Non-Cochrane · aetiology · PM31856793
Oral health in children and adolescents with juvenile idiopathic arthritis - a systematic review and meta-analysis.
Skeie Marit S, Gil Elisabeth G, Cetrelli Lena, et al. · BMC oral health · 2019 · PubMed · doi:10.1186/s12903-019-0965-4
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
13
current version
GRADE rated
0
No studies
1
Included studies
20
linked below
No studies 1 · 7.7%Ungraded 12 · 92.3%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents (with and without JIA) | Children and adolescents with JIA vs healthy peers (n=19 studies; per-study JIA group 14-168) |
| Intervention | Juvenile idiopathic arthritis (JIA) | Juvenile idiopathic arthritis (JIA) (n=19 studies) |
| Comparison | Children and adolescents without JIA (healthy peers) | Children and adolescents without JIA (one study used healthy population norms) |
| Outcomes | Oral health measures (dental caries, oral hygiene/plaque, periodontal conditions, enamel defects, dental maturation, oral ulcerations, TMD/TMJ disease, orofacial pain) and oral health-related quality of life (OHRQoL) | Dental caries dmft (meta-analyzed, n=3) and DMFT (meta-analyzed, n=6); oral hygiene/plaque (narrative); periodontal conditions (narrative); enamel defects (n=1); oral ulcerations (n=1); dental maturation (n=2); TMD/TMJ disease and orofacial pain (n=5); OHRQoL (n=2); dental erosive wear (n=0, no studies) |
| Study designs | RCTs, controlled clinical trials, cohort, cross-sectional and case-control studies (systematic reviews, meta-analyses, case reports, conference publications and grey literature excluded) | 18 cross-sectional studies; 1 prospective cohort study (Miranda et al.) (n=19) |
| Timing | Not specified | Cross-sectional (single time point) for 18 studies; 2-year follow-up for the cohort |
Search date: 25 November 2018. Databases: Medline Ovid; Embase; CINAHL; SweMed+; Cochrane Library
Questions and results
Juvenile idiopathic arthritis (JIA) vs Children and adolescents without JIA (healthy peers)
Population: Children and adolescents with juvenile idiopathic arthritis (JIA)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Temporomandibular disorders (TMD), TMJ arthritis/involvement and orofacial pain TMD and TMJ arthritis/involvement (and orofacial pain) were consistently reported more frequently in children/adolescents with JIA than in healthy peers, though several studies had small samples; no pooled estimate (ungraded). Source: Results 'TMD' and 'OHRQoL' paragraphs; Discussion; Abstract; Conclusions · same question in other reviews | TMJ arthritis, TMJ involvement and TMD were coherently reported more frequently among children with JIA than healthy peers [35-38] (TMJ dysfunction also in [22]); e.g., higher frequency of condylar surface flattening… | 5 studies · 367 participants | Ungraded |
Oral ulcerations A single study reported more oral ulcerations in children with JIA (5/41) than without JIA (1/41); evidence is limited to one study (ungraded). Source: Results 'Developmental enamel defects and ulcers' paragraph · same question in other reviews | One study focused on oral ulceration [25] found five of forty-one children with JIA affected versus one of forty-one children without JIA. | 1 study · 82 participants | Ungraded |
Dental maturation (tooth calcification) Evidence on dental maturation was divergent across two studies (one found more advanced maturation in JIA, one found no difference); no clear conclusion (ungraded). Source: Results 'Dental maturation' paragraph; Discussion · same question in other reviews | Two studies gave divergent results: Lehtinen et al. [24] documented more advanced dental development in children with JIA, whereas Ley et al. [40] found dental maturity within the norms of healthy peers. | 2 studies | Ungraded |
Developmental enamel defects A single small study suggested developmental enamel defects were more frequent in children with JIA, but the evidence is insufficient (1 study; ungraded). Source: Results 'Developmental enamel defects and ulcers' paragraph · same question in other reviews | The only study reporting developmental enamel defects [22] found the condition more frequent among children with JIA than healthy peers, but the sample size was too small to draw any reliable conclusion. | 1 study · 110 participants | Ungraded |
