Oral microbiota composition · Individuals assessed for oral microbiota (mainly children and adolescents)
Oral microbiota composition differs between persons with orofacial cleft and healthy controls, synthesized qualitatively across 8 studies but not meta-analyzed (ungraded).
1 finding from 1 review
no estimate extracted
8 studies
GRADE not reported
Dental caries · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)
Pooling 3 studies, children/adolescents with CLP were about 2.03 times more likely to have dental caries than non-CLP controls (p<0.005; low heterogeneity), though most included studies were at high risk of bias; the evidence is ungraded.
1 finding from 1 review
Lactobacillus spp. salivary/plaque counts (cariogenic microbiota) · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)
A meta-analysis found no significant difference in mean Lactobacillus spp. levels between children with and without CLP, with high heterogeneity; the evidence is ungraded.
1 finding from 1 review
Streptococcus mutans count · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)
A meta-analysis of 2 studies found no difference in mean Streptococcus mutans levels between children with and without CLP, with very high heterogeneity; the evidence is ungraded.
1 finding from 1 review
Periodontal conditions (gingival inflammation, bleeding on probing, probing depth, clinical attachment loss) · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)
Narrative synthesis of 6 studies suggests children/adolescents with CLP have poorer periodontal status (higher gingival and plaque indices, deeper probing, more bleeding and attachment loss) and harbor periodontopathogens; no pooled estimate and the evidence is ungraded.
1 finding from 1 review
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 outcomesLong-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 outcomesLong-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
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
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
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
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 outcomesLong-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 outcomesLong-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
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
Clinical attachment level (CAL) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)
Clinical attachment level loss is greater in persons with orofacial cleft than in healthy controls (p<0.00001), but no pooled effect size was reported (ungraded).
1 finding from 1 review
Intervention not reported
Bleeding on Probing (BoP)
1 finding from 1 review
no estimate extracted
1 study
GRADE not reported
Bleeding Index (BI) · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)
Bleeding index is significantly higher in persons with orofacial cleft than in healthy controls (p<0.0001), but no pooled effect size was reported (ungraded).
1 finding from 1 review
Plaque · Patients with cleft lip and palate (CLP)
Plaque index does not differ significantly between unilateral and bilateral cleft lip and palate (MD -0.13, 95% CI -0.38 to 0.12; ungraded).
1 finding from 1 review
Probing pocket depth · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)
Persons with orofacial cleft have a greater probing pocket depth than healthy controls (MD 0.88, 95% CI 0.82 to 0.95; low certainty).
1 finding from 1 review
Plaque · Individuals assessed for periodontal health (mainly children and adolescents, age >2 years)
Persons with orofacial cleft have a higher plaque index than healthy controls (MD 0.29, 95% CI 0.24 to 0.34; low certainty).
1 finding from 1 review
Intervention not reported
Periodontopathogenic microbiota composition
1 finding from 1 review
Lactobacillus spp. mean levels/counts · Children and adolescents aged 0-18 years with non-syndromic cleft lip and palate (CLP)
No significant difference in Lactobacillus spp. presence was reported; GRADE was not reported.
1 finding from 1 review
Intervention not reported
Cariogenic microbiota counts (Streptococcus mutans, Lactobacillus spp.)
1 finding from 1 review