Asthma and oral changes in children: Associated factors in a community of southern Brazil

The Association Between Long-Term Corticosteroids Use and Dental Caries: A Systematic Review

Corticosteroids (CSs) are a group of medications prescribed regularly to treat a wide range of inflammatory and immune-related conditions with great benefit. The impact of long-term use of CSs on the oral cavity has been reported before, including increased risk of periodontal disease and dental caries. Thus, the aim of this study is to evaluate the prevalence of dental caries in patients using CSs. A literature review was completed using PubMed and Cochrane search engines. The search was based on questions related to adults and children (P); corticosteroids (I); no corticosteroids (C); and dental caries (O) (PICO questions) using the keywords "steroids" and "caries" with all relevant variations and MeSH terms. Decay missing filling tooth/decay missing filling surface (DMFT/DMFS) scores were selected as parameters to assess the effects of CSs on caries prevalence. Data was extracted and analyzed for comparisons. The search yielded 1,206 articles from January 2001 to January 2023, of which 21 papers were eligible for analysis. Overall, 14 studies reported an increase in caries with CSs use. However, seven studies failed to report an association of caries prevalence with CSs use. Current evidence supports the correlation between increased risk of caries with chronic CSs use, specifically for inhaler formulation. Future studies with randomized controlled clinical studies are warranted to confirm these findings.

Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health

Asthma is a chronic, heterogeneous respiratory pathology characterized by reversible airway inflammation. Therapeutics focus on symptom reduction and control, aimed at preserving normal pulmonary function and inducing bronchodilatation. The objective of this review is to describe the adverse effects produced by anti-asthmatic drugs on dental health, according to the reported scientific evidence. A bibliographic review was carried out on databases, such as Web of science, Scopus, and ScienceDirect. Most anti-asthmatic medications are administered using inhalers or nebulizers, making it impossible to avoid contact of the drug with hard dental tissues and oral mucosa, and thus promoting a greater risk of oral alterations, mainly due to decreases in the salivary flow and pH. Such changes can cause diseases, such as dental caries, dental erosion, tooth loss, periodontal disease, bone resorption, as well as fungal infections, such as oral candidiasis.

The association between erosive toothwear and asthma - is it significant? A meta-analysis

BACKGROUND

The association of asthma with oral conditions such as dental caries, dental erosion, periodontal diseases and oral mucosal changes has been the subject of debate among dental practitioners. Existing evidence indicates that an inhaler is the most common and effective way of delivering the asthma medications directly into the lungs. Few studies in the past attributed this association to the changes in salivary flow caused due to these medications. Considering this unclear association, the aim of the present meta-analyses is to identify the association between erosive toothwear and asthma from individual studies conducted until date.

METHODOLOGY

Electronic databases were systematically searched until 30th September 2022. Articles identified using the search strategy were imported to RAYYAN systematic review software. Data was extracted relating to study design, geographic location, year of publication, sample size, the assessment method for erosive toothwear and asthma. The Newcastle Ottawa scale was utilized to assess the quality of evidence reported from the included studies. RevMan Version 5.3 was used to perform a random-effects meta-analysis to produce pooled estimates from OR and 95% CI of included studies. The I² statistic was used to determine the extent of heterogeneity. A funnel plot was generated to visually assess the potential for publication bias. Sensitivity analyses were performed by excluding individual studies one at a time. GRADE approach was used for grading the evidence for key comparisons.

RESULTS

Twelve articles were included in the final meta-analysis. A total of 1027 asthmatics and 5617 non-asthmatics were included. All studies demonstrated moderate to low risk of bias. The overall pooled estimate (OR: 2.03; 95% CI: 0.96, 4.29) and subgroup analyses in children (OR: 1.67; 95% CI: 0.63, 4.42) did not show statistically significant difference in the occurrence of dental erosion between the asthmatic and non-asthmatic group. However, asthmatic adults had significantly greater dental erosion in comparison to the control adults (OR: 2.76; 95% CI: 1.24, 6.16). Sensitivity analyses also provided inconclusive evidence. Funnel plot asymmetry indicated significant heterogeneity, changes in effect size and selective publication.

