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BMC Oral Health
Published in: BMC Oral Health 1/2019

Open Access 01-12-2019 | Trisomy 21 | Research article

Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis

Authors: Mark D. Robertson, Falk Schwendicke, Mariana Pinheiro de Araujo, John R. Radford, Jenny C. Harris, Scott McGregor, Nicola P. T. Innes

Published in: BMC Oral Health | Issue 1/2019

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Abstract

Background

Children with learning disabilities (CLD) have worse health outcomes than children with no learning disabilities (CNLD). This systematic review compared caries experience and met dental care need for CLD to CNLD using Decayed, Missing, Filled Permanent Teeth (DMFT) and decayed, missing/extracted, filled primary teeth (dmft/deft), care index (CI), and restorative index (RI) values.

Methods

Without date or language restrictions four databases were searched for; cross-sectional studies comparing caries experience and CI/ RI in CLD matched to groups of CNLD. Screening and data extraction were carried out independently and in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were carried out (random effects model).

Results

There were 25 articles with 3976 children (1 to 18 years old), from 18 countries, fitting the inclusion criteria. Children with; Down syndrome were investigated in 11 studies, autism in 8 and mixed learning disabilities in 6. The overall mean DMFT for CLD was 2.31 (standard deviation±1.97; range 0.22 to 7.2) and for CNLD was 2.51 (±2.14; 0.37 to 4.76). Using standardised mean difference (SMD), meta-analysis showed no evidence of a difference between CLD and CNLD (n = 16 studies) for caries experience (SMD = -0.43; 95%CI = -0.91 to 0.05). This was similar for sub-groups of children with autism (SMD = -0.28; 95%CI = 1.31 to 0.75) and mixed disabilities (SMD = 0.26; 95%CI = -0.94 to 1.47). However, for children with Down syndrome, caries experience was lower for CLD than CNLD (SMD = -0.73; 95%CI = -1.28 to − 0.18). For primary teeth, mean dmft/deft was 2.24 for CLD and 2.48 for CNLD (n = 8 studies). Meta-analyses showed no evidence of a difference between CLD and CNLD for caries experience across all disability groups (SMD = 0.41; 95% CI = -0.14 to 0.96), or in sub-groups: Down syndrome (SMD = 0.55; 95%CI- = − 0.40 to 1.52), autism (SMD = 0.43; 95%CI = -0.53 to 2.39) and mixed disabilities (SMD = -0.10; 95%CI = -0.34 to 0.14). The studies’ risk of bias were medium to high.

Conclusion

There was no evidence of a difference in caries levels in primary or permanent dentitions for CLD and CNLD. This was similar for learning disability sub-groups, except for Down syndrome where dental caries levels in permanent teeth was lower. Data on met need for dental caries was inconclusive.

