Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

83 questions · 109 findings · 12 reviews · Oral and maxillofacial surgery · All outcomes

No studies found 2 · 1.8%GRADE not reported 95 · 87.2%Very low 2 · 1.8%Low 10 · 9.2%Moderate 0 · 0%High 0 · 0%

Metronidazole gel 25% (local antibiotic) vs Placebo gel

Presence of dry socket · Adults (>18 years) having permanent tooth extraction (predominantly mandibular third molars)

Metronidazole gel (25%, intrasocket) showed no clear difference in presence of dry socket compared with placebo gel; GRADE not reported.

1 finding from 1 review

Topical methyl salicylate (Theraflex-TMJ) vs placebo

Spontaneous masseter muscle pain (numerical graph rating scale) · Adult patients aged >=18 years, clinically or radiographically diagnosed with TMD (McNeill 1997 criteria); moderate to severe pain of…

Topical methyl salicylate (Theraflex-TMJ) led to lower spontaneous masseter muscle pain (numerical graph rating scale) compared with placebo; GRADE not reported.

1 finding from 1 review

Topical methyl salicylate (Theraflex-TMJ) vs placebo

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

Topical methyl salicylate (Theraflex-TMJ) led to lower spontaneous TMJ pain (numerical graph rating scale) compared with placebo; GRADE not reported.

1 finding from 1 review

Resorbable (bioresorbable) plates or screws for fixation vs Titanium plates or screws for fixation

Swelling (mean) · Adults (>16 years old) undergoing orthognathic surgery
1 finding from 1 review
  • Resorbable versus titanium plates for orthognathic surgery 2017 · Cochrane All outcomes
    Up to 3 years postoperatively
    Though Cheung 2004 reported the presence of postoperative swelling, it was only noted in conjunction with infection and pus discharge; assessment of this outcome did not include the use of photography or digital…
    1 study · 60 participants
    GRADE not reported

Squeezable (modified) feeding bottle vs Rigid feeding bottle

Reliability of feeding method (number of times bottle modified) · Infants up to 6 months (from term) born with cleft lip, cleft palate or cleft lip and palate (Pierre Robin sequence or other syndromes…
1 finding from 1 review

Minimal incision palatopharyngoplasty (MIPP) vs MIPP with additional individualised velopharyngeal surgery (pharyngeal flap or sphincter pharyngoplasty)

Instrumental assessment: nasalance score (nasometry and pressure-flow measure) · Children or adolescents aged 3 years or older with velopharyngeal insufficiency (VPI) associated with non-syndromic submucous cleft palate

The review found no eligible studies for this question.

1 finding from 1 review

Dental examinations at three-month intervals and preventive treatments vs usual care

MRONJ (incidence proportion) · Men with metastatic prostate cancer receiving intravenous zoledronic acid (at risk of MRONJ)

It is very uncertain whether dental examinations at three-month intervals and preventive treatments changes MRONJ (incidence proportion) compared with standard care (very low certainty).

1 finding from 1 review

Dental examinations at three-month intervals and preventive treatments vs usual care

MRONJ (incidence rate: cases per patient-year) · Men with metastatic prostate cancer receiving intravenous zoledronic acid (at risk of MRONJ)

It is very uncertain whether dental examinations at three-month intervals and preventive treatments changes MRONJ (incidence rate: cases per patient-year) compared with standard care (very low certainty).

1 finding from 1 review

Intra-articular injection of sodium hyaluronate vs corticosteroid injection

Complications (adverse effects) · Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

Intra-articular injection of sodium hyaluronate showed no clear difference in complications (adverse effects) compared with intra-articular injection of corticosteroids (betamethasone); GRADE not reported.

1 finding from 1 review

Intra-articular injection of sodium hyaluronate vs corticosteroid injection

Presence of TMJ sounds · Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

Intra-articular injection of sodium hyaluronate led to lower presence of TMJ sounds compared with intra-articular injection of corticosteroids (betamethasone); GRADE not reported.

1 finding from 1 review

Intra-articular injection of sodium hyaluronate vs corticosteroid injection

Pain on palpation of the affected/contralateral TMJ and masticatory muscles · Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

Intra-articular injection of sodium hyaluronate led to lower pain on palpation of the affected/contralateral TMJ and masticatory… compared with intra-articular injection of corticosteroids (betamethasone); GRADE not reported.

1 finding from 1 review
  • Interventions for managing temporomandibular joint osteoarthritis 2012 · Cochrane All outcomes
    14 days to 6 months
    Pain on palpation of the affected and contralateral TMJ and masticatory muscles presented similar frequencies regardless of the time (Analyses 1.4-1.12); no statistically significant differences reported. Point…
    1 study · 40 participants
    GRADE not reported

Intra-articular injection of sodium hyaluronate vs corticosteroid injection

Extent of mandibular movement (maximum jaw opening, lateral and contralateral movement, jaw protrusion) · Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

Intra-articular injection of sodium hyaluronate showed no clear difference in extent of mandibular movement (maximum jaw opening, lateral and… compared with intra-articular injection of corticosteroids (betamethasone); GRADE not reported.

1 finding from 1 review
  • Interventions for managing temporomandibular joint osteoarthritis 2012 · Cochrane All outcomes
    14 days to 6 months
    None of the mean differences between interventions for the measures of jaw movements (maximum jaw opening, lateral movement to affected side, contralateral movement, jaw protrusion; Analyses 1.16-1.27) showed…
    1 study · 40 participants
    GRADE not reported

Intra-articular injection of sodium hyaluronate vs corticosteroid injection

Reported pain (mm on VAS) · Adults (>18 years) with temporomandibular joint osteoarthritis (TMJ OA) diagnosed by RDC/TMD or compatible criteria

Intra-articular injection of sodium hyaluronate led to lower reported pain (mm on VAS) compared with intra-articular injection of corticosteroids (betamethasone); GRADE not reported.

1 finding from 1 review

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

Fracture · general population

Non-linear positive dose-response: little change in overall fracture risk below ~1.5 mg/L drinking-water fluoride, with risk increasing above that threshold (RR 1.06, 1.19, 1.35 at 2.0, 3.0, 4.0 mg/L vs null); ungraded (4 studies).

4 findings from 1 review
Show 1 more finding

Cleft lip and/or palate (CL/P) vs Healthy controls without cleft

Gingival index (GI) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)

Persons with orofacial cleft have a higher gingival index than healthy controls (MD 0.15, 95% CI 0.11 to 0.19; low certainty).

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

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 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