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REVIEW ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 8  |  Page : 1109-1116

Dental Caries Experience among Down's Syndrome Population in Saudi Arabia – A Systematic Review


Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Submission07-Aug-2020
Date of Acceptance23-Dec-2020
Date of Web Publication14-Aug-2021

Correspondence Address:
Dr. H Ashi
Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_492_20

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   Abstract 


It is the most common and best-known chromosomal disorder in humans. Its incidence in Saudi Arabia is reported to be 1 in 554 live births. and the scientific evidence on the experience of dental caries (Dental Caries) in DS population is non-conclusive. The aim of this systematic review was to report on the Dental Caries experience among DS population in Saudi Arabia. The electronic databases were searched for scientific research articles published from January 2000 to July 2020. The data search was performed in the electronic search engines like PubMed, Google scholar, Scopus, Web of science, Medline, Embase, Cochrane, and Saudi Digital Library. Eight studies which met the eligibility criteria were further analyzed. The qualitative and quantative data were included in the analysis. The sample size of the study population in the included studies varied from 36 to 224 participants and their age ranged from 3 years to 40 years. In this systematic review we found that five studies have reported a higher prevalence of Dental Caries among the DS population. Three studies reported that there was no difference in the Dental Caries prevalence among the DS population when compared to those without DS. The findings of these studies emphasizes the need to prioritize preventive and curative programs for this special care group. Oral health education programs should focus on targeting the DS population as well as their caretakers in order to help them in achieving better quality of life.

Keywords: Caries incidence, caries prevalence, dental caries, Down's syndrome, trisomy 21


How to cite this article:
Ashi H. Dental Caries Experience among Down's Syndrome Population in Saudi Arabia – A Systematic Review. Niger J Clin Pract 2021;24:1109-16

How to cite this URL:
Ashi H. Dental Caries Experience among Down's Syndrome Population in Saudi Arabia – A Systematic Review. Niger J Clin Pract [serial online] 2021 [cited 2022 Jan 22];24:1109-16. Available from: https://www.njcponline.com/text.asp?2021/24/8/1109/323861




   Introduction Top


Down's syndrome (DS) is one of the most common autosomal disorders caused by an extra chromosome 21, in which an individual has an extra chromosome 47 instead of a normal 46 chromosomes. In most of these cases there are usually three copies of chromosome 21, hence they were named as Trisomy 21.[1] Worldwide it has been estimated that incidence of DS is between 1 in 1000 to 1 in 1100 live births.[2] In Saudi Arabia the incidence of DS is relatively higher, with a incidence of 1 in 554 live births.[3] An individual with DS usually presents with a deficiency in general and mental development, which is characterized by systemic and physical manifestations[4]

An individual with DS presents within complete development of the mid-face complex, mouth breathing and characterized by typical oral findings of open bite, macroglossia, fissured tongue and lips, delayed eruption of teeth, malformed teeth, microdontia, missing teeth, malocclusion, and crowding.[5],[6],[7]

The scientific evidence on the prevalence of Dental Caries in DS population is conflictive and non-conclusive.[8],[9],[10] Several studies have reported lower prevalence of Dental Caries among DS population when compared with the one without DS.[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] On the contrary studies have also reported increased prevalence of Dental Caries among DS population.[21],[22],[23] Few studies have also reported that there is no difference in the prevalence of Dental Caries between the individuals with or without DS.[7],[24],[25],[26]

The results of these studies are nonconclusive about the prevalence of Dental Caries in DS population. Knowing the facts that the individuals suffering with DS are compromised with intellectual and neuro-developmental disabilities, due to delayed motor and cognitive abilities, which will eventually result in compromise with the self-care skills, with an increase in the reliance on others for their health care activities. Considering the increased incidence of DS patients in the Saudi Arabian population and having a knowledge of the dentofacial and alterations present in this population, it is very much important to define the real situation of Dental Caries in this population. This evidenced base data from the reported studies from Saudi Arabian population would be very helpful in identifying the priorities that can be placed for the oral health care for this special population. The knowledge of trends and prevalence of Dental Caries in this population would be very helpful in developing a relevant and effective oral health care program in order to benefit this population. Hence the aim of the present systematic review was to report on the Dental Caries experience among DS population in Saudi Arabia by analyzing the results of the studies reported on Dental Caries prevalence.