Trial registration

The protocol was published in PROSPERO: CRD42017068964 (June 8th, 2017).
Appendix
Available only for authorised users
Literature
1.
Emerson E. Deprivation, ethnicity and the prevalence of intellectual and developmental disabilities. J Epidemiol Community Health. 2012;66(3):218-24.PubMedCrossRef
2.
3.
Lancioni GE, O'Reilly MF. Teaching food preparation skills to people with intellectual disabilities: a literature overview. J Appl Res Intellect Disabil. 2002;15(3):236–53.CrossRef
4.
5.
Allerton LA, Welch V, Emerson E. Health inequalities experienced by children and young people with intellectual disabilities: a review of literature from the United Kingdom. J Intellect Disabil. 2011;15(4):269–78.PubMedCrossRef
6.
Jansen DE, Krol B, Groothoff JW, Post D. People with intellectual disability and their health problems: a review of comparative studies. J Intellect Disabil Res. 2004;48(Pt 2):93–102.PubMedCrossRef
7.
Marmot M. The Marmot review final report: fair society, healthy lives: strategic review of health inequalities in England post-2010. London: University College; 2010.
8.
Anders PL, Davis EL. Oral health of patients with intellectual disabilities: a systematic review. Spec Care Dentist. 2010;30(3):110–7.PubMedCrossRef
9.
da Silva SN, Gimenez T, Souza RC, Mello-Moura ACV, Raggio DP, Morimoto S, et al. Oral health status of children and young adults with autism spectrum disorders: systematic review and meta-analysis. Int J Paediatr Dent. 2017;27(5):388–98.PubMedCrossRef
10.
Moreira MJ, Schwertner C, Jardim JJ, Hashizume LN. Dental caries in individuals with Down syndrome: a systematic review. Int J Paediatr Dent. 2016;26(1):3–12.PubMedCrossRef
11.
Zhou N, Wong HM, Wen YF, McGrath C. Oral health status of children and adolescents with intellectual disabilities: a systematic review and meta-analysis. Dev Med Child Neurol. 2017;59(10):1019–26.PubMedCrossRef
12.
Sgan-Cohen HD, Evans RW, Whelton H, Villena RS, MacDougall M, Williams DM, et al. IADR global Oral health inequalities research agenda (IADR-GOHIRA(R)): a call to action. J Dent Res. 2013;92(3):209–11.PubMedCrossRef
13.
Shahtahmasebi S, Emerson E, Berridge D, Lancaster G. Child disability and the dynamics of family poverty, hardship and financial strain: evidence from the UK. J Soc Policy. 2011;40(4):653–73.CrossRef
14.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.PubMedPubMedCentralCrossRef
15.
Al Habashneh R, Al-Jundi S, Khader Y, Nofel N. Oral health status and reasons for not attending dental care among 12- to 16-year-old children with Down syndrome in special needs centres in Jordan. Int J Dent Hyg. 2012;10(4):259–64.PubMedCrossRef
16.
Al-Maweri SA, Halboub ES, Al-Soneidar WA, Al-Sufyani GA. Oral lesions and dental status of autistic children in Yemen: A case-control study. J Int Soc Prev Community Dent. 2014;4(Suppl 3):S199–203.PubMedPubMedCentralCrossRef
17.
AlSarheed M. A comparative study of oral health amongst trisomy 21 children living in Riyadh, Saudi Arabia: part 1 caries, malocclusion, trauma. Saudi Dent J. 2015;27(4):220–3.PubMedPubMedCentralCrossRef
18.
Areias C, Sampaio-Maia B, Macho V, Leal I, Melo P, de Andrade C. Does the chemistry in the saliva of Down syndrome children explain their low caries prevalence? Eur J Paediatr Dent. 2013;14(1):23–6.PubMed
19.
Bhandary S, Hari N. Salivary biomarker levels and oral health status of children with autistic spectrum disorders: a comparative study. Eur Arch Paediatr Dent. 2017;18(2):91–6.PubMedCrossRef
20.
Cornejo LSZ, A G, Dorronsoro de Cattoni ST, Calamari SE, Azcurra AI, Battellino LJ. Bucodental health condition in patients with Down syndrome of Cordoba City, Argentina. Acta Odontol Latinoam. 1996;9(2):65–79.PubMed
21.
