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Table 3 Evidence on respiratory diseases and caries

From: Associations between dental caries and systemic diseases: a scoping review

Study Objectives and study design Study type Number of participants Location of study Outcomes and conclusions
Human studies on respiratory diseases and caries
 Cystic fibrosis (CF)
  Alkhateeb et al
Evaluate association of unstimulated salivary flow, pH and buffering capacity to dental caries prevalence in CF patients Cross sectional 83 United States Outcomes: No significant interaction between unstimulated salivary flow, pH and buffering capacity to dental caries prevalence
Conclusion: Future studies should measure other potential biomarkers in saliva of CF patients
  Peker et al
Evaluate association of treatment, diet, oral hygiene and salivary factors to dental caries and molar-incisor hypomineralization (MIH) in CF patients Case-control 60 (30 cases and controls) Turkey Outcomes: DMF-T score was significantly lower in CF patients when compared to controls (p = 0.001). All other parameters were non-significantly different and 43% of children with MIH used antibiotics
Conclusion: MIH frequency and lower caries experience in CF pediatric patients could be related to certain salivary factors or pharmacological therapy
  Botelho et al
Evaluate caries risk by studying biofilm control and microbiological factors in addition to caries incidence and severity (DMFT) in a pediatric participants with and without asthma Case-control 160 (80 cases and controls) Brazil Outcomes: No statistically significant difference was noted for caries experience between the two groups. However, in asthma group, significantly higher plaque index and S. mutans, positive correlation between S. mutans and plaque index and positive correlation between S. mutans and duration of treatment were noted
Conclusion: Asthma may be a risk factor for increased caries prevalence due to higher S. mutans and biofilm accumulation
  Cherkasov et al
Compare oral microbiota using 16 S sequencing in pediatric participants with asthma (with and without caries) Case-control 18 (10 cases, 8 controls) Russia Outcomes: No significant differences in oral microbiotas were noted between the two groups. Genus Veillonella was significantly higher in abundance in asthma with caries group and genus Neisseria was significantly higher in asthma without caries group (p < 0.05)
Conclusion: Veillonella may be related to caries in asthmatic children; potential respiratory pathogens were present in both groups
  Ergöz et al
Compare caries experience (DMFT/dmft and DMFS/dmfs) between asthmatic and healt hy children and evaluate genetic association with enamel development genes Case-control 200 (100 cases and controls) Turkey Outcomes: Association between a SNP variation in Ameloblastin gene (AMBN rs4694075) and caries experience was noted in asthmatic children (p = 2.525e-007) after controlling for confounding factors
Conclusion: Ameloblastin is associated with caries in asthmatic children
  Heidari et al
Evaluate associations of asthma medications to caries prevalence (DMFT/dmft and DMFS/dmfs) in pediatric cohort Cross sectional 85 Iran Outcomes: Significant correlation was noted between tablet form of asthma medications (cetirizine and ketotifen) and DMFT/dmft scores (p = 0.006) but no correlations were noted between combination of medications, duration of treatment, quantity of medications used, route of administration and caries prevalence
Conclusion: Tablet form of medication significantly increased the severity of dental caries
  Stensson et al
Investigate caries determinants in a pediatric cohort with asthma examined at 3 and 6 years and compared with healthy controls Case-control 114 (64 cases, 50 controls) Sweden Outcomes: Significantly higher caries increments in asthmatic children between 3 and 6 years (p < 0.05); at 3 years, asthmatic children had significantly higher consumption of sugary drinks and gingival inflammation (p < 0.05) and at 6 years, significantly more children were mouth breathers in the asthma group
Conclusion: Asthma, intake of sugary drinks more than once daily and increased caries prevalence at 3 years were strongest predictors of developing more carious lesions till 6 years of age
  Stensson et al.  [72] Compare caries (DFS) prevalence, dental caries related factors (dietary and oral hygiene habits, cariogenic bacterial counts, and salivary flow and pH) and Cariogram in 12-16-year-old participants with long-term asthma Case-control 40 (20 cases and controls) Sweden Outcomes: Significantly lower salivary flow rate (p < 0.05), salivary pH (p < 0.05) and significantly higher DFS score (p < 0.01) were noted in the asthmatic group when compared to controls. Cariogram data showed that 10% of asthmatics and 55% of controls had high chance of avoiding caries, a significant difference (p < 0.01)
Conclusion: Adolescents with long-term asthma showed comparatively higher total DFS and caries risk but reduced salivary flow rate
  Hassanpour et al.  [73] Compare dental caries prevalence in asthmatic children on inhaled corticosteroids and healthy children in 3-12-year-old age group. Dental caries was assessed and recorded using DMFT index and information on duration of corticosteroid use was collected Case-control 140 (70 cases and controls) Iran Outcomes: DT (p = 0.001) and DMFT (p = 0.002)/dmft (p = 0.001) were significantly higher in children with asthma that used corticosteroids for 2 years
Conclusion: Asthmatic children on inhaled corticosteroids may be at increased risk for dental caries and may benefit from preventive dental programs
  Khalifa et al. [74] Compare dental caries burden (DMFS/DMFT) between controlled asthmatics and healthy controls (age-matched and first-degree relatives). Salivary electrolytes, pH and cariogenic bacterial counts were recorded. Further, duration of asthma and type of medications used were collected (β2 agonists with or without corticosteroids) Case-control 120 (60 cases and controls) Saudi Arabia Outcomes: Caries prevalence was higher in asthmatics compared to controls (48.3 and 23.3% respectively). There was a positive correlation between duration of asthma and caries. Cariogenic bacterial counts (S. mutans, Lactobacilli) and salivary electrolytes (Ca, K, P) were higher in asthmatics
Conclusion: Higher caries prevalence was noted in asthmatics and positive correlation was noted with reduced salivary pH, increased S.mutans and Lactobacilli.
Animal study on respiratory diseases and caries
 Cystic fibrosis (CF)
  Catalán et al
Animal study to measure effect of S. mutans oral inoculation and high sucrose diet by comparing carious lesions in CF and wildtype mice Outcomes: Significantly higher incidence of carious lesions in CF mice (p < 0.003, t test); Salivary bicarbonate concentration was significantly reduced in CF mice (p < 0.01, t test)
Conclusion: Decrease in salivary bicarbonate concentration may be partially responsible for increased severity of carious lesions in CF mice