Efeito da asma na cárie dentária nas dentições decídua e permanente: estudo nas coortes de nascimentos de 1993 e 2004, Pelotas RS

Abstract

Asthma and dental caries are both high prevalent chronic diseases, beginning in childhood and with a widespread occurrence in the world, affecting quality of life of the individuals. Although some studies assessed the association between both diseases, a true causal relationship is controversial in the literature. Considering the association between both situations, the antiasthmatics drugs being discussed as key factor. Through their xerostomic (dry mouth) potential, antiasthmatic drugs favor a harmful oral environment leading in dental caries lesions occurrence. This thesis, was firstly performed aiming to systematically review the literature about asthma and dental caries association and estimate the effect of asthma in dental caries occurrence considering possible influence of methodological aspects (article 1). The pathways which asthma have relation with dental caries were assessed evaluating possible direct, indirect and mediated effects of asthma symptoms in dental caries of primary dentition occurrence (article 2). Although asthma medication seems the key-factor of all this relation, its use occurs only after physician diagnosis, which is easily detected in individuals who have persistent symptoms in the life-course. Considering the aforementioned was assessed the effect of the time of diagnosis and the trajectory of asthma-related symptoms in the life-course in the occurrence of dental caries in permanent dentition (article 3). Data from the literature about the topic were used to develop the article 1. It were used samples of two birth cohorts of Pelotas to attend the objectives of articles 2 and 3. Data from 2004 birth cohort at 6-years-old of the individuals (primary dentition – article 2) and from 1993 birth cohort at 18-years-old of individuals (permanent dentition – article 3) were used. It was considered the hypothesis that asthmatic individuals had a higher occurrence of dental caries by direct way or mediated by antiasthmatic drugs due to its salivary effects. In the first article, it was found that literature stated a positive association being the chance in of caries occurrence in asthmatic individuals 50% higher than their counterparts (Odds Ratio: 1.45 and 1.52, for primary and permanent dentition, respectively). However, the results are based on studies which cares in methodological aspects and did not explored causal relations. In the second article, when it was reviewed the literature about xerostomia and hyposalivation it was found a global prevalence of 22% of dry mouth (xerostomia/hyposalivation) and age was a strong determinant of its occurrence, seeming that there is no impact in early ages. In the second article, assessing possible pathways which asthmas was associated with caries in primary dentition, it was found no direct, indirect or mediated effect of asthma in occurrence of caries lesions. Moreover, socioeconomic and behavioral factors are the main determinants of caries even in respiratory compromised individuals. In the article 3, similarly as the finding in the primary dentition, asthma symptoms in life-course (persistent wheezing) and asthma diagnosis do not affect the occurrence of dental caries lesions in the permanent dentition at 18-years-old. The original studies oppose the stated by the systematic reviews, however the results were based in high quality methodological aspects overcoming the lacks in the previous studies, providing reliable evidence to refute the stated previously. The results are consistent between the original articles, presenting no effect of asthma in dental caries occurrence in primary or permanent dentition, highlighting the socioeconomic and behavioral factors as determinants of dental caries even in respiratory compromised children.