Davidovich E, Aframian DJ, Shapira J, Peretz B. A comparison of the sialochemistry, oral pH, and oral health status of Down syndrome children to healthy children. Int J Paediatr Dent. 2010;20(4):235–41.PubMedCrossRef
22.
El Khatib AA, El Tekeya MM, El Tantawi MA, Omar T. Oral health status and behaviours of children with autism Spectrum disorder: a case-control study. Int J Paediatr Dent. 2014;24(4):314–23.PubMedCrossRef
23.
Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. European archives of Paediatric dentistry: official journal of the European academy of Paediatric. Dentistry. 2015;16(2):205–9.
24.
Forsberg H, Quick-Nilsson I, Gustavson KH, Jagell S. Dental health and dental care in severely mentally retarded children. Swed Dent J. 1985;9(1):15–28.PubMed
25.
Hashizume LN, Schwertner C, Moreira MJS, Coitinho AS, Faccini LS. Salivary secretory IgA concentration and dental caries in children with Down syndrome. Special care in dentistry: official publication of the American association of hospital dentists, the academy of dentistry for the handicapped, and the American society for geriatric. Dentistry. 2017;37(3):115–9.
26.
27.
Mathias MF, Simionato MR, Guare RO. Some factors associated with dental caries in the primary dentition of children with Down syndrome. Eur J Paediatr Dent. 2011;12(1):37–42.PubMedCrossRef
28.
Moreira RN, Alcantara CE, Mota-Veloso I, Marinho SA, Ramos-Jorge ML, Oliveira-Ferreira F. Does intellectual disability affect the development of dental caries in patients with cerebral palsy? Res Dev Disabil. 2012;33(5):1503–7.PubMedCrossRef
29.
Subramaniam P, Girish Babu K, Mohan Das L. Assessment of salivary total antioxidant levels and oral health status in children with Down syndrome. Special care in dentistry: official publication of the American association of hospital dentists, the academy of dentistry for the handicapped, and the American society for geriatric. Dentistry. 2014;34(4):193–200.
30.
Yashoda R, Puranik MP. Oral health status and parental perception of child oral health related quality-of-life of children with autism in Bangalore, India. J Indian Soc Pedod Prev Dent. 2014;32(2):135–9.PubMedCrossRef
31.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
32.
33.
Margulis AV, Pladevall M, Riera-Guardia N, Varas-Lorenzo C, Hazell L, Berkman ND, et al. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle-Ottawa scale and the RTI item bank. Clin Epidemiol. 2014;6:359–68.PubMedPubMedCentralCrossRef
34.
Areias CM, Sampaio-Maia B, Guimaraes H, Melo P, Andrade D. Caries in Portuguese children with Down syndrome. Clinics (Sao Paulo). 2011;66(7):1183–6.PubMedCentralCrossRef
35.
Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent. 2010;4(4):361–6.PubMedPubMedCentral
36.
Areias C, Sampaio-Maia B, Pereira Mde L, Azevedo A, Melo P, Andrade C, et al. Reduced salivary flow and colonization by mutans streptococci in children with Down syndrome. Clinics (Sao Paulo). 2012;67(9):1007–11.CrossRef
37.
Mohinderpal Chadha G, Kakodkar P, Chaugule V, Nimbalkar V. Dental survey of institutionalized children with autistic disorder. Int J Clin Pediatr Dent. 2012;5(1):29–32.PubMedPubMedCentralCrossRef
38.
Bakarcic DP, Ivancic-Jokic N, Bilic I, Lajnert V, Bukovic D. Dental status as a quality control health care parameter for children with disabilities. Coll Antropol. 2009;33(1):139–42.PubMed
39.
Fahlvik-Planefeldt CH. P. Dental care of autistic children within the non-specialized public dental service. Swed Dent J. 2001;25(3):113–8.PubMed
40.
Fuertes-González MC, Silvestre FJ. Oral health in a group of patients with Rett syndrome in the regions of Valencia and Murcia (Spain): A case-control study. Med Oral Patol Oral Cir Bucal. 2014;19(6):e598–604.PubMedPubMedCentralCrossRef
41.
