The role of asthma in caries occurrence - meta-analysis and meta-regression

Chronic oral disease burden at the first 1000 days: Intergenerational risk factors, BRISA cohort

OBJECTIVE

To analyze multiple-causal models, including socioeconomic, obesity, sugar consumption, alcohol smoking, caries, and periodontitis variables in pregnant women with early sugar exposure, obesity, and the Chronic Oral Disease Burden in their offspring around the first 1000 days of life.

METHODS

The BRISA cohort study, Brazil, had two assessments: at the 22nd-25th gestational weeks and during the child's second year (n = 1141). We proposed a theoretical model exploring the association between socioeconomic and pregnancy factors (age, smoking, alcohol, sugars, obesity, periodontitis, and caries) and child's variables (sugars and overweight) with the outcome, Chronic Oral Disease Burden (latent variable deduced from visible plaque, gingivitis, and tooth decay), using structural equation modeling.

RESULTS

Caries and periodontitis were correlated in pregnant women. Addictive behaviors in the gestational period were correlated. Obesity (Standardized coefficient - SC = 0.081; p = 0.047) and added sugar consumption (SC = 0.142; p = 0.041) were observed intergenerationally in the pregnant woman-child dyads. Sugar consumption by the children (SC = 0.210; p = 0.041) increased the Chronic Oral Disease Burden.

CONCLUSIONS

Poor caries and periodontal indicators were correlated in pregnant women and their offspring. Obesity and sugar consumption act intergenerationally. Oral health in early life may change life trajectory since the worst oral conditions predict main NCDs.

Structural Relationships between Asthma and Dental Caries in Children: A Birth Cohort Study in Southern Brazil

INTRODUCTION

There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition.

METHODS

Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries.

RESULTS

The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries.

CONCLUSION

Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.

Association between asthma and oral conditions in children and adolescents: a systematic review with meta-analysis

OBJECTIVE

To investigate the association between asthma and oral conditions in children and adolescents.

MATERIAL AND METHODS

Observational studies that evaluated the association between asthma and oral conditions in children and/or adolescents were retrieved from five databases, grey literature and reference lists up to April 7^th, 2022. Meta-analyses were performed, and I² statistics were calculated. The mean difference was used as a measure of effect for continuous variables. Event frequencies were evaluated to determine odds ratios for dichotomous variables. Publication bias was investigated using Egger's test. The methodological quality (JBI) and certainty of the evidence (GRADE) were assessed.

RESULTS

Forty-two studies were eligible, and sixteen were included in the meta-analysis. Mean dmft (MD: 1.11, 95%CI: 0.48-1.73), DMFT (MD: 1.01, 95% CI: 0.45-1.56), dmfs (MD: 3.62, 95%CI: 2.60-4.63) and DMFS (MD: 4.47, 95%CI: 0.98-7.96) indices were significantly higher in asthmatic children and adolescents compared to those without asthma. In the analysis of biofilm, asthmatic children and adolescents had a higher Plaque Index compared to those without asthma (MD: 0.18, 95%CI: 0.03-0.33).

CONCLUSION

Asthmatic children and adolescents may be more likely to develop tooth decay and build up biofilm compared to those without asthma. It is suggested that there are no differences between asthmatic and non-asthmatic children and adolescents regarding gingivitis, developmental defects of enamel or erosive tooth wear. The certainty of the evidence was classified as 'very low'.

CLINICAL RELEVANCE

Knowledge of the risks that asthma and asthma medications for oral health can assist in counselling families of children and adolescents with this condition in terms of control and prevention measures for oral problems.

Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Influence of childhood asthma on dental caries: A longitudinal study

OBJECTIVES

The study investigated the influence of childhood asthma on dental caries development and caries risk factors among children with asthma in Slovenia.

MATERIAL AND METHODS

The study population consisted of 2-17 years old children (n = 138), who had used anti-asthmatic medicines for at least 1 year. Controls were their non-asthmatic siblings (n = 140). International Caries Detection and Assessment System-II was used to assess caries status. After 3 years, 106 baseline participants (53 asthmatic and 53 siblings) were reexamined. Questionnaires completed by parents and data from the patients' medical records provided information on demographics, child's medical history, medication usage, and oral health behaviors. Additional 308 asthmatic children were examined to assess caries risk factors among children with asthma.