CONCLUSION

The association between inhalational asthmatic medication and tooth wear is inconclusive. There are a number of confounding factors that play a greater role in causing dental erosion in these patients. Dentist must pay particular attention to these factors while treating asthmatic patients. The authors produce a comprehensive checklist in order to ensure complete assessment before providing advice on their medications alone.

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.

Malocclusions in Pediatric Patients with Asthma: A Case-Control Study

Asthma is a public health problem that has been widely described, but little has been reported about its effects on dental occlusions. The aim of this study was to compare the alterations of normal occlusions in asthmatic children and those without the disease. The study included 186 patients between 5 and 12 years old, divided into two groups. The first group included patients with a previous diagnosis of asthma given by a specialist, which was confirmed by using the International Study of Asthma and Allergies in Childhood questionnaire. The second group included patients without the disease. All patients underwent a clinical examination to determine the presence of occlusion alterations in the sagittal, transverse, and vertical planes. Subsequently, chi-squared tests were performed to compare the variables between the groups. A significant association was found between asthma and the variables studied here: alterations in the sagittal plane (chi2 = 7.839, p = 0.005), alterations in the vertical plane (chi2 = 13.563, p < 0.001), alterations in the transverse plane (Fisher’s F p < 0.001), and oral habits (chi2 = 55.811, p < 0.001). The results suggest that asthmatic patients are more likely to develop malocclusions, especially anterior open bite and posterior crossbite. These conditions are typically related to mouth breathing, which is common in asthmatic patients.

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.

Association between asthma and enamel defects in primary and young permanent teeth - A systematic review

Childhood respiratory diseases, such as asthma, are important public health problems worldwide and could be associated with tooth enamel defects. This study aimed to verify the relationship between asthma and enamel defects in teeth, to answer the following question: "Could asthma in children be significantly associated with enamel defects in deciduous dentition and young permanent teeth?." PUBMED-MEDLINE, EMBASE, LILACS, and COCHRANE databases were systematically searched and assessed articles (2000-2021) were cautiously scored according to a predetermined criterion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were considered. Twenty-two articles were critically appraised and used as a basis for conclusions. The relationship between asthma and enamel defects was confirmed in the majority of appraised papers, one with a high level of evidence, nine with a moderate level, and four with a low level. Out of the eight manuscripts investigating the influence of asthma medication on enamel defects, only three (one with high, one moderate, and another with a low level of evidence) suggested an association. It can be concluded that asthma is closely connected with enamel defects in young permanent teeth. However, as most of the papers appraised were of cross-sectional or case-control design, further well-designed clinical investigations with a prospective design are welcome to reinforce our findings.

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.

Relation between Childhood Asthma and Dental Erosion in Al-Kharj Region of Saudi Arabia: A Cross-Sectional Study

Background:

Asthma is a long-lasting disease that affects large number of the society and could impact on the oral health leading to increase in the needs of prevention and treatment. Currently, the prevalence of childhood asthma in Saudi Arabia is ranging from 9% to 33%.

Objective:

the objective was to evaluate dental erosion in control children and those with asthma.

Materials and Methods:

This was a cross-sectional study, with a sample of 100 children aged 3–12 years. Equally distribution of subjects was between the asthmatic and non-asthmatic group, at Prince Sattam Bin Abdulaziz University Dental Clinics, Alkharj, Saudi Arabia. The assessment consisted of an oral examination assessing erosive wear according to the American Academy of Pediatrics 2018 guidelines and a questionnaire to the parents/guardians addressing the background details and information about the child asthma.

Results:

Among 12 (24%) asthmatic children and 9 (18%) non-asthmatic children had dental erosion. In the adjusted analysis, no association was found between asthma and erosion. It has been shown that oral hygiene may have an effect occurrence or severity of erosion; brushing teeth once or more per day appeared to have less incidence of dental erosion compared with those not brushing their teeth regularly.

