Dental Caries in Adult Patients with Rheumatoid Arthritis—A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Central Issue of the Systematic Review
2.2. Eligibility Criteria
2.3. Search Strategy
2.4. Data Extraction
- Publication year, study type, country;
- Sample size, sex, age, disease duration;
- Caries (e.g., decayed teeth (DT) or decayed-missing-filled-teeth index (DMFT), tooth loss/remaining teeth, oral hygiene parameters);
- Laboratory parameters (if applicable): c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disease activity score (DAS-28), rheumatoid factor (RF);
- Salivary parameters: salivary flow and pH-value;
- Bacterial metabolism (if applicable);
- Presence of a control group, sex, age.
2.5. Quality Appraisal
3. Results
3.1. Systematic Search Results
3.2. Study Characteristics
3.3. Oral Health Record and Findings
3.4. Quality Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
RA | rheumatoid arthritis |
EURA | early untreated rheumatoid arthritis |
CRA | chronic rheumatoid arthritis |
CRP | C-reactive protein |
DAS-28 | disease activity score |
ESR | erythrocyte sedimentation rate |
RF | rheumatoid factor |
DT | number of decayed teeth |
DMFT | decayed, missing and filled teeth index |
FT | number of filled teeth |
GI | gingival index |
MT | number of missing teeth |
PI | plaque index |
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Author, Year | Country | No. of Patients | Study Type | Subjects’ Mean Age in Years | Treatment Time | Male (%) | Control Group (n, Age, Sex (%)) |
---|---|---|---|---|---|---|---|
Helenius et al., 2005 [18] | Finland | 24 | monocentric | 49.4 (11.5) | 10.5 (2.6) years | 8.3% men | 24, 44.6 (12.7) years, 8.3% men |
Arneberg et al., 1992 [19] | Southeastern Norway | 125 | monocentric | 44–56 years (city of Oslo: 52 ± 3; Oslo suburbs: 51 ± 4; rest of southeastern Norway: 51 ± 3) | 4–9 years: 26.4%, 10–19 years: 40.8%, 20–42 years: 32.8% | 16.8% men | n/a |
Descamps et al., 2020 [20] | France | 223 | monocentric retrospective | 54.4 ± 10.9 | 8.9 ± 8.6 years | 20.6% men | n/a |
Gonzales-Chavez et al., 2019 a [21] | Mexico | 30 | monocentric | 44.30 ± 13.50 | n/a | 7% men | 30, 41.7 ± 12.25 years, 20% men |
Mehdipour et al., 2022 [14] | Iran | 45 | cross-sectional descriptive analytical | 53.5 ± 7.99 | mean duration 5.82 ± 6.1 years (minimum 6 months, maximum 25 years) | 16% men | 45, 53.9 ± 7.55 years, % of men not clear |
Gonzales-Chavez et al., 2019 b [22] | Mexico | 62 | monocentric descriptive observational | 51 (18–72) | n/a | 13%men | n/a |
Äyräväinen et al., 2018 [13] | Finland | 81 (EURA: n = 53, CRA: n = 28) | monocentric | EURA: 52 (22–78), CRA: 54 (20–64) | n/a | EURA: 15.1% men, CRA: 17.9% men | 43, 56 (30–82) years, 11.6% men |
Almasi et al., 2021 * [23] | Iran | 118 | monocentric case-control study | 51.49 ± 10.91 | 9.15 ± 7.88 | 17.8% men | 118 * |
Kim et al., 2019 [24] | South Korea | 157 | data from fifth and sixth Korea National Health and Nutrition Examination Surveys | 56.3 ± 1.4 years | n/a | 22.3% men | 20, 140, 43.9 ± 0.2 years, 42.5% men |
Kroese et al., 2022 [25] | The Netherlands | 150 (early rheumatoid arthritis n = 50, risk of RA n = 50) | cross-sectional (part of larger longitudinal cohort study) | RA: 52.1 (13.2) years, risk of RA: 51.4 (10.3) years | <1 year | RA: 22% men, risk of RA: 24% men | 50, 51.2 (11.0) years, 24% men |