RESULTS

Asthmatic children had significantly higher mean d12 fs and D12 MFS (p ≤ 0.05), and fewer caries-free individuals (p ≤ 0.01). In asthmatic children, 3 years mean increment in D12 MFS was significantly higher (p ≤ 0.05). Furthermore, progression over 3 years from sound tooth surfaces to decayed cavitated and filled lesions in primary and permanent teeth were present in significantly higher (p ≤ 0.05) percentage, and likewise transition from decayed cavitated lesions to missing tooth surfaces because of caries in primary teeth, and from filled to filled non-cavitated and cavitated lesions in permanent teeth. Lower caries experience in asthmatic children was associated with lower doses of inhaled glucocorticoid use, leucotriene antagonist use, and daily milk and cheese consumption.

CONCLUSIONS

Asthmatic children who had used anti-asthmatic medicines had higher caries experience and higher caries progression over 3 years in both primary and permanent dentitions. Besides anti-asthmatic medicines, other factors were associated with higher caries experience in asthmatic children.

Associations between dental caries and systemic diseases: a scoping review

BACKGROUND

The objective of this study was to evaluate and present evidence from animal and human clinical studies on associations between dental caries and systemic diseases, and to suggest potential mechanisms that might explain such associations.

METHODS

An electronic search was conducted of PubMed, Embase and Cochrane Central Register of Controlled Trials for articles published from 2010 to 2020 in the English language. From the initial search, 404 full-text studies were assessed for eligibility. After excluding studies for technical and study limitations, a total of 67 studies were included in the summary tables and additional studies were included in the review to support evidence.

RESULTS

Few systemic disease and conditions were found to be clinically meaningfully associated with caries experience. Best evidence from human and animal studies described association between metabolic diseases and dental caries. Several interesting animal studies were noted that could generate clinical hypotheses and further investigations in rodent models for cardiovascular injury and hyperglycemia. Inadequate data was found to suggest any modifications to current clinical practice or prevention guidelines.

CONCLUSIONS

Limited clinical evidence was found connecting several systemic diseases and dental caries. Inadequate data was found to suggest any modifications to current clinical practice or prevention guidelines.

CLINICAL SIGNIFICANCE

Understanding of associations between dental caries and systemic diseases play a crucial role in the treatment planning and education of the dental patient.

General- and Oral-Health-Related Predisposing Factors for Interrupting Military Service in the Finnish Defence Forces

INTRODUCTION

Finland's security policy relies heavily on its own independent national defense, which is based on conscription. In 2011, 26,492 conscripts started their military service in Finland. Of these, 1,706 interrupted their military service and 191 changed to civilian service. Conscripts who interrupt their service seem to have an increased tendency to smoking, alcohol consumption, and taking snuff, which previous studies suggest to have strong associations with the need for restorative dental treatment and with lower socioeconomic status. The aim of this study was to compare the general and oral health habits between Finnish conscripts who interrupt their service and those who completed their military service and to find out what general- and oral-health-related factors could be used in predicting interruption of service.

METHODS

The study population consisted of 13,819 conscripts taking an oral examination during the service. Of these, 8,449 answered a computer-based anamnestic questionnaire and 264 interrupted their service.Predisposing factors on the anamnestic questionnaire for interrupting military service were evaluated by using a binary logistic regression model. The statistically significant factors were selected to form a sum variable which finally consisted of seven predisposing questions. Odds ratio (OR) values and 95% confidence intervals were calculated for each question and for the sum variable. Predictive accuracy was assessed by area under the receiver-operating curve.

RESULTS

The most obvious predisposing factor among those who interrupted their service compared to the reference group was lack of weekly physical exercise (OR = 5.80). The risk for interruption of military service was 68.6 times higher in cases where a subject exhibited six predisposing factors out of seven compared to those who had none.

CONCLUSION

As a conclusion, a set of statistically chosen anamnestic questions could help identify conscripts who have an increased risk of interruption of military service in addition to a risk of dental problems.

Comparison of dental caries (DMFT and DMFS indices) between asthmatic patients and control group in Iran: a meta-analysis

Background

The association between caries index, which is diagnosed by Decayed, Missing, and Filled Teeth (DMFT), and asthma has been assessed in several studies, which yielded contradictory results. Meta-analysis is the statistical procedure for combining data from multiple studies and reducing the differences among parameters due to the increased number of studies involved in the analysis process. Therefore, the present study aimed to determine the relationship between dental caries using decayed, missing, filled teeth indices (DMFT, dmft, and DMFS indices) and asthma using meta-analysis.

