Downs syndrome is a common genetic abnormality with around one in every thousand children born having the condition. Individuals with Downs syndrome are associated with a range of orofacial characteristics and a number of common disorders including periodontal disease, malocclusion, mouth breathing, macroglossia, delayed teeth eruption, missing and malformed teeth and bruxism.

Susceptibility of those with Downs syndrome to dental caries is less clear with some studies reporting an increased incidence although a majority suggest a lower incidence. The aim of this review was to assess the association between dental caries and Downs syndrome.

Methods

Searches were conducted in the Medline, Web of Science, Cochrane Library, Brazilian Library of Dentistry (BBO) and the Latin American and Caribbean System of Health Sciences databases with no restriction on language or date of publication. Study selection and data abstraction was carried out independently by two reviewers.  The Newcastle-Ottawa Scale (NOS) was used to assess study quality. The random effect model was used for meta-analysis.

Results

• 13 cross sectional studies featuring a comparison group were included.
• Studies took place in 9 separate countries involving a total of 1879 patients of whom 943 had Downs syndrome.
• Sample sizes varied from 47 to 336 
patients.
• 8 studies contributed to a meta-analysis.
• Meta-analysis (2 studies) found a lower prevalence of dental caries in individuals with Downs Syndrome than control subjects OR = 0.36; (95% CI; 0.22–0.57).
• Meta-analysis (6 studies) showed a lower mean DMFT among individuals with Downs Syndrome than among control subjects (Standard difference = -0.18; SE = 0.09; 95%CI = -0.35–-0.02).

Conclusions

The authors concluded: –

The limited scientific evidence suggests that individuals with DS have fewer dental caries than individuals without DS. This evidence can be weakened by the absence of controlling the confounders. More observational studies with larger sample sizes, proper matching between cases and controls, and better control of confounding factors such as medication, dietary habits and exposure to fluoride are needed to confirm this evidence.

Comments

Thirteen observational studies were included in this review, which were all published in English. The majority found that caries incidence was lower in those with Downs syndrome with 7 of the studies reporting statistically significant results. The authors note that none of the studies controlled for a range of potential confounders, which has the potential to impact on the findings. Several of the studies did not mention whether the examiners had undergoing training and calibration and a majority did not confirm a diagnosis of Downs syndrome through karyotype examination. These issues mean that the results of this review need to be interpreted cautiously and higher quality studies are needed.

Links

Deps TD, Angelo GL, Martins CC, Paiva SM, Pordeus IA, Borges-Oliveira AC. Association between Dental Caries and Down Syndrome: A Systematic Review and Meta-Analysis. PLoS One. 2015 Jun 18;10(6):e0127484. doi: 10.1371/journal.pone.0127484. eCollection 2015. PubMed PMID: 26086498; PubMed Central PMCID: PMC4472226.