Caries experience in children and adolescents with Down Syndrome: A systematic review and meta-analysis

Oral health characteristics in children and adolescents with Down syndrome

AIM

To compare oral health indicators of children/adolescents with Down syndrome (DS) with a group of children/adolescents without DS.

METHODS AND RESULTS

This cross-sectional study included 144 individuals with DS, ages 4 to 18 years, matched for age and sex with a group of 144 individuals without DS, and their parents/caregivers. Parents/caregivers completed a questionnaire regarding sociodemographic information and habits related to their children's oral health. Clinical examination of the children/adolescents evaluated dental caries experience (DMFT/dmft), bleeding on periodontal probing, presence of visible plaque, clinical consequences of untreated dental caries (PUFA/pufa), and malocclusion (DAI). The chi-square test, linear by linear test, and Mann-Whitney test were used to compare the variables between the groups (p < .05). Children/adolescents without DS brushed their teeth more times per day (p < .001) and had a higher frequency of daily sugar intake (p < .001). The children/adolescents in the DS group had a greater presence of gingival bleeding (p < .001) and had a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = .001). No difference was found in the prevalence of dental caries between the two groups.

CONCLUSION

The children/adolescents in the DS group had a greater presence of gingival bleeding during the clinical examination and had a greater need for orthodontic treatment.

Systems mapping of multilevel factors contributing to dental caries in adolescents

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.

Conclusions

Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.

Treatment of Class II malocclusion with anterior open bite and posterior crossbite with the aid of mini-implants in a patient with Down syndrome: Clinical case report

OBJECTIVE

We report the orthodontic treatment of a class II malocclusion with anterior open bite and posterior crossbite in a patient with Down syndrome (DS) treated with mini-implants.

METHODS

Treatment began with rapid maxillary expansion with a Haas appliance, followed by dental alignment and leveling with a fixed appliance and the correction of class II dental relationships with the use of orthodontic mini-implants associated with a sliding jig.

RESULTS

The results obtained at the end of the treatment were satisfactory, with improvements in occlusion, including bite closure; maxillary expansion; and the correction of dental relationships.

CONCLUSION

When well-planned, orthodontic treatment in a patient with DS achieves satisfactory results from a skeletal, occlusal, and facial perspective.

Comparison of the malocclusion and orthodontic treatment needs of Down syndrome and non-syndromic subjects by using the dental aesthetics index

OBJECTIVE

To evaluate the prevalence and significance of the malocclusion traits and orthodontic treatment needs of Down syndrome (DS) subjects with matched non-syndromic (NS) controls.

METHODOLOGY

This cross-sectional study involved 222 subjects (50% DS, 50% NS) who were matched by gender and age. The casts were digitized into three-dimensional images. These images were used alongside the ten occlusal characteristics of the Dental Aesthetic Index (DAI) to determine malocclusion severity and the need for orthodontic treatment.

RESULTS

There were 58 (52.3%) females and 53 (47.7%) males with a mean age of 18.4 ± 8.4 years in both groups. The most common and significant (p < .05) malocclusion traits among the DS subjects were missing teeth (56.2%), incisal spacing segments (73.0%), anterior maxillary irregularity (95.5%), mandibular overjet (36.0%), and full cusp deviation of the molar relationship (61.3%). On the other hand, increased maxillary overjet (69.3%) is a more significant (p < .05) trait amongst NS subjects. There were 85 (76.6%) DS subjects who presented severe malocclusion, which implies a highly orthodontic treatment need (DAI > 30). The DS showed some impact of malocclusion traits components of the DAI.

CONCLUSION

The occurrence of malocclusion was higher in DS, implying a higher need for orthodontic treatments than for NS subjects.

Lateral cephalometric characteristics in individuals with Down Syndrome compared to non-syndromic controls: A meta-analysis

OBJECTIVES

The aim of the present meta-analysis was to provide a complete synthesis of all studies involving lateral cephalometric measurements in populations with Down Syndrome (DS).

