Caries Experience in Asthmatic Children: A Review of Literature

This review explores the discriminating factors involved for increased caries experience in asthmatic children. Background: Dental caries is the single most common chronic disease of childhood. Children with chronic medical conditions are considered high caries risk. Asthma is one of the most common chronic medical conditions in childhood. Material: 27 studies examined the asthma-caries causative relationship. Most of them were cross sectional studies; only 5 longitudinal studies were reported. In the literature, there is a lack of consensus regarding the relationship between dental caries and asthma in a child population. Conclusion: Despite the fact that some relatively recent studies have provided little evidence for an asthmacaries causative relationship, the majority and the most recent reports have concluded that the individualistic nature of asthmatic condition, through either its disease status or its pharmacotherapy (different combinations of medicaments), or attempts to alleviate the condition’s physiologic sequelea, carries several factors for an increased caries risk.

Systematic review, asthma, caries, child

1. Reich E, Lussi A, Newbrun E. Caries-risk assessment. Int Dent J, 49: 15–26, 1999.

2. American Academy of Pediatric Dentistry. Policy on use of a cariesrisk assessment tool (CAT) for infants, children, and adolescents. Pediatr Dent, 30: 29–33, 2008.

3. Hobson P. Sugar based medicines and dental disease. Community Dent Health, 2: 57–62, 1985.

4. Weiss KB, Gergen PJ, Wagener DK. Breathing better or wheezing worse? The changing epidemiology of asthma morbidity and mortality. Annu Rev Public Health, 14: 491–513, 1993.

5. Tattersfield AE, Knox AJ, Britton JR, Hall IP. Asthma. Lancet, 360: 1313–1322, 2002.

6. Bloom B, Cohen RA, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2007. Vital Health Stat, 10: 1–80, 2009.

7. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J, 12: 315–335, 1998.

8. Pearce N, Ait-Khaled N, Beasley R, et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax, 62: 758–766, 2007.

9. Taylor WR, Newacheck PW. Impact of childhood asthma on health. Pediatrics, 90: 657–662, 1992.

10. Nicolai T, Pereszlenyiova-Bliznakova L, Illi S, Reinhardt D, von Mutius E. Longitudinal follow-up of the changing gender ratio in asthma from childhood to adulthood: role of delayed manifestation in girls. Pediatr Allergy Immunol, 14: 280–283, 2003.

11. Steinbacher DM, Glick M. The dental patient with asthma. An update and oral health considerations. J Am Dent Assoc, 132: 1229–1239, 2001.

12. Casey KR, Winterbauer RH. Acute severe asthma. How to recognize and respond to a life-threatening attack. Postgrad Med, 97: 71–78, 1995.

13. Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute. National Asthma Education Program. Expert Panel Report. J Allergy Clin Immunol, 88: 425–534, 1991.

14. Urbano FL. Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm, 14: 41–49, 2008.

15. Pulmonary disease In: Little J, Palace D, Miller C, Rhodus N eds, Dental Management of the Medically Compromised Patient. 6th ed. St. Louis, Missouri: Mosby; 125–146, 2002.

16. Zhu JF, Hidalgo HA, Holmgreen WC, et al. Dental management of children with asthma. Pediatr Dent, 18: 363–370, 1996.

17. Tootla R, Toumba KJ, Duggal MS. An evaluation of the acidogenic potential of asthma inhalers. Arch Oral Biol, 49: 275–283, 2004.

18. Milano M, Lee JY, Donovan K, Chen JW. A cross-sectional study of medication-related factors and caries experience in asthmatic children. Pediatr Dent, 28: 415–419, 2006.

19. Al-Dlaigan YH, Shaw L, Smith AJ. Is there a relationship between asthma and dental erosion? A case control study. Int J Paediatr Dent, 12: 189–200, 2002.

20. Reddy DK, Hegde AM, Munshi AK. Dental caries status of children with bronchial asthma. J Clin Pediatr Dent, 27: 293–295, 2003.

21. Meldrum AM, Thomson WM, Drummond BK, Sears MR. Is asthma a risk factor for dental caries? Finding from a cohort study. Caries Res, 35: 235–239, 2001.

22. Shashikiran ND, Reddy VV, Raju PK. Effect of antiasthmatic medication on dental disease: dental caries and periodontal disease. J Indian Soc Pedod Prev Dent, 25: 65–68, 2007.