Fung K, Lawrence H, Allison P. A paired analysis of correlates of dental restorative care in siblings with and without Down syndrome. Spec Care Dentist. 2008;28(3):85–91.PubMedCrossRef
42.
Lowe OL. R. Assessment of the autistic patient's dental needs and ability to undergo dental examination. ASDC J Dent Child. 1985;52(1):29–35.PubMed
43.
Macho V, Palha M, Macedo AP, Ribeiro O, Andrade C. Comparative study between dental caries prevalence of Down syndrome children and their siblings. Special care in dentistry: official publication of the American association of hospital dentists, the academy of dentistry for the handicapped, and the American society for geriatric. Dentistry. 2013;33(1):2–7.
44.
Mattila MLR.; Paunio, P.; Hyssala, L.; Helenius, H.; Sillanpaa, M.; Ojanlatva, A. Impact of dental health care on dental health of children with long-term diseases: a nested case-control study. J Clin Dent. 2001;12(3):77–82.
45.
Oredugba FA. Oral health condition and treatment needs of a group of Nigerian individuals with Down syndrome. Downs Syndr Res Pract. 2007;12(1):72–6.PubMedCrossRef
46.
Pollard MA, Curzon ME. Dental health and salivary Streptococcus mutans levels in a group of children with heart defects. Int J Paediatr Dent. 1992;2(2):81–5.PubMedCrossRef
47.
Purohit BM, Acharya S, Bhat M. Oral health status and treatment needs of children attending special schools in South India: a comparative study. Special care in dentistry: official publication of the American association of hospital dentists, the academy of dentistry for the handicapped, and the American society for geriatric. Dentistry. 2010;30(6):235–41.
48.
Radha G, Swathi V, Jha A. Assessment of salivary and plaque pH and oral health status among children with and without intellectual disabilities. J Indian Soc Pedod Prev Dent. 2016;34(3):257–61.PubMedCrossRef
49.
Du RY, Yiu CK, King NM, Wong VC, McGrath CP. Oral health among preschool children with autism spectrum disorders: A case-control study. Autism. 2015;19(6):746–51.PubMedCrossRef
50.
Rai K, Hegde AM, Jose N. Salivary antioxidants and oral health in children with autism. Arch Oral Biol. 2012;57(8):1116–20.PubMedCrossRef
51.
Vishnu Rekha C, Arangannal P, Shahed H. Oral health status of children with autistic disorder in Chennai. European archives of Paediatric dentistry: official journal of the European academy of Paediatric. Dentistry. 2012;13(3):126–31.
52.
Ruiz LA, Diniz MB, Loyola-Rodriguez JP, Habibe CH, Garrubbo CC, Santos MT. A controlled study comparing salivary osmolality, caries experience and caries risk in patients with cerebral palsy. Medicina Oral. Patologia Oral Y Cirugia Bucal. 2018;23(2):e211–e5.
53.
Sarnat H, Samuel E, Ashkenazi-Alfasi N, Peretz B. Oral health characteristics of preschool children with autistic syndrome disorder. J Clin Pediatr Dent. 2016;40(1):21–5.PubMedCrossRef
54.
Shaw L, Maclaurin ET, Foster TD. Dental study of handicapped children attending special schools in Birmingham, UK. Community Dent Oral Epidemiol. 1986;14(1):24–7.PubMedCrossRef
55.
Suhaib F, Saeed A, Gul H, Kaleem M. Oral assessment of children with autism spectrum disorder in Rawalpindi, Pakistan. Autism. 2017;01:1362361317730299.
56.
Subramaniam P, Gupta M. Oral health status of autistic children in India. J Clin Pediatr Dent. 2011;36(1):43–7.PubMedCrossRef
57.
Weckwerth SA, Weckwerth GM, Ferrairo BM, Chicrala GM, Ambrosio AM, Toyoshima GH, et al. Parents' perception of dental caries in intellectually disabled children. Special care in dentistry: official publication of the American association of hospital dentists, the academy of dentistry for the handicapped, and the American society for geriatric. Dentistry. 2016;36(6):300–6.
58.
Namal N, Vehit HE, Koksal S. Do autistic children have higher levels of caries? A cross-sectional study in Turkish children. J Indian Soc Pedod Prev Dent. 2007;25(2):97–102.PubMedCrossRef
