Is caries a risk factor for dental trauma? A systematic review and meta‐analysis

Abstract

-Background/aim: The association between trauma and caries is still controversial in the literature. The aim of this study was to evaluate the possible association between caries and dental trauma through a systematic review with meta-analysis. Design: A systematic literature search was performed in PubMed, Lilacs, BBO, Scopus, Web of Science, Cochrane Library, and Open Grey databases. The MeSH terms used were 'Tooth injuries', 'Tooth fractures', 'Tooth avulsion', 'Tooth movement'; 'Dental caries'; 'DMF index'; and 'Tooth demineralization'. MeSH synonyms, related terms, and free terms were included. The inclusion criteria comprised clinical investigations of subjects with and without caries that had suffered dental trauma. Quality assessment and bias control were carried out. Meta-analysis was performed using the COMPREHENSIVE META-ANA-LYSIS software (version 3.2). Heterogeneity was assessed using the I 2 index, and the odds ratio was also calculated (P < 0.05). Results: From 1290 abstracts, seven met the inclusion criteria. All studies had high methodological quality and five were included in the meta-analysis. The results demonstrated a positive association (P < 0.001) between dental trauma and dental caries in permanent teeth [OR: 1.490, 95%, CI: 1.209-1.835]. However, for children with primary teeth, the results showed a negative association (P = 0.006) between dental trauma and caries [OR: 0.706, 95%, CI: 0.550-0.906]. Conclusions: The results demonstrated positive and negative association between the presence of caries and dental trauma in permanent and primary teeth, respectively.Oral health status is characterized by the health of oral tissues and the development of functions, which allow an individual to perform daily activities such as to eat, speak, and socialize without discomfort and embarrassment, contributing to the general well-being of the individual (1, 2). Dental caries and traumatic injuries are considered the main problems that affect the oral health of children and adolescents (3-5).Dental caries is a multifactorial disease caused by the demineralization of tooth enamel surface by oral bacteria, thus weakening its structure (6). Dental traumatic injuries are caused by an external impact on a tooth and its surrounding tissues (7). Studies have shown that social, economic, and behavioral factors are determinants for both caries and dental trauma (6-9). More recently, the relationship between dental trauma and caries experience has been studied; however, the results from those studies have been contradictory (10)(11)(12)(13)(14)(15)(16).If an association between these two conditions could be proved, children at risk could benefit from a common approach for the prevention of dental trauma and caries (10). Furthermore, dentists could help to implement health promotion measures targeting patients and their parents.The absence of a comprehensive study comparing all evidence from existing studies to reach clear conclusions, based on scientific evidence, about a specific object of interest ...

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“…Fowkes and Fulton contain guidelines that provide a standardized approach to quality assessment in cross‐sectional, case‐control, and cohort studies. This tool has been efficiently used in dentistry systematic reviews . All studies included in this meta‐analysis received a “no problem” classification in the summary questions related to presence of bias, confounding factors, and results occurred by chance, showing their good methodological quality.…”

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