Tanner L, Craig D, Holmes R, Catinella L, Moynihan P
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
JDR Clin Trans Res. 2022 Apr;7(2):104-117. doi: 10.1177/23800844211003529. Epub 2021 Apr 2.
A systematic review of the evidence on the impact of dental caries on malnutrition risk in children was conducted.
To systematically review published evidence pertaining to the effect of dental caries severity and prevalence on risk of wasting or stunting in children.
Four questions relating to caries of the permanent dentition, primary dentition, early childhood caries (ECC), and severe ECC as a risk factor for undernutrition were set. The target population was children aged 0 to 18 y from any country. Data sources included MEDLINE and Embase. All human epidemiological studies were included. Quality assessment excluded lowest-quality studies. Evidence synthesis by vote counting was depicted using harvest plots. A best available evidence approach was applied to narrative synthesis. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Of the 2,690 studies identified, 447 were screened in duplicate; of these, 117 underwent quality assessment, resulting in 46 included studies, of which 38 were included in vote counting (3 quasi-experimental, 1 cohort, 1 case control, and 33 cross-sectional studies). For the permanent dentition, findings were mixed; the balance of data showed no association between caries prevalence (7/11 studies) or severity (8/17 studies) with wasting. For the primary dentition, the balance of data showed a positive association between caries prevalence (10/15 studies) and severity (12/15 studies) with wasting, as well as between-caries prevalence (4/5 studies) and severity (6/6 studies) with stunting. Considering ECC only did not alter this pattern of findings.
The balance of evidence suggests that dental caries in the primary dentition is associated with undernutrition. There is a need for well-designed trials on the impact of caries rehabilitation on growth trajectories of children from low- and middle-income countries and for prospective studies of the impact of caries severity on both stunting and wasting to confirm causality.
The results of this study can be used by policy makers when considering the importance of oral health in addressing the United Nations Sustainable Development Goal to end all forms of malnutrition. The findings suggest that dental caries in the primary dentition may impair children's healthy weight gain. The findings indicate that higher-quality data are required to confirm a causal relationship and thus inform funding bodies of the need for research, especially in low- and middle-income countries, to substantiate the current knowledge and inform clear and accurate policy statements.
对龋齿对儿童营养不良风险影响的证据进行了系统综述。
系统综述已发表的关于龋齿严重程度和患病率对儿童消瘦或发育迟缓风险影响的证据。
提出了四个与恒牙龋齿、乳牙龋齿、幼儿龋齿（ECC）以及严重ECC作为营养不良风险因素相关的问题。目标人群为来自任何国家的0至18岁儿童。数据来源包括MEDLINE和Embase。纳入所有人类流行病学研究。质量评估排除了质量最低的研究。采用收获图描述通过投票计数进行的证据综合。采用最佳可得证据方法进行叙述性综合。本综述按照系统评价和Meta分析的首选报告项目声明进行。
在检索到的2690项研究中，447项进行了重复筛选；其中117项接受了质量评估，最终纳入46项研究，其中38项纳入投票计数（3项准实验研究、1项队列研究、1项病例对照研究和33项横断面研究）。对于恒牙，结果不一；数据总体显示龋齿患病率（7/11项研究）或严重程度（8/17项研究）与消瘦之间无关联。对于乳牙，数据总体显示龋齿患病率（10/15项研究）和严重程度（12/15项研究）与消瘦之间呈正相关，以及龋齿患病率（4/5项研究）和严重程度（6/6项研究）与发育迟缓之间呈正相关。仅考虑幼儿龋齿并未改变这一结果模式。
证据总体表明乳牙龋齿与营养不良有关。需要针对龋齿康复对低收入和中等收入国家儿童生长轨迹的影响开展精心设计的试验，并对龋齿严重程度对发育迟缓和消瘦的影响进行前瞻性研究，以确认因果关系。
政策制定者在考虑口腔健康在实现联合国消除一切形式营养不良可持续发展目标中的重要性时，可使用本研究结果。研究结果表明乳牙龋齿可能会损害儿童的健康体重增加。研究结果表明需要更高质量的数据来确认因果关系，从而告知资助机构开展研究的必要性，特别是在低收入和中等收入国家，以充实现有知识并形成清晰准确的政策声明。
