Limited evidence available of the caries risk in children and adolescents with cystic fibrosis

Cystic fibrosis (CF) is a genetic disorder that leads to the overproduction and accumulation of mucus in the lungs, which can result in airway obstruction and life-threatening bacterial. Four risk factors related to CF are considered to increase the risk of dental caries; a 20- fold increase in intraoral Streptococcus mutans levels; gastroesophageal reflux disease (GERD); high calorie diets to maintain weight; and enamel defects. However, it is considered that children and adolescents with CF are at low risk of caries because of their long-term use of antibiotics. The aim of this review was to assess the prevalence of dental caries in children and adolescents with CF.

The Medline, Web of Science, and Embase databases were searched got human clinical trials, evaluation studies, and systematic reviews related to dental caries prevalence in children and adolescents with CF under age 18 years published between 1960 and 2013. Risk of bias was assessed using adapted criteria from the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement

15 studies were included; 12 were classified as being at high risk of bias, three at medium risk . No studies were at low risk of bias.
- Ten studies concluded that children with CF had significantly lower caries prevalence than control children,
- Three studies reported that children with CF had higher caries prevalence,
- Two studies found no difference by CF status

The authors concluded

While children with CF may be a lower risk for dental caries, adolescents with CF may not be at lower caries risk than those without CF. Additional research is needed to evaluate a potentially flawed paradigm regarding caries risk in children and adolescents with CF.

Comment

The authors discuss a number of limitations to their review. The selections of control groups and whether they were appropriate; lack of power calculations in the original studies, potential for bias in outcome assessment and the fact the studies were mainly cross-sectional. All of whihc means there is limited information about the risk of caries in this patient group.

Links

Chi DL. Dental caries prevalence in children and adolescents with cystic fibrosis: a qualitative systematic review and recommendations for future research. Int J Paediatr Dent. 2013 Jun 12. doi: 10.1111/ipd.12042. [Epub ahead of print] PubMed PMID: 23758751.