Allergic rhinitis and dental caries: A systematic review
Main Article Content
Allergic rhinitis, caries, periodontitis, oral disease, allergy
Objective: Dental caries is one of the most common chronic diseases affecting millions of people globally. Some studies revealed the presence of bidirectional relationship between allergic rhinitis (AR) and oral diseases, with each disease having a potential impact on the other. In this study we aimed to systematically review the literature and analyze the available evidence regarding whether AR contributes to the development of dental caries.
Methods: Three authors, members of the YO-IFOS rhinology study group, independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing the relationship between rhinitis and caries, in adult and pediatric patients.
Results: Eight studies met the inclusion criteria (87612 participants). Six studies were performed in children. A total of three studies found an association between AR and dental caries. Only two studies had adjusted the measure of effect for potentially confounding variables. Regarding the quality of the selected studies according to the NICE classification, the most observed methodological limitations detected were: (1) the cross-sectional design of the included studies which could have introduced a simultaneity bias, and (2) not clearly reporting the inclusion and exclusion criteria.
Conclusion: This systematic review can neither confirm nor deny the presence of an association between AR and caries. Despite the evidence is very scarce to conclude a relationship between AR and caries, the option for examining patients with repetitive caries by an otolaryngologist and those with AR by odontologist should be considered, as these examinations do not possess any risk for the patient.
2. Asher MI, Montefort S, Björkstén B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet Lond Engl. 2006;368(9537): 733–43. 10.1016/S0140-6736(06)69283-0
3. Stensson M, Wendt LK, Koch G, Nilsson M, Oldaeus G, Birkhed D. Oral health in pre-school children with asthma—Followed from 3 to 6 years. Int J Paediatr Dent. 2010;20(3):165–72. 10.1111/j.1365-263X.2010.01037.x
4. Yazdanbakhsh M, Kremsner PG, van Ree R. Allergy, parasites, and the hygiene hypothesis. Science. 2002;296(5567):490–4. 10.1126/science.296.5567.490
5. Choi JE, Waddell JN, Lyons KM, Kieser JA. Intraoral pH and temperature during sleep with and without mouth breathing. J Oral Rehabil. 2016;43(5):356–63. 10.1111/joor.12372
6. Guo L, Shi W. Salivary biomarkers for caries risk assessment. J Calif Dent Assoc. 2013;41(2):107–9, 112–8.
7. National Institute for Health and Care Excellence. Appendix F. En: Methods for the development of NICE public health guidance (3rd ed). London, England: National Institute for Health and Care Excellence (NICE); 2012. p. 179–98.
8. Lai WY, Wei CC, Wan L, Mai CH, Lin CL, Tsai JD. Allergic rhinitis and dental-supporting tissue diseases in children. Medicine (Baltimore). 2021;100(7):e24780. 10.1097/MD.0000000000024780
9. Wee JH, Yoo DM, Byun SH, Lee HJ, Park B, Park MW, et al. Subjective oral health status in an adult Korean population with asthma or allergic rhinitis. Medicine (Baltimore). 2020;99(43): e22967. 10.1097/MD.0000000000022967
10. Wee JH, Park MW, Min C, Park IS, Park B, Choi HG. Poor oral health is associated with asthma, allergic rhinitis, and atopic dermatitis in Korean adolescents: A cross-sectional study. Medicine (Baltimore). 2020;99(31):e21534. 10.1097/MD.0000000000021534
11. Friedrich N, Völzke H, Schwahn C, Kramer A, Jünger M, Schäfer T, et al. Inverse association between periodontitis and respiratory allergies. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2006;36(4):495–502. 10.1111/j.1365-2222.2006.02455.x
12. Herrström P, Högstedt B. Dental restorative materials and the prevalence of eczema, allergic rhino-conjunctivitis, and asthma in schoolchildren. Dental amalgam and allergy in schoolchildren. Scand J Prim Health Care. 1994;12(1):3–8. 10.3109/02813439408997049
13. Kiykim A, Mumcu G, Ogulur I, Karakoc-Aydiner E, Direskeneli H, Baris S, et al. Could sublingual immuno-therapy affect oral health in children with asthma and/or allergic rhinitis sensitized to house dust mite? Int Arch Allergy Immunol. 2017;174(1):52–56. 10.1159/000480082
14. Matsson L, Möller C. Gingival inflammatory reactions in children with rhinoconjunctivitis due to birch pollinosis. Scand J Dent Res. 1990;98(6):504–9. 10.1111/j.1600-0722.1990.tb01005.x
15. Lee DW, Kim JG, Yang YM. Influence of mouth breathing on atopic dermatitis risk and oral health in children: A population-based cross-sectional study. J Dent Sci. 2021; 16(1):178–85. 10.1016/j.jds.2020.06.014