   Material and Methods Top


Search strategy

The present systematic review is in accordance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[27] The search for articles was carried out in the electronic databases by four independent researchers. The electronic databases were searched for scientific research articles published from January 2000 until July 2020. The data search was performed in the electronic search engines like PubMed, Google scholar, Web of science, Scopus, Medline, Embase, Cochrane, and Saudi Digital Library. A combination of Index words like dental caries, tooth decay, Downs syndrome, trisomy 21, caries prevalence, caries incidence was used for searching the articles. A manual search for the research articles was also conducted simultaneously.

During the preliminary search, articles were retrieved pertaining to the title and abstract. The preliminary search yielded us 286 articles that were related to our topic of interest. Due to duplication of the data 148 articles were eliminated. The remaining 138 articles were considered for the next stage, after which, the eligibility criteria were applied.

Eligibility criteria

Inclusion criteria

In this systematic review cross sectional observational studies that estimated the experience of Dental Caries among DS in Saudi Arabian population were included. There was no age limit for the study population for inclusion.

Exclusion criteria

Unpublished papers uploaded online, articles with only abstracts with no full text, articles which were not in English language and review articles were excluded from the study.

Study selection

Ten articles qualified for these eligibility criteria, then the journal details were covered and distributed among the six panel members to critically assess the included studies. The panel members were instructed to assess the quality by referring to the criteria of Newcastle-Ottawa Scale modified for cross-sectional studies.[28] Following this the authors had a difference in opinion for the inclusion of two articles, hence they had to be excluded from the systematic review after an agreement between the panel members. Finally, the eight articles which met the eligibility criteria were considered in this systematic review for quality synthesis [Figure 1].
Figure 1: Flow chart for screening and selection of articles

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   Results Top


Search results

Eight articles which had met the eligibility criteria were assessed for qualitative data in this systematic review. The trend shows that these studies were conducted in different parts of Saudi Arabia over the last 10 years.

Data extraction and qualitative synthesis

[Table 1] shows the details of the characteristics of cross-sectional studies that were included in this systematic review. These studies were conducted in different regions of Saudi Arabia. Four studies were conducted in Riyadh,[29],[31],[34],[36] two studies were conducted in Makkah,[33],[35] one study was conducted in AlKharj,[30]and one study was conducted in Al Qassim [Figure 2].[32]
Figure 2: Studies conducted in different regions of Saudi Arabia

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Table 1: Details of the characteristics of cross-sectional studies that were included in this systematic review

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The study settings in this systematic review were the special needs centers and rehabilitation centers in seven studies and university dental clinic in one study.

There was no mention of sample size estimation in any of the studies. The sample size of the study population in the studies varied from 36 to 224 participants. The age of the study participants ranged from 3 to 40 years. All the studies mentioned the eligibility criteria for enrolling the study participants in their respective studies.

The clinical evaluation of Dental Caries experience was carried out in accordance with World Health Organization (WHO) criteria using DMFT, DMFS, dmft, dmfs.

Quality assessment of the cross-sectional studies included in this systematic review

[Table 2] shows the detailed analysis of the methodological quality of the included studies cross sectional studies, which was performed using the Newcastle-Ottawa Scale modified for cross-sectional studies. Only male or female participants were included in three[30],[32],[36] and one[35] study, respectively. Such type of discretion was made owing to segregation of gender in Saudi Arabia. Hence, samples cannot be regarded as truly or somewhat representative of the average in the target population. Two studies failed to mention the gender distribution in their study.[33],[34] Moreover, majority of the studies failed to comment on the randomization of the sample. World Health Organization recommended validated measurement tool was used in all the studies Trained dental surgeons performed assessment of the outcome and hence full score was awarded. Study scores ranged from 3–9 out of a possible score of 11. Six studies reported high quality assessment score[30],[31],[32],[33],[35],[36] while two studies were graded as low.[29],[34]
Table 2: Details of the quality assessment of the cross sectional studies included in this systematic review