Martinez-Martinez et al., 2019 [10] | Mexico | 80 | cross-sectional prospective study | 46 ± 8 (rage: 32–60) years | ≥5 years but <15 years | 8% men | 80, 46 ± 8 (rage: 32–60) years, 8% men |
Silvestre-Rangil et al., 2016 [26] | Spain | 73 | prospective cross-sectional case-controlled study | 53.3 ± 12.1 years | n/a | 28.7% men | 73, 52.6 ± 11.2 years, 32.8% men |
Juan et al., 2022 [27] | Taiwan | 1337 | secondary cohort analysis with data from Taiwan’s National Health Insurance Research Database | 53.2 (SD 13.4) years | newly diagnosed | 22.6% men | 13,370, 53.2 (SD 13.4) years, 22.6% men |
Mok et al., 2022 [28] | Hong Kong | 238 | monocentric cross-sectional | 58.8 ± 10.8 years | 15.1 ± 11.0 years | 6.3% men | n/a |
Sánchez-Medrano et al., 2021 [29] | Mexico | 13 | descriptive pilot study | 45 (SD 8.0) years | newly diagnosed | 7% men | 16, 49 (SD 10) years, 50% men |
de Pablo et al., 2007 [30] | USA | 103 | cross-sectional survey: data from the third National Health Nutrition Examination Survey (USA) | 73 ± 8.3 years | n/a | 43% men | 4358, 72 ± 8.1 years, 49% men |
Author, Year | Tooth Loss, Remaining Teeth, Dentures | Caries | Oral Hygiene Parameters | Laboratory Parameters | Saliva Parameters | Bacterial-/Metabolism | ||||
---|---|---|---|---|---|---|---|---|---|---|
CRP (mg/L) | DAS-28 | ESR (mm/h) | RF | Saliva Flow Rate | pH | |||||
Helenius et al., 2005 [18] | n/a | Prevalence: RA: 75% in patients with missing teeth, 17% in patients with caries at clinical examination; C: 53% in patients with missing teeth, 22% in patients with caries at clinical examination | CPI (RA: 2 = 25%, 3 = 38%, 4 = 33%; C: 2 = 74%, 3 = 25%, 4 = 1%) | n/a | n/a | n/a | n/a | Resting flow: decreased flow RA: 8%, C: 0%; stimulated flow: decreased flow RA: 8%, C: 0% | low pH: RA: 17%; C: 4% | Mutans streptococci (>105 CFU/mL): RA: 8%, C: 12%; Lactobacilli (>106 CFU/mL): RA: 4%, C: 6%; positive yeast count: RA: 50%, C: 22%; A.a. pos: RA: 8%, C: 6%; P.g. pos: RA: 13%, C: 16%; P.i. pos: RA: 63%, C: 75%; P.n. pos: RA: 63%, C: 53%; B.f. pos: RA: 0%, C: 3% |
Arneberg et al., 1992 [19] | mean number: 25 | Caries problems: 0–2 cavities/yr: 78.4%, 3–5 cavities/yr: 10.4%, >5 cavities/yr: 5.6% | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
Descamps et al., 2020 [20] | n/a | Panoramic dental X-ray: 11.8% had dental caries | n/a | high CRP level (<5 mg/L): 63.5% | 5.5 ± 2.6 | n/a | 77.4% | n/a | n/a | n/a |
Gonzales-Chavez et al., 2019 a [21] | n/a | Missing: RA: 6.90 ± 5.77; C: 3.03 ± 2, cavities: RA: 13.46 ± 5.48, C: 4.90 ± 6.55; slight cavities: RA: 4.30 ± 4.39, C: 2.33 ± 3.91; moderate cavities: RA: 6.83 ± 5.25, C: 1.96 ± 3.48; advanced: RA: 2.33 ± 3.45, C: 0.6 ± 1.88 | SOHI (RA: 3.29 ± 1.73; C: 1.51 ± 1.52) | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
Mehdipour et al., 2022 [14] | n/a | DMFT RA: 18.87 ± 6.76, C: 11.11 ± 5.90; DT: RA: 3.84 ± 3.90, C: 1.93 ± 1.86 | n/a | yes * | yes * | yes * | n/a | n/a | n/a | n/a |
Gonzales-Chavez et al., 2019 b [22] | n/a | missing: 73.8%, caries: 98.3% (initial: 70%, moderate: 91.7%, advanced: 73.8%), restored: 59% | OHI-S (3.2 (0.2–6)) | 10.9 (0.2–86.6) | 4.1 (1–6.2) | 33 (10–78) | 82% positive | n/a | n/a | n/a |