Methods

Databases were searched using such keywords as “Asthma,” “Caries,” “DMFT,” “DMFS,” “Iran,” and OR operators, AND, and NOT. After the elimination of duplicate documentation, the articles which met the inclusion criteria were selected. Quality assessment was performed based on the Newcastle-Ottawa Quality Checklist (NOS). After that, standardized mean difference (SMD) of DMFT, dmft, and Decayed, Missing, and Filled Surfaces (DMFS) indices were estimated.

Results

The number of 10 evidence was extracted out of nine studies in which mean oral health indices were compared between asthmatic patients and the control group. Out of 10 evidences that examined the association of DMFT, dmft, and DMFS with asthma, these indices were higher in asthmatic patients than the control group in seven cases. In three cases, these differences were statistically significant. The SMD of DMFT, dmft, and DMFS indices between asthmatic patients and the control group at the confidence level of 95% were reported as 0.29 (− 0.05, 0.62), 0.48 (− 0.20, 1.17), and − 0.05(− 0.30, 0.21), respectively.

Conclusion

According to the results, the prevalence of dental caries is higher among patients with asthma than in the control group. Therefore, having asthma could be considered a risk factor for the development of dental caries.

Association between asthma and severe tooth loss in the adult population of the United States

OBJECTIVE

This study aimed to investigate the association between asthma and severe tooth loss in the U.S. (United States) adult population.

METHODS

Data were analyzed from the national health and nutritional examination survey (NHANES), 2009-2014. Study-participants were classified into current, former, and never asthmatics based on their asthma status. Former-asthmatics were excluded. The case definition of severe tooth loss (outcome variable) was having 9 or fewer remaining permanent teeth. Characteristics of our study-sample were identified based on the descriptive statistical analyses. Logistic regression analyses were performed to examine the association between asthma and severe tooth. Multivariable models were constructed to control for the known common clinical, demographic, and lifestyle factors. Each analysis accounted for the examination sample weights and the complex clustered design of the continuous NHANES.

RESULTS

Total study-participants were 14,184 representing ≈185.77 million U.S. adults. Prevalence of asthma was 8.99% in our study-sample, and 8.78% had severe tooth loss. Current-asthmatic adults had 34% higher odds of severe tooth loss as compared to their reference group of never-asthmatics adults in the U.S. after controlling for age, race or ethnicity, gender, diabetes, smoking, body mass index, education, and family income-to-poverty ratio.

CONCLUSION

In the United States, as compared to never-asthmatic adults, current-asthmatic adults were more likely to have severe tooth-loss. Oral health promotion is therefore recommended through medical-dental integration to ensure overall health for asthmatic adults.

Association between asthma and caries-related salivary factors: a meta-analysis

OBJECTIVES

This meta-analysis aimed to examine the comprehensive conclusive evidence of association between asthma and caries-related salivary factors including salivary pH (SpH), salivary flow rate (SFR), salivary buffer capacity (SBC), and other salivary components.

METHODS

Electronic databases (Web of Science, PubMed, Scopus, Cochrane Library, and Open Gray databases) were searched for relevant studies. After screening, studies were selected and data were collected from each study. The risk of bias in individual studies and across studies was evaluated. Mean differences (MD) were used to measure the effect estimates in the comparisons of SFR, SpH, SBC, and other salivary components. Additional analyses, namely sensitivity, subgroup, and Grades of Recommendation, Assessment, Development, and Evaluation analyses, were also conducted.

RESULTS

Eighteen and fourteen studies were included in the qualitative and quantitative synthesis, respectively. Significantly higher SFR (MD = -0.3, 95% CI [-0.39, -0.2], p < 0.001) and SpH (MD = -0.25, 95% CI [-0.45, -0.05], p = 0.01) were found in the reference group compared to the group with asthma. A significant difference in SBC was found only for unstimulated saliva (MD = -0.20, 95% CI [-0.24, -0.15], p < 0.001). No significant associations were found between asthma and other salivary components (p > 0.05).

CONCLUSIONS

Notwithstanding the limitations of this study, the evidence showed that SFR whether stimulated or unstimulated was significantly reduced in asthma patients. SBC and SpH were significantly reduced in asthma patients only when saliva was unstimulated. No evidence was found regarding the association between asthma and other salivary components.

