Oral health in children and adolescents with juvenile idiopathic arthritis – a systematic review and meta-analysis

Abstract

BackgroundObservational studies examining the association between oral health and juvenile idiopathic arthritis (JIA) among children and adolescents have reported inconsistent findings. The aims of this systematic review and meta-analysis were to ascertain a potential difference in oral health and oral health-related quality of life (OHRQoL) among children and adolescents with JIA and healthy peers, and to assess the association of prevalence of oral diseases/conditions, temporomandibular disorders (TMD), including temporomandibular joint (TMJ) diseases, in relation to activity and severity of JIA.MethodMedline Ovid, Embase, CINAHL, SweMed+ and Cochrane Library were searched up to 25 November 2018. All articles published in English, German and Scandinavian languages focusing on children and adolescents with JIA and without JIA in relation to oral health measures, were considered. Two authors independently evaluated observational studies for inclusion. The study quality was assessed using modified Newcastle Ottawa Scale. Meta-analysis was performed for studies focusing on dental caries as an outcome.ResultsNineteen articles met the inclusion criteria, covering a range of oral diseases/conditions and OHRQoL. Eighteen studies had cross-sectional design. No mean difference of dmft/DMFT indices (decayed/missed/filled teeth) was observed between the JIA - and healthy group. None of the oral health measures including dental erosive wear, enamel defects, dental maturation and OHRQoL, indicated better oral health among children and adolescents with JIA compared to healthy group. However, periodontal conditions and TMD were more predominant among children and adolescents with JIA compared to healthy peers.ConclusionsBased on the cross-sectional studies, periodontal diseases and TMD were found to be more frequent in children and adolescents with JIA compared to healthy peers. Furthermore, more high-quality studies with large sample size are needed before we infer any concrete conclusion regarding the association between the prevalence of oral and TMJ diseases or oral conditions in relation to activity and severity of JIA.

Salivary Oral Microbiome of Children With Juvenile Idiopathic Arthritis: A Norwegian Cross-Sectional Study

“…The significantly higher gingival inflammation found in patients with JIA compared to healthy controls is in line with many studies investigating JIA and oral health ( Welbury et al., 2003 ; Ahmed et al., 2004 ; Leksell et al., 2008 ; Santos et al., 2015 ; Grevich et al., 2019 ). Other studies find no significant difference between JIA and healthy controls ( Miranda et al., 2003 ; Savioli et al., 2004 ; Reichert et al., 2006 ; Feres De Melo et al., 2014 ; Pugliese et al., 2016 ; Kobus et al., 2017 ; Maspero et al., 2017 ), probably depending on different study design and measurement indices of gingival inflammation ( Skeie et al., 2019 ). Despite higher GBI, no difference in frequency of tooth brushing was found between JIA and healthy controls in our study.…”

Association Between Subjects with Newly Diagnosed Rheumatoid Arthritis and Dental Caries

“…A possible explanation for the absence of differences between groups could be the various techniques or guides used to assess the presence or absence of caries. Therefore, it is necessary to carry out epidemiological studies with unified criteria to evaluate the presence or absence of dental caries (36).…”

Dental caries in children and adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis

“…A recent systematic review and meta-analysis by our research team focusing on caries and other oral health conditions among children and adolescents with JIA, found no significant difference in mean dmft/DMFT (decayed/missing/filled teeth) between the groups with and without JIA [6]. This finding contrasts previous reviews by Walton et al [7] and Synodinos et al [8], reporting a high prevalence of caries among children and adolescents with JIA.…”

“…Insufficient sample sizes [6] and non-optimal utilization of data [16] are common challenges in caries epidemiology concerning children and adolescents with JIA. The aggregated dmf/DMF index does not account for the hierarchical structure of the data with surfaces clustered within teeth and teeth clustered within individuals.…”