25 April 2023

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The association between erosive toothwear and asthma – is it significant? A meta-analysis

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Background

The association of asthma with oral conditions such as dental caries, dental erosion, periodontal diseases and oral mucosal changes has been the subject of debate among dental practitioners. Existing evidence indicates that an inhaler is the most common and effective way of delivering the asthma medications directly into the lungs. Few studies in the past attributed this association to the changes in salivary flow caused due to these medications. Considering this unclear association, the aim of the present meta-analyses is to identify the association between erosive tooth wear and asthma from individual studies conducted until date.

Methodology

Electronic databases were systematically searched until 30th September 2022. Articles identified using the search strategy were imported to RAYYAN systematic review software. Data was extracted relating to study design, geographic location, year of publication, sample size, the assessment method for erosive tooth wear and asthma. The Newcastle Ottawa scale was utilized to assess the quality of evidence reported from the included studies. RevMan Version 5.3 was used to perform a random-effects meta-analysis to produce pooled estimates from OR and 95% CI of included studies. The I² statistic was used to determine the extent of heterogeneity. A funnel plot was generated to visually assess the potential for publication bias. Sensitivity analyses were performed by excluding individual studies one at a time. GRADE approach was used for grading the evidence for key comparisons.

Results

The initial search strategy identified articles, which was reduced to 42 articles after duplicates were removed. Thirty-four articles met the inclusion criteria for full text assessment. Eight studies were conducted in children and four studies in adults.  

Researchers included 12 articles in the final meta-analysis. A total of 1,027 people with asthma and 5,617 non-asthmatics were included. All studies demonstrated moderate to low risk of bias. The overall pooled estimate (OR: 2.03; 95% CI: 0.96, 4.29) and subgroup analyses in children (OR: 1.67; 95% CI: 0.63, 4.42) did not show statistically significant difference in the occurrence of dental erosion between the asthmatic and non-asthmatic group. However, asthmatic adults had significantly greater dental erosion in comparison to the control adults (OR: 2.76; 95% CI: 1.24, 6.16). Sensitivity analyses also provided inconclusive evidence. Funnel plot asymmetry indicated significant heterogeneity, changes in effect size and selective publication.

Conclusion

The association between inhalational asthmatic medication and tooth wear is inconclusive. Although some of the results obtained may show statistical significance, considering the increased heterogeneity in these studies, a conclusive association cannot be elucidated.

There are a number of confounding factors that play a greater role in causing dental erosion in these patients. Dentists must pay particular attention to these factors while treating asthmatic patients. The authors produce a comprehensive checklist in order to ensure complete assessment before providing advice on their medications alone.

Sivaramakrishnan, G., Sridharan, K. & Alsobaiei, M. "The association between erosive toothwear and asthma – is it significant? A meta-analysis." British Dental Journal Open 9, 9 (2023). https://doi.org/10.1038/s41405-023-00137-9.