METHODS

A literature search was carried out using six electronic databases to identify studies comparing cephalometric characteristics between populations with DS and control (healthy) populations. Studies were selected according to the research objectives, and predefined inclusion and exclusion criteria. Only the cephalometric measurements included in three or more studies selected were analyzed. The random-effects meta-analysis model was used for data analysis, and all analyses were carried out using RevMan5 software.

RESULTS

From an initial 871 articles identified through the literature search, ten cross-sectional studies were finally selected based on the inclusion and exclusion criteria. Ten cephalometric measurements underwent meta-analysis, five linear and five angular measurements. Concerning the five linear measurements, namely S-N, ANS-PNS, Go-Gn, Ar-Go, and N-ANS, all were significantly smaller in the DS group with the exception of Go-Gn. Of the five angular measurements, only three were statistically different between the DS and control groups. SNB and ANB angles were smaller in individuals with DS, whereas the basilar angle was larger. Subgroup analysis was also carried out based on age, and it was found that the gonial angle was significantly smaller before puberty, in individuals with DS. No differences between groups were found for the SNA angle.

CONCLUSION

There are significant cephalometric differences between individuals with and without DS. Individuals with DS have a shorter anterior cranial base, maxillary length, upper anterior facial height and mandibular height. The ANB and SNB angles were also smaller in those with DS, but the SNA angle showed no differences. These findings may indicate that the Class III malocclusion commonly found in individuals with DS does not seem to be due to mandibular prognathism.

CLINICAL RELEVANCE

Lateral cephalometric measurements in individuals with DS show significant differences from individuals without DS. Practitioners need to be aware of this and monitor growth from an early age in these children.

Dental and health aspects in the co-occurrence of Treacher Collins and Down syndromes: Case report

The goal of this case report is to identify the dental care of a patient who has co-occurrence of Treacher Collins and Down syndromes. It is the third case reported in the literature and the first relating dental treatment under general anesthesia and multidisciplinary importance. It was necessary the child's nutritional assessment in this case. This case highlights the importance of individualizing therapeutic protocols, due to the behavioral aspects of patients with special needs, optimizing treatment results in a single session under general anesthesia. Oral health is closely related to overall health, and it is important for awareness that the whole influences the success of medical treatment.

The Incidence of Dental Caries in Children with Down Syndrome: A Systematic Review and Meta-Analysis

Scientific evidence regarding the incidence of dental caries in Down syndrome (DS) patients is limited and sometimes presents divergent opinions among authors, making it difficult to reach definitive conclusions. We aimed to evaluate the caries incidence in the DS pediatric population and compare it against healthy controls. The search was performed using 4 universal databases: Cochrane, B-on, Biomed, and PubMed. The selected articles were synthesized and subsequently evaluated according to an adaptation of the Quality Assessment Checklist for Prevalence Studies risk of bias tool, and analysis charts were performed by the Risk of Bias visualization tool (ROBVIS). Statistics and graphs were performed by Open Meta Analyst and JASP software. The confounding effect on caries incidence of the following factors was evaluated through meta-regression: age, Male/Female (M/F) ratio, DMFT, dmft, and study geographic location. Overall, the incidence of caries in the DS population was 49.9%, whereas in the control population was 63.4%. The M/F ratio, DMFT, and dmft significantly affected the incidence of DS individuals (p-value < 0.05). The evidence regarding the lower pooled incidence of caries in individuals with DS regarding controls is limited by the few scientific reports available and cross-section designs. Therefore, further studies are needed to confirm these results.

Molecular Detection of Streptococcus downii sp. nov. from Dental Plaque Samples from Patients with Down Syndrome and Non-Syndromic Individuals