59.
Jokic NIM, Bakarcic D, Katalinic A, Szirovicza L. Dental caries in disabled children. Coll Anthropol. 2007;31(1):321–4.
60.
Palin T, Hausen H, Alvesalo L, Heinonen OP. Dental health of 9--10-year-old mentally retarded children in eastern Finland. Community Dent Oral Epidemiol. 1982;10(2):86–90.PubMedCrossRef
61.
Lee SR, Kwon HK, Song KB, Choi YH. Dental caries and salivary immunoglobulin A in Down syndrome children. J Paediatr Child Health. 2004;40(9–10):530–3.PubMedCrossRef
62.
Pope JE, Curzon ME. The dental status of cerebral palsied children. Pediatr Dent. 1991;13(3):156–62.PubMed
63.
Stabholz AM, Sela M, Schurr D, Steinberg D, Shapira J. Caries experience, periodontal treatment needs, salivary pH, and Streptococcus mutans counts in a preadolescent Down syndrome population. Spec Care Dentist. 1991;11(5):203–8.PubMedCrossRef
64.
Bakry NS, Alaki SM. Risk factors associated with caries experience in children and adolescents with intellectual disabilities. J Clin Pediatr Dent. 2012;36(3):319–23.PubMedCrossRef
65.
Cogulu D, Sabah E, Kutukculer N, Ozkinay F. Evaluation of the relationship between caries indices and salivary secretory IgA, salivary pH, buffering capacity and flow rate in children with Down's syndrome. Arch Oral Biol. 2006;51(1):23–8.PubMedCrossRef
66.
Bakry NS, Alaki SM. Risk factors associated with caries experience in children and adolescents with intellectual disabilities. J Clin Pediatr dent. 2012;36(3):319–23.PubMedCrossRef
67.
Cornejo LS, Zak GA, Dorronsoro de Cattoni ST, Calamari SE, Azcurra AI, Battellino LJ. Bucodental health condition in patients with Down syndrome of Cordoba City, Argentina. Acta Odontol Latinoam. 1996;9(2):65–79.PubMed
68.
Fahlvik-Planefeldt C, Herrstrom P. Dental care of autistic children within the non-specialized. Public Dental Service Swed Dent J. 2001;25(3):113–8.PubMed
69.
Stabholz A, Mann J, Sela M, Schurr D, Steinberg D, Shapira J. Caries experience, periodontal treatment needs, salivary pH, and Streptococcus mutans counts in a preadolescent Down syndrome population. Spec Care Dentist. 1991;11(5):203–8.PubMedCrossRef
70.
Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. Eur Arch Paediatr Dent. 2015;16(2):205–9.PubMedCrossRef
71.
Reid SM, Meehan EM, Arnup SJ, Reddihough DS. Intellectual disability in cerebral palsy: a population-based retrospective study. Dev Med Child Neurol. 2018;60(7):687–94.PubMedCrossRef
72.
Fung K, Allison PJ. A comparison of caries rates in non-institutionalized individuals with and without Down syndrome. Special care in dentistry: official publication of the American association of hospital dentists, the academy of dentistry for the handicapped, and the American society for geriatric. Dentistry. 2005;25(6):302–10.
73.
Gupta E, Innes N, Schuller AA, Vermaire JH, Marshman Z. A scoping review of the uses of the care index in children. Community Dent Health. 2017;34(3):131–6.PubMed
74.
Deeks JJ, Higgins JPT, Altman DG. Analysing data and undertaking meta-analyses. Cochrane handbook for systematic reviews of interventions: Cochrane book series; 2008. p. 243–96.CrossRef
75.
Glasziou P, Altman DG, Bossuyt P, Boutron I, Clarke M, Julious S, et al. Reducing waste from incomplete or unusable reports of biomedical research. Lancet. 2014;383(9913):267–76.PubMedCrossRef
Metadata
Title
Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis
Authors
Mark D. Robertson
Falk Schwendicke
Mariana Pinheiro de Araujo
John R. Radford
Jenny C. Harris
Scott McGregor
Nicola P. T. Innes
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2019
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-019-0795-4

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