Dental erosive wear No eligible studies reported dental erosive wear, so its association with JIA could not be assessed (evidence gap). Source: Discussion paragraph ('The present review lacked studies with focus on erosive wear'); Abstract; Conclusions · same question in other reviews | The present review lacked studies with focus on erosive wear; it concluded that for dental erosive wear there is no scientific evidence to answer the posed research questions. | 0 studies | No studies |
Oral hygiene / dental plaque (Plaque Index, OHI-S) Evidence on oral hygiene/dental plaque was inconsistent: several studies found higher plaque in the JIA group while others found no difference; no pooled estimate (ungraded). Source: Results 'Plaque, gingivitis and periodontitis' paragraph · same question in other reviews | Some studies showed a statistically higher Plaque Index or Simplified Oral Hygiene Index (OHI-S) in the JIA group [23, 25, 28, 31]; other studies did not find this association [22, 26, 27, 29, 30, 39]. Meta-analysis… | NR | Ungraded |
Oral health-related quality of life (OHRQoL) Evidence on OHRQoL was limited: one study found no significant difference between groups while another found orofacial symptoms affected daily life more in JIA; no pooled estimate (ungraded). Source: Results 'OHRQoL' paragraph; Discussion · same question in other reviews | Santos et al. [29] found oral health status had little or no effect on well-being with no significant difference between JIA and healthy groups (SF:13-B-PCPQ); Leksell et al. [38] found orofacial symptoms influenced… | 2 studies · 111 participants | Ungraded |
Periodontal conditions (gingival inflammation, bleeding on probing, probing depth, clinical attachment loss) Periodontal conditions (gingival inflammation, bleeding, probing depth, attachment loss) were more frequently reported in children/adolescents with JIA than in healthy peers, although not all studies agreed; no pooled estimate (ungraded). Source: Results 'Plaque, gingivitis and periodontitis' paragraph; Abstract; Conclusions · same question in other reviews | Many studies documented poorer periodontal status among children/adolescents with JIA: more gingival inflammation and bleeding [22, 29, 31], bleeding on probing [25], deeper probing depth [25, 26] and periodontal… | NR | Ungraded |
Dental caries in primary teeth (dmft index) There was no significant difference in dental caries of the primary teeth (dmft) between children with JIA and healthy peers (pooled MD -1.16, 95% CI -3.02 to 0.71; 3 cross-sectional studies; very high heterogeneity I2=87.9%; ungraded). Source: Results 'Quantitative synthesis' paragraph; Fig. 1 (dmft forest plot) · same question in other reviews | MD -1.16 [-3.02, 0.71] | 3 studies · 141 participants | Ungraded |
Dental caries in permanent teeth (DMFT index) There was no significant difference in dental caries of the permanent teeth (DMFT) between children/adolescents with JIA and healthy peers (pooled MD -0.08, 95% CI -0.42 to 0.26; 6 cross-sectional studies; no heterogeneity I2=0%; ungraded). Source: Results 'Quantitative synthesis' paragraph; Fig. 2 (DMFT forest plot) · same question in other reviews | MD -0.08 [-0.42, 0.26] | 6 studies · 320 participants | Ungraded |
Higher JIA disease activity/severity (e.g., high JADAS/activity scores, polyarticular RF-negative subtype, active disease, anti-TNFalpha or cyclosporine medication) vs Lower JIA disease activity / inactive or milder JIA
Population: Children and adolescents with juvenile idiopathic arthritis (JIA)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence and severity of oral and TMJ diseases/conditions (periodontal status and dental caries) Some studies suggested greater JIA disease activity/severity (and certain medications) was associated with worse periodontal and caries outcomes, but small samples meant no solid conclusion could be drawn (ungraded). Source: Results 'Influence by JIA activity and severity' paragraph; Discussion; Conclusions · same question in other reviews | Higher JIA disease activity/severity was associated with worse oral outcomes in several studies: JADAS and global activity scores correlated positively with DMFT and gingival indices [27]; a polyarticular RF-negative… | NR | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental calculus accumulation - | Calculus index (presence) NR (significantly higher in JIA) | 1 study | Ungraded |