23. Stensson M, Wendt LK, Koch G, Oldaeus G, Birkhed D. Oral health in preschool children with asthma. Int J Paediatr Dent, 18: 243–250, 2008.

24. Arnrup K, Lundin SA, Dahllof G. Analysis of paediatric dental services provided at a regional hospital in Sweden. Dental treatment need in medically compromised children referred for dental consultation. Swed Dent J, 17: 255–259, 1993.

25. Wierchola B, Emerich K, Adamowicz-Klepalska B. The association between bronchial asthma and dental caries in children of the developmental age. Eur J Paediatr Dent, 7: 142–145, 2006.

26. Bimstein E, Wilson J, Guelmann M, Primosch RE. The relationship between oral and demographic characteristics of children with asthma. J Clin Pediatr Dent, 31: 86–89, 2006.

27. Mazzoleni S, Stellini E, Cavaleri E, et al. Dental caries in children with asthma undergoing treatment with short-acting beta2-agonists. Eur J Paediatr Dent, 9: 132–138, 2008.

28. Khalilzadeh S, Salamzadeh J, Salem F, Salem K, Vala M. Dental Caries-Associated Microorganisms in Asthmatic Children. Tanaffos, 6: 42–46, 2007.

29. Ersin NK, Gulen F, Eronat N, et al. Oral and dental manifestations of young asthmatics related to medication, severity and duration of condition. Pediatr Int, 48: 549–554, 2006.

30. McDerra EJ, Pollard MA, Curzon ME. The dental status of asthmatic British school children. Pediatr Dent, 20: 281–287, 1998.

31. Milano M. Increased risk for dental caries in asthmatic children. Tex Dent J, 116: 35–42, 1999.

32. Kankaala TM, Virtanen JI, Larmas MA. Timing of first fillings in the primary dentition and permanent first molars of asthmatic children. Acta Odontol Scand, 56: 20–24, 1998.

33. Storhaug K. Caries experience in disabled pre-school children. Acta Odontol Scand, 43: 241–248, 1985.

34. Ryberg M, Moller C, Ericson T. Effect of beta 2-adrenoceptor agonists on saliva proteins and dental caries in asthmatic children. J Dent Res, 66: 1404–1406, 1987.

35. Ryberg M, Moller C, Ericson T. Saliva composition and caries development in asthmatic patients treated with beta 2-adrenoceptor agonists: a 4-year follow-up study. Scand J Dent Res, 99: 212–218, 1991.

36. Wogelius P, Poulsen S, Sorensen HT. Use of asthma-drugs and risk of dental caries among 5 to 7 year old Danish children: a cohort study. Community Dent Health, 21: 207–211, 2004.

37. Amaechi B, Lozano-Pineda J. Prevalence of caries among siblings with and without asthma. J Dent Res, AADR 37th Annual Meeting 2008; 87.

38. Ghasempour M, Mohammadzade I, Hosaininia K. Dental health status in asthmatic children. Journal of Isfahan Dental School, 1: 41–46, 2005.

39. Mehta A, Sequeira PS, Sahoo RC. Bronchial asthma and dental caries risk: results from a case control study. J Contemp Dent Pract, 10: 59–66, 2009.

40. Holbrook WP, Kristinsson MJ, Gunnarsdottir S, Briem B. Caries prevalence, Streptococcus mutans and sugar intake among 4-year-old urban children in Iceland. Community Dent Oral Epidemiol, 17: 292–295, 1989.

41. Shulman JD, Taylor SE, Nunn ME. The association between asthma and dental caries in children and adolescents: A population-based casecontrol study. Caries Res, 35: 240–246, 2001.

42. Tanaka K, Miyake Y, Arakawa M, Sasaki S, Ohya Y. Dental caries and allergic disorders in Japanese children: the Ryukyus Child Health Study. J Asthma, 45: 795–799, 2008.

43. Bjerkeborn K, Dahllof G, Hedlin G, Lindell M, Modeer T. Effect of disease severity and pharmacotherapy of asthma on oral health in asthmatic children. Scand J Dent Res, 95: 159–164, 1987.