Association between asthma and dental caries in US (United States) adult population

Objective: To investigate the associations of asthma with dental-caries-experience (DFT: decayed and filled teeth) and untreated-dental-caries (DT: decayed teeth) in the US adult population.Methods: Data from the National Health and Nutritional Examination Survey, 2009-2014 were analyzed. Study-participants were classified into current, former and never asthmatics based on their asthma-status. Former-asthmatics were excluded. Both the outcomes, dental-caries-experience and untreated-dental-caries were dichotomized as being either present or absent, and were also categorized into tertiles based on their distributions in our study-sample. Logistic regression analyses were performed to determine the associations of asthma with dichotomized outcomes. The generalized logit model was applied for multilevel categorical outcomes. Multivariable models were developed to control for common demographic, clinical, and lifestyle factors.Results: Total study-participants were 13,135, representing 175.26 million US adults. In the adjusted models, current-asthmatics, when compared to the reference group of never-asthmatics, were more likely to have dental-caries-experience (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.66) and untreated-dental-caries (OR, 1.38; 95% CI, 1.10-1.73) in ≥1 tooth. Asthma was associated with all three categories of dental-caries-experience in our study-sample. We observed a positive gradient in the OR with an increasing extent of untreated-dental-caries. Relative to never-asthmatics, asthma doubled the odds of having untreated dental caries in the subgroup of current-smokers.Conclusion: Current-asthmatic adults had higher odds of dental-caries-experience and untreated-dental-caries as compared to never-asthmatic adults in the US. Based on the observations from this study, interprofessional collaboration should be recommended to institute caries control and health promotion in current-asthmatic adult population.

Impact of asthma and its medication on salivary characteristics and oral health in adolescents: A cross-sectional comparative study

OBJECTIVE

To assess and compare the salivary characteristics and oral health and to evaluate the impact of asthma and its medication on dental caries among adolescents with and without asthma.

METHODS

A cross-sectional comparative study was conducted among 50 asthmatic and 50 nonasthmatic adolescents aged 12-15 years in Bangalore City. Data were acquired using a structured questionnaire. Salivary samples were collected to determine the flow rate, pH, buffering capacity, and Streptococcus mutans and Lactobacilli counts. Oral health assessment was performed using WHO 2013 proforma. Inferential statistics such as chi-square, student's t-test, spearman's correlation, multinomial logistic. and stepwise linear regression were applied with P < .05 considered as significant.

RESULTS

Asthmatic participants had significantly higher mean number of teeth with dental caries, gingival bleeding, and dental erosion than nonasthmatics (P < .05). The prevalence of fluorosis, traumatic dental injuries, and oral mucosal lesions in asthmatics were 34.0%, 38.0%, and 28.0%, respectively. Most of the asthmatic participants required preventive or routine (18.0%) and prompt treatment (30.0%). Statistically significant difference was found in the flow rate, pH, buffering capacity, S. mutans and Lactobacilli counts, and Decayed, Missing, Filled Teeth (DMFT) index between asthmatic and nonasthmatic participants. Severity of asthma, medication use, and dental caries experience significantly correlated with low salivary flow rate, pH and buffering capacity, and higher levels of S. mutans and Lactobacilli (P < .001). Asthmatic participants had significantly higher odds of having very low unstimulated salivary flow rate (odds ratio [OR] = 3.2), buffering capacity (OR = 2.94), highly acidic pH (OR = 3.65), high risk of S. mutans (OR = 6.02), and DMFT ≥ 1 (OR = 2.06) than nonasthmatics (P < .05).

CONCLUSION

Salivary characteristics and oral health were significantly poor in asthmatic adolescents. Asthma and its medications had significant impact on salivary characteristics and dental caries among asthmatic adolescents.

Enhancement of cariogenic virulence properties of dental plaque in asthmatics

OBJECTIVE

The aim of this study was to investigate the caries risk of asthmatics in relation to acidogenicity and the expression of caries-related genes in dental plaque.

METHODS

A case-control study composed of 38 asthmatics (cases) and 22 controls with an age range from 6 to 60 years. Characteristics of asthma, use of medications, oral hygiene practices and dietary habits assessed by questionnaires and interviews. The dental plaque maturity evaluated using GC Tri Plaque ID Gel TM. The expression of brpA, gtfB, gbpB, ldh, luxS and spaP genes analyzed using real-time PCR.

RESULTS

Asthmatics had a higher percentage of mature and acidogenic plaque than immature plaque. In contrast, immature plaque was more evident in controls. Acidogenic plaque commonly occurred in patients using 1 or a combination of two medications. High frequency in meals and sweets were found in asthmatics. Real-time PCR revealed that the expression of spaP, gtfB, gbpB, ldh, brpA and luxS were enhanced in asthmatics compared with the control group.

CONCLUSION

An increase in acidogenic and mature plaque is found in asthmatics. The expression of spaP, gtfB, gbpB, ldh, brpA and luxS in dental plaque are upregulated in asthmatics.