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   Discussion Top


In this systematic review we critically analyzed eight cross sectional studies that have reported on the Dental Caries prevalence among the Down Syndrome (DS) population in different regions of Saudi Arabia. Out of the studies that have been conducted worldwide among the DS population on the experience of Dental Caries, some have documented that the prevalence of Dental Caries in DS population is lower when compared to those without DS.[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] Some authors have documented that the prevalence of Dental Caries in DS population is higher when compared to those without DS.[21],[22],[23] Studies have also documented that there is no difference in the prevalence of Dental Caries in DS population when compared to the one without DS.[7],[24],[25],[26]

Several studies that were conducted among the Saudi population have documented that the children experience higher prevalence of Dental Caries.[27],[28] A need to Consider the higher incidence of DS in Saudi Arabia was felt to report on the Dental Caries experience among DS population. In this systematic review we found that five studies reported higher prevalence of Dental Caries among the DS population.[29],[30],[31],[32],[33] The higher prevalence of Dental Caries can be attributed to low physical abilities or decreased manual dexterity among this group which could cause difficulty in performing appropriate oral hygiene practices. Limited understanding of the importance of oral health, difficulties in expressing and communicating their oral health care needs could also be the reasons for higher prevalence of oral diseases among this special group.[34],[35],[36]

The prevalence of Dental Caries among DS population has been associated with other factors, which include the salivary buffering capacity, salivary flow rate, streptococcus mutans, and lactobacilli counts. Further studies that have reported the role of salivary pH on the tooth decay have conflicting results. Some studies have reported that there is no difference in the salivary pH levels between the DS and the normal children.[15],[24],[37],[38] However, some studies have found higher levels of salivary pH levels among the DS population when compared to those without DS.[27],[39] Salivary flow rate also has a role in caries prevalence, studies have reported that increase in the salivary flow rate has been associated with lower caries experience among DS population.[31],[40]

Whereas, three studies reported no difference in the Dental Caries prevalence among the DS population when compared to those without DS,[32],[37],[41] while none of the studies reported a lower prevalence of Dental Caries among DS population compared to those without DS in Saudi Arabia which is of a greater concern for the health care professionals. Worldwide studies that reported a lower prevalence of Dental Caries in DS population when compared to the one without DS,[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] indicated several reasons for that. These reasons have been attributed as risk factors and need to be considered when considering these findings. One study reported that the institutionalized DS children were administered controlled diets and this could be one of the reason for lower prevalence of Dental Caries in DS children.[12] Delayed eruption of teeth and increase in the spacing between the teeth are also considered as possible reasons for decrease prevalence of Dental Caries among DS population.[14]

Several studies that have been conducted worldwide have reported on mixed conclusion. Studies that have reported on higher prevalence of Dental Caries among DS population mentioned limited access to oral health care facilities as a major reason for lesser utilization of dental services.[15] Barriers to utilization of dental care facilities also include fear of dental treatments, difficulty to access the facilities, negative attitude towards dental treatment, lack of awareness towards prevention, and parental neglect.[30],[42]

The limitation of this paper is that most of the reported studies are cross sectional observational studies and the use of only decayed, missing, and filled teeth (DMFT) index for estimating the Dental Caries prevalence, though, it is a good tool for estimating past caries experience and it accounts for filled teeth as well.


   Conclusion Top


In the present systematic review, we found that most of the studies have reported that the prevalence of Dental Caries is higher in the DS population when compared with normal population in Saudi Arabia. These findings emphasize on establishing priorities towards planning preventive and curative programs for this special care group. Oral health education programs should focus on targeting the DS population as well as their caretakers in order to help them in achieving better quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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