44. Hyyppa T, Paunio K. Oral health and salivary factors in children with asthma. Proc Finn Dent Soc, 75: 7–10, 1979.

45. Eloot AK, Vanobbergen JN, De Baets F, Martens LC. Oral health and habits in children with asthma related to severity and duration of condition. Eur J Paediatr Dent, 5: 210–215, 2004.

46. Baum BJ. Neurotransmitter control of secretion. J Dent Res, 66 Spec No: 628–632, 1987.

47. Venter JC, Fraser CM, Harrison LC. Autoantibodies to beta 2-adrenergic receptors: a possible cause of adrenergic hyporesponsiveness in allergic rhinitis and asthma. Science, 207: 1361–1363, 1980.

48. Fraser CM, Venter JC, Kaliner M. Autonomic abnormalities and autoantibodies to beta-adrenergic receptors. N Engl J Med, 305: 1165–1170, 1981.

49. O’Sullivan EA, Curzon MEJ. Drug treatments for asthma may cause erosive tooth damage. BMJ, 317: 820, 1998.

50. Pearce EI, Sissons CH. On the cariogenicity of lactose. N Z Dent J, 83: 32–36, 1987.

51. Makinen KK, Philosophy L. The role of sucrose and other sugars in the development of dental caries; a review. Int Dent J, 22: 363–386, 1972.

52. Maguire A, Rugg-Gunn AJ, Butler TJ. Dental health of children taking antimicrobial and non-antimicrobial liquid oral medication long-term. Caries Res, 30: 16–21, 1996.

53. Siu AS, Chu FC, Yip HK. Cough syrup addiction and rampant caries: a report of two cases. Prim Dent Care, 9: 27–30, 2002.

54. Tredwin CJ, Scully C, Bagan-Sebastian JV. Drug-induced disorders of teeth. J Dent Res, 84: 596–602, 2005.

55. Shaw L, al-Dlaigan YH, Smith A. Childhood asthma and dental erosion. ASDC J Dent Child, 67: 102–106, 182, 2000.

56. Shaw L, Smith A. Erosion in children: an increasing clinical problem? Dent Update, 21: 103–106, 1994.

57. Williams DM. Clinical considerations in the use of inhaled corticosteroids for asthma. Pharmacotherapy, 21: 38S–48S, 2001.

58. Agertoft L, Pedersen S. Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N Engl J Med, 343: 1064–1069, 2000.

59. Ferreira F, Botelho M, Fernandes K, et al. Levels of cariogenic microorganisms and oral conditions of asthmatic children. J Dent Res IADR/CADR 86th General Session 2008; 87

60. Hegde PP, Ashok Kumar BR, Ankola VA. Dental caries experience and salivary levels of Streptococcus mutans and Lactobacilli in 13-15 years old children of Belgaum city, Karnataka. J Indian Soc Pedod Prev Dent, 23: 23–26, 2005.

61. Lenander-Lumikari M, Laurikainen K, Kuusisto P, Vilja P. Stimulated salivary flow rate and composition in asthmatic and non-asthmatic adults. Arch Oral Biol, 43: 151–156, 1998.

62. Laurikainen K, Kuusisto P. Comparison of the oral health status and salivary flow rate of asthmatic patients with those of nonasthmatic adults—results of a pilot study. Allergy, 53: 316–319, 1998.

63. Ryberg M, Moller C, Ericson T. Saliva composition in asthmatic patients after treatment with two dose levels of a beta 2-adrenoceptor agonist. Arch Oral Biol, 35: 945–948, 1990.

64. Kargul B, Tanboga I, Ergeneli S, Karakoc F, Dagli E. Inhaler medicament effects on saliva and plaque pH in asthmatic children. J Clin Pediatr Dent, 22: 137–140, 1998.

65. Leone CW, Oppenheim FG. Physical and chemical aspects of saliva as indicators of risk for dental caries in humans. J Dent Educ, 65: 1054–1062, 2001.

66. Sag C, Ozden FO, Acikgoz G, Anlar FY. The effects of combination treatment with a long-acting beta2-agonist and a corticosteroid on salivary flow rate, secretory immunoglobulin A, and oral health in children and adolescents with moderate asthma: a 1-month, single-blind clinical study. Clin Ther, 29: 2236–2242, 2007.

67. Pedersen S. Inhalers and nebulizers: which to choose and why. Respir Med, 90: 69–77, 1996.