A new bacterial species has recently been identified in the dental plaque of an adolescent with Down syndrome. The species is known as Streptococcus downii sp. nov. (abbreviated to S. downii), and it inhibits the growth of S. mutans and certain periodontal pathogens. The aim of this study was to determine the distribution of S. downii in the oral cavity of individuals with Down syndrome. Methods: A specific polymerase chain reaction for the operon of bacteriocin (class IIb lactobin A/cerein 7B family) was designed to detect S. downii in individuals with Down syndrome (n = 200) and in the general population (n = 100). We also compared the whole genome of S. downii and the regions related to its bacteriocins against 127 metagenomes of supragingival plaque of the “Human Microbiome Project”. Results: We detected the specific gene of the S. downii bacteriocin in an individual with Down syndrome (Cq, 34.52; GE/μL, 13.0) and in an individual of the non-syndromic control group (Cq, 34.78 Cq; GE/μL, 4.93). The prevalence of S. downii was ≤1% both in Down syndrome and in the general population, which did not allow for clinical-microbiological correlations to be established. This result was confirmed by detecting only one metagenome with an ANIm with approximately 95% homology and with 100% homology with ORFs that code class IIb lactobiocin A/cerein 7B bacteriocins among the 127 metagenomes of the “Human Microbiome Project” tested. Conclusions: The detection rate of S. downii in the supragingival dental plaque was very low, both in the Down syndrome individuals and in the non-syndromic controls. A clinical-microbiological correlation could therefore not be established.

Cardiovascular Risk According to Body Mass Index in Women of Reproductive Age With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Background

Polycystic ovary syndrome (PCOS) is a heterogeneous condition that affects women of reproductive age. The association between PCOS and cardiovascular risk according to body mass index (BMI) categories is unclear.

Objective

We evaluated the association between cardiovascular risk according to BMI categories and PCOS in women of reproductive age.

Methods

A literature search was conducted in the EMBASE, MEDLINE, Cochrane Library, and PubMed databases from their inception to 9 September, 2021. Observational cross-sectional, retrospective, and prospective controlled studies were included. The main analyses examined the relationship between cardiovascular risks (i.e., blood pressure and lipid levels) and BMI in women of reproductive age with PCOS.

Results

Thirty-eight studies, with a total of 6,078 subjects, were included in this metaanalysis. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in women of reproductive age with PCOS. Lower high-density lipoprotein (HDL)-cholesterol [SMD (95% CI): −0.21 (−0.35, −0.08), p = 0.002], higher triglycerides [SMD (95% CI): 0.38 (0.29, 0.48), p < 0.001], higher low-density lipoprotein (LDL)-cholesterol [SMD (95% CI): 0.29 (0.20, 0.39), p < 0.001], higher nonHDL-cholesterol [SMD (95% CI): 0.42 (0.31, 0.52), p < 0.001] and waist-to-hip ratio (WHR) [MD (95% CI): 0.03 (0.02, 0.04), p < 0.001] were seen in women of reproductive age with PCOS. In addition, the subgroup analysis revealed that systolic BP and HDL-cholesterol increased at BMI < 25 kg/m² and BMI 25–30 kg/m². Diastolic BP increased at BMI 25–30 kg/m². Triglycerides, LDL-cholesterol, nonHDL-cholesterol, and WHR increased in all BMI categories.

Conclusions

PCOS is associated with cardiovascular risk. Lipid levels and BP increased in women of reproductive age with PCOS, regardless of BMI.

Systematic Review Registration

Open Science Framework (10.17605/OSF.IO/92NBY).

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

Evaluation of the craniofacial and oral characteristics of individuals with Down syndrome: A review of the literature

The aim of this investigation was to describe the craniofacial and oral characteristics of children and/or adolescents with and without Down syndrome (DS). A bibliographic search of the Medline database (via PubMed), Scopus and SCIELO was performed using the keywords "craniofacial characteristics", "dental characteristics" and "Down syndrome". Systematic reviews, observational cross-sectional and longitudinal studies were included. On the contrary, case reports, letters to the editor, editorials and opinion articles were excluded. 251 articles were recovered, and only 30 fulfilled the selection criteria. DS patients were characterized by reduced dimensions of the maxillary bone, mandible, and skull base, compared to normal patients. Likewise, some of these abnormalities influenced more frequent presentation of a class III malocclusion in these patients. On the other hand, this population group showed a higher prevalence of periodontal diseases, less risk of dental caries, and the presence of alterations in the tongue, lips, dental development and palate morphology. The quality of life of these individuals is affected by difficulties in swallowing, talking, eating or breathing through the nose. In conclusion, the craniofacial and oral characteristics of DS patients present various alterations compared to healthy patients, and these alterations have a negative impact on their quality of life.