Äyräväinen et al., 2018 [13] | EURA: baseline: 27 (23–28), follow up: 27 (22–28); CRA: baseline: 27 (22–28), follow up: 27 (22–28), control: 27 (25–28) | DMFT: EURA: baseline: 19 (12–23), follow up: 20 (13–24); CRA: baseline: 19 (12–23), follow up: 19 (12–23), control: 17 (10–21) | n/a | EURA: baseline: 6 (3–14), follow up: 3 (2–6); CRA: baseline: 18 (5–30), follow up: 7 (2–19) | EURA: baseline: 4.0 (3.2–4.8), follow up: 2.4 (1.7–2.9); CRA: baseline: 4.1 (3.0–4.9), follow up: 3.1 (2.0–3.9) | EURA: baseline: 20 (11–34), follow up: 9 (5–16); CRA: baseline: 20 (9–46), follow up: 15 (5–31) | EURA: 79.2%; CRA: 69.2%; control: 8.1% | ml/ 5 min: unstimulated: EURA baseline: 1.0 (0.5–1.5), follow up: 1.4 (0.8–2.2); CRA baseline: 1.2 (0.7–2.0), follow up: 1.7 (0.8–2.3); stimulated: EURA baseline: 5.0 (3.5–7.0), follow up: 5.0 (3.0–8.6); CRA baseline: 5.5 (3.8–8.0), follow up: 5.0 (4.6–8.3) | n/a | n/a |
Almasi et al., 2021 * [23] | DMFT: * “dental caries were more prevalent in RA patients, but severe dental caries occur more in control group” | * PI: “dental plaques in RA patients are significantly more than the others”; good oral hygiene: RA: 27.1%, C: 29.7%; moderate oral hygiene: RA: 50%, C: 43.2%; low oral hygiene: RA: 45.8%, C: 27.1%; GI: RA: 55.4% gingivitis, C: 64.4% gingivitis | yes * | 2.880 ± 0.99 in RA patients | 27.40 ± 15.64 | 1+: 27.1%, 2+: 45.7%, 3+: 27.1% | n/a | n/a | n/a | |
Kim et al., 2019 [24] | RA: 22.6 ± 0.6; C: 25.7 ± 0.05 | Prevalence: caries in permanent teeth: RA: 0.5%, C: 35.7% | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
Kroese et al., 2022 [25] | Remaining teeth: early rheumatoid arthritis: 27 (24.8–28), risk of RA: 27 (25–28), control: 27.5 (25–28) | DMFT early rheumatoid arthritis: 12.8 (7.0), risk of RA:12.2 (5.9), control: 11.0 (6.5) | n/a | n/a | n/a | n/a | >5.0 kU/L = seropositive | n/a | n/a | n/a |
Martinez-Martinez et al., 2019 [10] | Missing teeth: RA: 3.9 ± 3.35 (0–15), Control: 4.0 ± 3.88 (0–16) | DMFT: RA: 13.02 ± 4.99, C: 14.84 ± 5.52, DT: RA: 5.79 ± 3.98, C: 3.88 ± 4.05 | n/a | n/a | n/a | n/a | n/a | n/a | n/a | Total of cariogenic bacteria: RA: 3.3 × 108 ± 8.2 × 108 (6483.4 − 4 × 109), control: 4.6 × 108 ± 3.1 × 109 (677.3 − 2 × 1010); S. mutans: RA: 5.9 × 107 ± 1.7 × 108 (41.72 − 8.9 × 108), control: 1.5 × 105 ± 4.9 × 105 (66.36 − 2.8 × 106); S. sobrinus: RA: 5.9 × 108 ± 1.8 × 109 (0−7.8 × 109), control: 9.5 × 108 ± 5.6 × 108 (0−3.8 × 108) |
Silvestre-Rangil et al., 2016 [26] | n/a | DMFT: RA: 11.84 ± 6.658, C: 10.56 ± 6.621 | Plaque index: RA: 1.60 ± 0.579, C: 1.07 ± 0.594 | n/a | n/a | n/a | n/a | mL/5 min: RWS (resting whole saliva): control 2.15 ± 1.545, RA 1.45 ± 0.765; SWS (stimulated whole saliva): control 4.564 ± 2.7947, RA 3.811 ± 2.2043; SPS (stimulated parotid saliva flow): control 1.187 ± 1.0838, RA 0.489 ± 0.5298 | n/a | n/a |
Juan et al., 2022 [27] | n/a | Prevalence: RA: 55.9%, C: 51.5% | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
Mok et al., 2022 [28] | Remaining teeth: (sample size n = 238) 24.8 ± 7.1 | (Sample size n = 238) DMFT: 12.8 ± 8.1 (97.9%); DT: 0.8 ± 1.5 (34%) | Plaque index: 0.73 ± 0.19 (sample size n = 183) | n/a | n/a | n/a | 74.8% + | n/a | n/a | n/a |
