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

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). Electronic supplementary material The online version of this article (10.1186/s12903-019-0795-4) contains supplementary material, which is available to authorized users.

Umbrella systematic review of systematic reviews and meta-analyses on comorbid physical conditions in people with autism spectrum disorder

“…Of the 24 included reviews, 6 were on sleep; 10-15 3 on sensory impairments (not sensory sensitivities; 1 on peripheral hearing loss, 18 1 on visual impairment, 19 and 1 on visual or hearing impairment 20 ); 3 on epilepsy; 7-9 3 on oral health; 21-23 1 on asthma 26 and 1 on allergic asthma; 27 1 each on diabetes, 16 gastro-intestinal conditions, 17 atopic dermatitis, 24 autoimmune disease, 25 obesity, 28 incontinence; 29 and 1 review on 5 conditionsimmunological, gastrointestinal, incontinence, epilepsy and hypospadias. 30 Fifteen studies were on children and young people, 11,13,14,[16][17][18][19][20][21][22][23][24][25][26][27] 8 were on children, young people and adults, [7][8][9]12,15,[28][29][30] and 1 study was on adults only. 10 Although the quality of the included reviews was good, most, in their own quality assessments, reported several limitations in the papers they included, and also considerable heterogeneity that precluded meta-analysis for several of the reviews.…”

“…21 Dental caries are common, but results are inconsistent as to whether they are more common than in the general population, and on comparisons of dental treatment for caries. [21][22][23] (d) Findings on peripheral hearing loss are inconsistent. 18 Among people with hearing impairment, the relative risk of ASD was high.…”

“Mom Let’s Go to the Dentist!” Preliminary Feasibility of a Tailored Dental Intervention for Children with Autism Spectrum Disorder in the Italian Public Health Service

“…Children with ASD have poor oral health and they present high care demands, which requires much time, effort, and patience [ 8 , 51 ]. Findings of this study suggest the feasibility of the MyDentist approach and the positive role of technology support [ 52 ].…”

“…ASD varies greatly in the severity of associated socio-communicative impairments and in the degree of cognitive and language development [ 4 ]. Although there is no specific relationship between ASD and oral disease, it is well-recognized that many individuals with ASD have much worse oral health than non-autistic people [ 5 , 6 , 7 , 8 , 9 , 10 ]. This may be related to barriers to dental services, sensory sensitivities and heightened levels of stress and anxiety during care; these factors may affect the level of cooperation of individuals with ASD in regard to daily hygiene routines, oral exams, and dental care [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi

“…Öğrenme güçlüğü olan çocukların diş çürüğü, ağız bakımı ve restorasyonlarının incelendiği bir sistematik derlemenin sonucunda; öğrenme güçlüğü olan ve olmayan çocukların süt dişlerinde ve daimi dişlerinde diş çürüğü karşılaştırması açısından kesin bir kanıt olmadığı belirlenmiştir. Öğrenme güçlüğü olan çocukların alt gruplarında, Down sendromu hariç diğer çocukların diş çürüğü seviyesi açısından benzerlik gösterdiği, Down sendromlu çocukların daimi dişlerinde diş çürüğünün daha az olduğu belirtilmiştir (14). Down sendromlu bireylerde diş çürüğünün daha düşük görülmesinin nedenleri arasında; dişlerin diastemalı olması, dişlerin geç sürmesi, tükürük kimyasının farklı olması, hipodonti, oligodonti, mikrodonti görülmesi ve bruksizme bağlı olarak diş yüzeylerinin düzleşmesi yer almaktadır (15) (11,17).…”