Conclusions:

This article provided no additional data than that given earlier, where no correlation was observed between asthma and dental erosion in children aged from 3 to 12 years.

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.

The effect of various asthma medications on surface roughness of pediatric dental restorative materials: An atomic force microscopy and scanning electron microscopy study

The aim of the study is to examine and compare the effects of various inhaled asthma medications (IAMs) on the surface roughness of dental restorative materials (DRMs). In total, 192 samples were prepared including 32 samples for the each material group from six different DRMs [Nanohybrid composite (Filtek Z550), Nanofilled flowable composite (Filtek Ultimate), Compomer (Dyract XP), Conventional glass ionomer (Fuji IX Fast), Resin-modified glass ionomer (Fuji II LC), Self-adhering flowable composite (Fusio Liquid Dentin)]. Each group, were divided into four subgroups (n = 8) according to four different IAMs. Surface roughness values (Ra) were obtained by atomic force microscopy (AFM). After the initial roughness of DRMs was analyzed by using AFM and scanning electron microscopy (SEM), each samples were exposed to the same IAMs for 21 days and all analysis were repeated on the 7th and 21st day. Ras increased in all DRMs and higher Ras were recorded through the long-term IAMs administrations. For all IAMs, Fuji II LC had the highest Ra and Filtek Z550 had the lowest Ra. The combined IAM created the highest roughness change on the 7th and 21st day compared to other IAMs. As a result, in in vitro conditions IAMs significantly increased the surface roughness of DRMs.

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.

Asthma, long-term asthma control medication and tooth wear in American adolescents and young adults

OBJECTIVE

This study explored the associations of asthma and long-term asthma control medication with tooth wear among American adolescents and young adults.

METHODS

Data from 2186 participants of the National Health and Nutrition Examination Survey (NHANES) were used. Asthma and prescribed long-term medication were collected through questionnaires. The number of surfaces with tooth wear was determined during clinical examinations. Associations were tested in Hurdle regression models adjusting for confounders.

RESULTS

The prevalence of tooth wear was 58%, with an average of 6.1 (SD: 4.0) surfaces affected among those with the condition. The prevalence of asthma was 10.3%, with 2.9% of participants using long-term medication for asthma control. In the adjusted regression model, asthma was not associated with tooth wear. However, long-term control medication was associated with greater odds of having tooth wear (odds ratio: 3.33; 95%CI: 1.24-8.97), but it was not associated with the number of surfaces with tooth wear among those with the condition (rate ratio: 1.01; 95% CI: 0.58-1.75).

CONCLUSION

This cross-sectional analysis of national data shows that taking long-term asthma medication was positively associated with having tooth wear.

Independent Variables of Dental Erosion among Tertiary Care Hospital Patients of a Developing Country

Background and Aim

Dental erosion is a multifactorial condition, which is mostly influenced by environmental factors. The aim of this study was to determine the prevalence of dental erosion, its associated risk factors, and their correlation with severity of the condition.

Materials and Methods

A total of 430 patients who attended the outpatient section of Government Dental College, Thiruvananthapuram, Kerala, India, were selected by systematic sampling method. Erosion was diagnosed by clinical examination and graded using Basic Erosive Wear Examination (BEWE) index. A pretested structured questionnaire on age, gender, medical history, medication history, and food habits was used.

Results and Conclusion

Among the study population, 44% (95% confidence interval, 39.3%-48.7%) had dental erosion. Age above 45 years (79.7%, P = 0.000), male population (50%, P = 0.032), residents of rural area (49.1%, P = 0.000), patients with asthma (84.2%, P = 0.000), diabetes (90.9%, P = 0.000), gastroesophageal reflux disorder (91.7%, P = 0.001), and frequent consumption of orange (68.9%, P = 0.000) were identified as factors associated with erosion. The prevalence of dental erosion in the community was high. Results of the study established that better awareness of the condition, better facilities for its early diagnosis in the community, and development of proper preventive strategies are required to reduce the severity of dental erosion.