Sánchez-Medrano et al., 2021 [29] | Missing teeth: RA: 2 ± 2 (0–9), Control: 2 ± 3 (0–11) | DMFT index: RA 0.51 ± 0.14 (healthy teeth: 13 ± 5 (7–21), D: 9 ± 4 (1–19), M: 2 ± 2 (0–9), F: 2 ± 4 (0–13)), control: 0.44 ± 0.17 (0.14–0.67) (healthy teeth: 15 ± 5 (7–24), D: 5 ± 4 (0–17), M: 2 ± 3 (0–11), F: 5 ± 5 (0–14)); FS-T index: RA: 13 ± 4 (7–21), control: 15 ± 5 (9–24); TNI index: RA: 102 ± 4 (100–111), control: 85 ± 42 (0–114); CI index: RA: 17 ± 30 (0–92), control: 46 ± 40 (0–81) | n/a | n/a | RA: 15% with moderate disease activity (DAS28-ESR: 3.2–≤5.1), 85% with high disease activity (DAS28-ESR: >5.1) [DAS28 = 5.7 ± 0.93 (3.6–7.6)] | yes | n/a | Total salivary flow: RA 5.2 ± 2.0 (1.50–9.0), control 11.6 ± 1.5 (8.5–14); salivary flow: RA 1.0 ± 0.4 (0.30–1.8), control 2.3 ± 0.3 (1.7–2.8) | RA: 7.0 ± 0.4 (6.56–8.1), control: 7.4 ± 0.2 (7.0–7.2) | n/a |
de Pablo et al., 2007 [30] | Missing teeth: RA: 20 ±10, Non-RA: 16 ± 11 | Decayed surfaces: RA: 2%, non-RA: 4%; decayed or filled surfaces: RA: 21%, non-RA: 24% | n/a | n/a | n/a | n/a | RA: 41% −, 18% +; non-RA: 52% −, 46% + | n/a | n/a | n/a |
Author, Year | Number of Participants | Caries Disease Group | Caries Healthy Control Group | Significant Difference between Disease and Control | |
---|---|---|---|---|---|
RA | Control | ||||
Helenius et al., 2005 [18] | 24 | 24 | Prevalence: 75% in patients with missing teeth, 17% in patients with caries at clinical examination | Prevalence: 53% in patients with missing teeth, 22% in patients with caries at clinical examination | no |
Gonzales-Chavez et al., 2019 a [21] | 30 | 30 | Missing: 6.90 ± 5.77; cavities: 13.46 ± 5.48, slight cavities: 4.30 ± 4.39, moderate cavities: 6.83 ± 5.25, advanced: 2.33 ± 3.45 | Missing: 3.03 ± 2; cavities: 4.90 ± 6.55, slight cavities: 2.33 ± 3.91, moderate cavities: 1.96 ± 3.48, advanced cavities: 0.6 ± 1.88 | yes |
Mehdipour et al., 2022 [14] | 45 | 45 | DMFT: 18.87 ± 6.76, DT: 3.84 ± 3.90 | DMFT: 11.11 ± 5.90, DT: 1.93 ± 1.86 | yes |
Äyräväinen et al., 2018 [13] | 81 (EURA: n = 53, CRA: n = 28) | 43 | DMFT: EURA: baseline: 19 (12–23), follow up: 20 (13–24); CRA: baseline: 19 (12–23), follow up: 19 (12–23), | DMFT: 17 (10–21) | yes |
Almasi et al., 2021 * [23] | 118 | 118 | DMFT: * “dental caries were more prevalent in RA patients, but severe dental caries occur more in control group” | * | yes |
Kim et al., 2019 [24] | 157 | 20,140 | Prevalence: caries in permanent teeth: 0.5% | Prevalence: caries in permanent teeth: 35.7% | no |
Kroese et al., 2022 [25] | 150 | 50 | DMFT early rheumatoid arthritis: 12.8 (7.0), risk of RA: 12.2 (5.9) | DMFT: 11.0 (6.5) | no |
Martinez-Martinez et al., 2019 [10] | 80 | 80 | DMFT: 13.02 ± 4.99, DT: 5.79 ± 3.98 | DMFT: 14.84 ± 5.52, DT: 3.88 ± 4.05 | DMFT: no, DT: yes |
Silvestre-Rangil et al., 2016 [26] | 73 | 73 | DMFT: 11.84 ± 6.658 | DMFT: 10.56 ± 6.621 | no |
Juan et al., 2022 [27] | 1337 | 13,370 | Prevalence: 55.9% | Prevalence: 51.5% | yes |
Sánchez-Medrano et al., 2021 [29] | 13 | 16 | DMFT: 0.51 ± 0.14, DT: 9 ± 4 | DMFT: 0.44 ± 0.17, decayed: 5 ± 4 | DMFT: no, DT: yes |
de Pablo et al., 2007 [30] | 103 | 4358 | Decayed surfaces: 2%, decayed or filled surfaces: 21% | Decayed surfaces: 4%; decayed or filled surfaces: 24% | Decayed surfaces: yes, decayed or filled surfaces: no |