Untreated dental caries prevalence - | Proportion with untreated caries NR (significantly higher in JIA) | 2 studies | Ungraded |
Included primary studies 20
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Abdul-Aziez et al. 2010 Serum S100A12 and temporomandibular joint magnetic resonance imaging in juvenile idiopathic arthritis Egyptian patients: a case control… PMID:20437698 | this review only | not stated | not extracted yet | not extracted yet |
| Ahmed et al. 2004 Oral health of children with juvenile idiopathic arthritis. PMID:15290746 | this review only | not stated | not extracted yet | not extracted yet |
| Al-Shwaikh et al. 2016 Radiologic features of temporomandibular joint osseous structures in children with juvenile idiopathic arthritis. Cone beam computed… PMID:27649720 | this review only | not stated | not extracted yet | not extracted yet |
| Feres de Melo et al. 2014 Clinical oral and salivary parameters of children with juvenile idiopathic arthritis. PMID:24332330 | this review only | not stated | not extracted yet | not extracted yet |
| Kobus et al. 2017 Unstimulated salivary flow, pH, proteins and oral health in patients with Juvenile Idiopathic Arthritis. PMID:28577525 | this review only | not stated | not extracted yet | not extracted yet |
| Lehtinen et al. 2000 Advanced dental maturity in children with juvenile rheumatoid arthritis. PMID:10872987 | this review only | not stated | not extracted yet | not extracted yet |
| Leksell et al. 2008 Intraoral condition in children with juvenile idiopathic arthritis compared to controls. PMID:18637044 | this review only | not stated | not extracted yet | not extracted yet |
| Leksell et al. 2012 Orofacial pain and dysfunction in children with juvenile idiopathic arthritis: a case-control study. PMID:22632030 | this review only | not stated | not extracted yet | not extracted yet |
| Ley et al. 2009 Entwicklung des Zahnalters bei Juveniler Idiopathischer Arthritis DOI:10.1055/s-0028-1119369 | this review only | not stated | not extracted yet | not extracted yet |
| Maspero 2017 Erratum. PMID:27583781 | this review only | not stated | not extracted yet | not extracted yet |
| Maspero et al. 2017 Periodontal conditions in juvenile idiopatic arthritis. PMID:27588378 | this review only | not stated | not extracted yet | not extracted yet |
| Miranda et al. 2003 Periodontal conditions in patients with juvenile idiopathic arthritis. PMID:14761119 | this review only | not stated | not extracted yet | not extracted yet |
| Miranda et al. 2005 Increased interleukin-18 in patients with juvenile idiopathic arthritis and early attachment loss. PMID:15830640 | this review only | not stated | not extracted yet | not extracted yet |
| Miranda et al. 2006 Changes in periodontal and rheumatological conditions after 2 years in patients with juvenile idiopathic arthritis. PMID:17032112 | this review only | not stated | not extracted yet | not extracted yet |
| Mohammed et al. 2012 Juvenile idiopathic arthritis and the temporomandibular joint DOI:10.1016/j.ajme.2011.11.004 | this review only | not stated | not extracted yet | not extracted yet |
| Pugliese et al. 2016 Juvenile idiopathic arthritis activity and function ability: deleterious effects in periodontal disease? PMID:26626632 | this review only | not stated | not extracted yet | not extracted yet |
| Reichert et al. 2006 Is there a relationship between juvenile idiopathic arthritis and periodontitis? PMID:16634951 | this review only | not stated | not extracted yet | not extracted yet |
| Santos et al. 2015 Oral health and quality of life of children and adolescents with juvenile idiopathic arthritis according to their caregivers' perceptions. PMID:26255878 | this review only | not stated | not extracted yet | not extracted yet |
| Savioli et al. 2004 Dental and facial characteristics of patients with juvenile idiopathic arthritis. PMID:15286827 | this review only | not stated | not extracted yet | not extracted yet |
| Welbury et al. 2003 Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis. PMID:12810923 | this review only | not stated | not extracted yet | not extracted yet |