16. Park HJ, Choi M, Park HJ, Haw S. Dental caries in adults with atopic dermatitis: A nationwide cross-sectional study in Korea. Ann Dermatol. 2021;33(2):154–62. 10.5021/ad.2021.33.2.154
17. Silverberg J, Simpson E. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013;24(5):476–86. 10.1111/pai.12095
18. Stecksén-Blicks C, Sunnegårdh K, Borssén E. Caries experience and background factors in 4-year-old children: Time trends 1967–2002. Caries Res. 2004;38(2):149–55. 10.1159/000075939
19. Widmer RP. Oral health of children with respiratory diseases. Paediatr Respir Rev. 2010;11(4):226–32. 10.1016/j.prrv.2010.07.006
20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71s
21. Ho SW, Lue KH, Ku MS. Allergic rhinitis, rather than asthma, might be associated with dental caries, periodontitis, and other oral diseases in adults. PeerJ. 2019;7:e7643. 10.7717/peerj.7643
22. Bakhshaee M, Ashtiani SJ, Hossainzadeh M, Sehatbakhsh S, Najafi MN, Salehi M. Allergic rhinitis and dental caries in preschool children. Dent Res J. 2017;14(6):376–81. 10.4103/1735-3327.218560
23. Chuang CY, Sun HL, Ku MS. Allergic rhinitis, rather than asthma, is a risk factor for dental caries. Clin Otolaryngol. 2018;43(1):131–6. 10.1111/coa.12912
24. Wongkamhaeng K, Poachanukoon O, Koontongkaew S. Dental caries, cariogenic microorganisms and salivary properties of allergic rhinitis children. Int J Pediatr Otorhinolaryngol. 2014;78(5):860–5. 10.1016/j.ijporl.2014.03.001
25. 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. 2008;45(9):795–9. 10.1080/02770900802252119
26. Vázquez-Nava F, Vázquez REM, Saldivar GAH, Beltrán GFJ, Almeida AVM, Vázquez RCF. Allergic rhinitis, feeding and oral habits, toothbrushing and socioeconomic status. Effects on development of dental caries in primary dentition. Caries Res. 2008;42(2):141–7. 10.1159/000121438
27. Kim CS, Lee KS. Effect of allergic rhinitis and asthma on oral health. J Dent Hyg Sci. 2019;19(4):228–37. 10.17135/jdhs.2019.19.4.228
28. Herrström P, Högstedt B. Allergic diseases, dental health, and socioeconomic situation of Swedish teenagers. Allergy, dental health, and social situation. Scand J Prim Health Care. 1994; 12(1):57–61. 10.3109/02813439408997058
29. Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiol Rev. 1986;50(4):353–80. 10.1128/mr.50.4.353-380.1986
30. Guggenheimer J, Moore PA. Xerostomia: Etiology, recognition and treatment. J Am Dent Assoc. 2003;134(1):61–9; quiz 118–9. 10.14219/jada.archive.2003.0018
31. Elad S, Heisler S, Shalit M. Saliva secretion in patients with allergic rhinitis. Int Arch Allergy Immunol. 2006;141(3):276–80. 10.1159/000095297
32. Mejàre I, Axelsson S, Dahlén G, Espelid I, Norlund A, Tranæus S, et al. Caries risk assessment. A systematic review. Acta Odontol Scand. 2014;72(2):81–91. 10.3109/00016357.2013.822548
33. American Academy of Pediatric Dentistry. Guideline on caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent. 2013;35(5):E157–164.
34. Maupomé G, Shulman JD, Medina-Solis CE, Ladeinde O. Is there a relationship between asthma and dental caries? A critical review of the literature. J Am Dent Assoc. 2010;141(9):1061–74. 10.14219/jada.archive.2010.0335
35. Vichyanond P, Suratannon C, Lertbunnaphong P, Jirapongsananuruk O, Visitsunthorn N. Clinical characteristics of children with non-allergic rhinitis vs with allergic rhinitis. Asian Pac J Allergy Immunol. 2010;28(4):270–4.
36. Gani F, Caminati M, Bellavia F, Baroso A, Faccioni, Pancera P, et al. Oral health in asthmatic patients: A review: Asthma and its therapy may impact on oral health. Clin Mol Allergy. 2020;18(1):22. 10.1186/s12948-020-00137-2
37. Lechien JR, Calvo-Henriquez C, Chiesa-Estomba CM, Barillari MR, Trozzi M, Meucci D, et al. Reflux and dental disorders in the pediatric population: A systematic review. Int J Pediatr Otorhinolaryngol. 2020;136:110166. 10.1016/j.ijporl.2020.110166
38. Lechien JR, Chiesa-Estomba CM, Calvo Henriquez C, Mouawad F, Ristagno C, Barillari MR, et al. Laryngopharyngeal reflux, gastro-esophageal reflux and dental disorders: A systematic review. PLoS One. 2020;15(8):e0237581. 10.1371/journal.pone.0237581
39. Hopcraft MS, Morgan MV. Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population. Community Dent Oral Epidemiol. 2005;33(3):212–8. 10.1111/j.1600-0528.2005.00216.x
40. Valero A, Navarro AM, Del Cuvillo A, Alobid I, Benito JR, Colás C, et al. Position paper on nasal obstruction: Evaluation and treatment. J Investig Allergol Clin Immunol. 2018;28(2):67–90. 10.18176/jiaci.0232