Association between Dental Caries and Down Syndrome: A Systematic Review and Meta-Analysis

Abstract

Scientific evidence of susceptibility to dental caries in the population with Down Syndrome (DS) is limited and conflicting, making it difficult to establish firm conclusions. The aim of this systematic review and meta-analysis was to obtain scientific evidence of the possible association between dental caries and individuals with DS, compared to individuals without DS (control). An electronic search of five databases was performed, with no language or publication date restrictions. The studies were selected by two independent reviewers (Kappa = 0.83). The systematic review included 13 studies, while eight studies were included in the meta-analysis. The studies are presumably all at risk of bias given their observational character. Two of these evaluated the presence or absence of caries in permanent and deciduous teeth, and six evaluated the mean DMFT index in permanent teeth. Combined odds ratios (OR), standard difference, standard error and a 95% confidence interval (CI) were obtained. The vast majority of the studies found that individuals from control groups had more carious lesions or caries experience than those with DS. The results were statistically significant in seven studies (p<0.05). Meta-analysis of two studies revealed that individuals with DS had a lower dental caries than those in the control group (OR = 0.36; 95% CI = 0.22–0.57). In six studies, individuals with DS had a significantly lower mean DMFT index than individuals from the control group (Sd = -0.18; SE = 0.09; 95% CI = -0.35–-0.02). The quality of the studies varied and in general had a high risk of bias. Scientific evidence suggests that individuals with DS have fewer dental caries than individuals without DS.

The Relationship of Parents Knowledge Level and Socioeconomic Factor to Oral Health of Down Syndrome Children

“…All of these could be caused by several factors, including parents too busy so it was hard to assist children in brushing their teeth, there is no time to control regularly to the dentist, difficulty to control children for dental care, economic status, communication problems and the attitude of children who were not cooperative (McDonald and Avery, 1994;Normastura et al, 2013). This study was consistent with Deps et al (2015), which highlighted from previous studies that a higher caries prevalence in children with Down syndrome caused by some local determinant factors of caries (difficult access to dental care, poor dietary habits, use drugs for severe infections of the upper airways, reduced manual dexterity, poor oral hygiene, parental neglect) extended over protective factors (such as the buffer capacity of saliva, bruxism, diastema, agenesis and microdontia). On the other hand, Areias et al (2012) have found that the lower number of mutans streptococci could be one of the factors contributing to the lower caries rate in Down syndrome children.…”

Malocclusion in children and adolescents with Down syndrome: A systematic review and meta‐analysis

“…The literature has already recognized that the prevalence of periodontal outcomes among DS children/adolescents is higher than among individuals without DS . On the other hand, the prevalence of dental caries is lower among DS young individuals in comparison with non‐DS individuals . Based on different diagnostic parameters, the 11 studies included in this systematic review demonstrated that children/adolescents with DS have a higher prevalence of malocclusion compared to their peers without DS .…”

“…Oral conditions, such as dental caries and periodontal disease among individuals with DS, have been largely discussed in the scientific literature by means of systematic reviews and meta‐analysis. No systematic attempt, however, has been carried out to summarize the evidence regarding the susceptibility to malocclusion among individuals with DS thus far .…”

Oral Health of Down Syndrome Adults in Bosnia and Herzegovina

“…The vast majority of published studies report a lower prevalence and experience of caries in this group of individuals than in groups not affected by DS and groups with other disabilities, while a smaller number of studies, however, have highlighted an equivalent or higher prevalence of caries in individuals with DS (4). …”