Item | (1) Define the Source of Information (Survey, Record, Review) | (2) List Inclusion and Exclusion Criteria for Exposed and Unexposed Subjects (Cases and Controls) or Refer to Previous Publications | (3) Indicate Time Period Used for Identifying Patients | (4) Indicate Whether or Not Subjects Were Consecutive If Not Population-Based | (5) Indicate If Evaluators of Subjective Components of Study Were Masked to Other Aspects of the Status of the Participants | (6) Describe Any Assessments Undertaken for Quality Assurance Purposes (e.g., Test/Retest of Primary Outcome Measurements) | (7) Explain Any Patient Exclusions from Analysis | (8) Describe How Confounding Variables Were Assessed and/or Controlled. | (9) If Applicable, Explain How Missing Data Were Handled in the Analysis | (10) Summarize Patient Response Rates and Completeness of Data Collection | (11) Clarify What Follow-Up, If Any, Was Expected and the Percentage of Patients for Which Incomplete Data or Follow-Up Were Obtained | Total Score |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Helenius et al., 2005 [18] | yes | no | no | yes | no | no | yes | no | n/a | yes | n/a | 4 |
Arneberg et al., 1992 [19] | yes | no | no | yes | no | yes | yes | yes | yes | yes | n/a | 7 |
Descamps et al., 2020 [20] | yes | no | yes | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Gonzales-Chavez et al., 2019 a [21] | yes | yes | yes | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Mehdipour et al., 2022 [14] | yes | yes | no | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Gonzales-Chavez et al., 2019 b [22] | yes | yes | no | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Äyräväinen et al., 2018 [13] | yes | no | yes | yes | yes | no | yes | no | yes | yes | yes | 8 |
Almasi et al., 2021 [23] | yes | yes | no | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Kim et al., 2019 [24] | yes | yes | yes | yes | no | yes | yes | yes | yes | yes | n/a | 9 |
Kroese et al., 2022 [25] | yes | yes | yes | yes | no | no | no | no | yes | yes | n/a | 6 |
Martinez-Martinez et al., 2019 [10] | yes | yes | no | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Silvestre-Rangil et al., 2016 [26] | yes | yes | yes | yes | no | no | yes | no | n/a | yes | n/a | 6 |
Juan et al., 2022 [27] | yes | yes | yes | yes | no | no | yes | no | n/a | yes | n/a | 6 |
Mok et al., 2022 [28] | yes | yes | yes | yes | no | no | yes | no | n/a | yes | n/a | 5 |
Sánchez-Medrano et al., 2021 [29] | yes | yes | yes | yes | no | no | yes | no | n/a | yes | n/a | 6 |
de Pablo et al., 2007 [30] | yes | no | yes | yes | no | no | yes | no | n/a | yes | n/a | 4 |
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Kreher, D.; Ernst, B.L.V.; Ziebolz, D.; Haak, R.; Ebert, T.; Schmalz, G. Dental Caries in Adult Patients with Rheumatoid Arthritis—A Systematic Review. J. Clin. Med. 2023, 12, 4128. https://doi.org/10.3390/jcm12124128
Kreher D, Ernst BLV, Ziebolz D, Haak R, Ebert T, Schmalz G. Dental Caries in Adult Patients with Rheumatoid Arthritis—A Systematic Review. Journal of Clinical Medicine. 2023; 12(12):4128. https://doi.org/10.3390/jcm12124128
Chicago/Turabian StyleKreher, Deborah, Bero Luke Vincent Ernst, Dirk Ziebolz, Rainer Haak, Thomas Ebert, and Gerhard Schmalz. 2023. "Dental Caries in Adult Patients with Rheumatoid Arthritis—A Systematic Review" Journal of Clinical Medicine 12, no. 12: 4128. https://doi.org/10.3390/jcm12124128