Peer-reviewed article
Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis
Mark Robertson, Falk Schwendicke, Mariana Pinheiro Araújo, John R. Radford, Jenny C Harris et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis compared dental caries (tooth decay) between children with learning disabilities and children without learning disabilities across 25 studies involving 3,976 children aged 1-18 years from 18 countries. Overall, there was no significant difference in cavity levels between the two groups in either primary or permanent teeth. The exception was children with Down syndrome, who had lower cavity rates than their non-disabled peers. The review found that most studies had medium to high risk of bias, and data on whether dental care needs were actually met remained inconclusive.
Key points
- Mean permanent tooth decay (DMFT) was 2.31 for children with learning disabilities and 2.51 for children without learning disabilities, with no statistically significant difference overall
- Children with Down syndrome had significantly lower caries experience in permanent teeth compared to children without learning disabilities
- Children with autism and mixed learning disabilities showed no significant difference in caries levels compared to non-disabled peers
- For primary teeth, mean decay scores were 2.24 and 2.48 respectively, with no significant difference between groups
- Information on whether met dental care needs differed between groups was inconclusive
Limitations
The review notes medium to high risk of bias across included studies, which limits confidence in findings. Data on whether dental care needs were actually being met was sparse and inconclusive, so the review cannot determine whether access to or quality of dental treatment differs between groups.
Abstract
BACKGROUND: Children with learning disabilities (CLD) have worse health outcomes than children with no learning disabilities (CNLD). This systematic review compared caries experience and met dental care need for CLD to CNLD using Decayed, Missing, Filled Permanent Teeth (DMFT) and decayed, missing/extracted, filled primary teeth (dmft/deft), care index (CI), and restorative index (RI) values. METHODS: Without date or language restrictions four databases were searched for; cross-sectional studies comparing caries experience and CI/ RI in CLD matched to groups of CNLD. Screening and data extraction were carried out independently and in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were carried out (random effects model). RESULTS: There were 25 articles with 3976 children (1 to 18 years old), from 18 countries, fitting the inclusion criteria. Children with; Down syndrome were investigated in 11 studies, autism in 8 and mixed learning disabilities in 6. The overall mean DMFT for CLD was 2.31 (standard deviation±1.97; range 0.22 to 7.2) and for CNLD was 2.51 (±2.14; 0.37 to 4.76). Using standardised mean difference (SMD), meta-analysis showed no evidence of a difference between CLD and CNLD (n = 16 studies) for caries experience (SMD = -0.43; 95%CI = -0.91 to 0.05). This was similar for sub-groups of children with autism (SMD = -0.28; 95%CI = 1.31 to 0.75) and mixed disabilities (SMD = 0.26; 95%CI = -0.94 to 1.47). However, for children with Down syndrome, caries experience was lower for CLD than CNLD (SMD = -0.73; 95%CI = -1.28 to - 0.18). For primary teeth, mean dmft/deft was 2.24 for CLD and 2.48 for CNLD (n = 8 studies). Meta-analyses showed no evidence of a difference between CLD and CNLD for caries experience across all disability groups (SMD = 0.41; 95% CI = -0.14 to 0.96), or in sub-groups: Down syndrome (SMD = 0.55; 95%CI- = - 0.40 to 1.52), autism (SMD = 0.43; 95%CI = -0.53 to 2.39) and mixed disabilities (SMD = -0.10; 95%CI = -0.34 to 0.14). The studies' risk of bias were medium to high. CONCLUSION: There was no evidence of a difference in caries levels in primary or permanent dentitions for CLD and CNLD. This was similar for learning disability sub-groups, except for Down syndrome where dental caries levels in permanent teeth was lower. Data on met need for dental caries was inconclusive. TRIAL REGISTRATION: The protocol was published in PROSPERO: CRD42017068964 (June 8th, 2017).