of contact point (high certainty).

1 finding from 1 review

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

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

Mean DMFT is lowest in West Europe (0.88) and North Europe (1.34) and highest in East Europe (2.76) and South Europe (2.61) (Figure 3); not GRADE-rated.

4 findings from 1 review
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Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs HIV-negative individuals

Dental caries severity (dmfs index, primary dentition) · Children and adolescents (<18 years) living with HIV (CLWH)

In case-control studies, HIV+ children on ART had a significantly higher dmfs index than HIV-negative peers (MD 5.15, 95% CI 2.20 to 8.11; not separately GRADE-rated).

2 findings 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)

Diagnostic accuracy (prevalence of accuracy) · Patients undergoing dental X-ray (radiographic) imaging for caries detection

On digital bitewing X-rays, AI accuracy was around 80% (single study, narrow CI; ungraded subgroup, numeric estimate not precisely readable).

4 findings from 1 review
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