Periodontal and oral health status of people with Cystic Fibrosis: a systematic review

Caries Experience of People with Cystic Fibrosis: A Systematic Review

OBJECTIVES

Cystic Fibrosis is a multi-system disease, arising from a mutation of the cystic fibrosis transmembrane conductance regulator gene (CFTR). There is a lack of information regarding oral disease levels among people with cystic fibrosis. As part of an ongoing study assessing oral health in adults with cystic fibrosis at XXXXXXXXXX, a systematic review of available literature was conducted to ascertain the caries experience of people with cystic fibrosis. The objective was to systematically present and evaluate the literature comparing caries experience between people with cystic fibrosis and people without cystic fibrosis.

METHODS

Five online databases were searched; Embase, Scopus, Web of Science Core Collection, Medline Ebsco and Cochrane Library. Studies that reported caries experience in people with cystic fibrosis were included in this review.

RESULTS

The initial search identified 1199 publications from online databases. Twenty-one studies were included for qualitative analysis. Fourteen studies reported a lower caries experience in children with CF compared to children without CF, five studies reported a higher caries experience in adults with CF, and two studies found inconclusive evidence regarding the association between caries experience and CF status. All studies had a risk of bias that may influence results.

CONCLUSION

Despite a lack of complete unanimity between all studies, there is a general trend that children with cystic fibrosis have a lower caries experience than their healthy counterparts, whereas adults with cystic fibrosis have a higher caries experience. The review highlights the need for further studies involving adults with cystic fibrosis as the majority of studies primarily consist of paediatric populations.

CLINICAL SIGNIFICANCE

Dental practitioners should be aware that adults with cystic fibrosis have higher caries experience. Tailored approaches to dental care specific to cystic fibrosis individuals should be developed.

Oral health and related outcomes in children and adolescents with cystic fibrosis: a scoping review

PURPOSE

Good oral health is important for children and adolescents with cystic fibrosis (CF). The purpose of this scoping review is to describe the existing evidence base regarding oral health in children and adolescents with CF and provide recommendations for future research.

METHODS

Using a scoping review framework, a comprehensive search was undertaken using medline, embase, and PubMed. The search strategy included broad terms relating to CF, oral health, and children and adolescents and included only papers written in English.

RESULTS

61 articles were included. Topics investigated included dental caries, enamel defects, periodontal health, dental staining, oral health related quality of life, dental management, and dental development of children and adolescents with CF.

CONCLUSION

Dental outcomes of children and adolescents with CF differ from the healthy population. The current literature describing dental health in children and adolescents with CF includes predominately descriptive analyses. A shift to hypothesis-based studies to explore causal relationships that explain the differences in dental outcomes seen in the CF population offers an opportunity to better understand the problems faced by children and adolescents with CF. Research that actively engages stakeholders, including children and adolescents with CF and their families will enable evidence-based recommendations to improve their oral health.

Periodontal disease prevalence and oral hygiene status of adults with cystic fibrosis: A case-control study

AIM

To investigate the prevalence of gingivitis and periodontitis, and the oral hygiene status of adults with cystic fibrosis (CF) in the Republic of Ireland.

MATERIALS AND METHODS

A case-control study in the form of a clinical examination of 92 adults with a diagnosis of CF was carried out in the adult CF unit in Cork University Hospital. A 40-item questionnaire was used to capture socio-demographic variables and medical and dental information. Two calibrated examiners carried out a periodontal assessment on participants, using the WHO-recommended CPI-modified index, and oral hygiene status was measured using the Greene-Vermillion index. The results were compared with a population-based control group of similar socio-demographic profile.

RESULTS

Oral hygiene levels (plaque and calculus) were significantly worse in people with CF, with a median plaque index of 0.83 (interquartile range [IQR] 0.333-1.542) in the CF group compared with 0.5 (IQR 0.167-0.667) in the non-CF group. Calculus index in the CF group was 0.33 (IQR 0.17-0.83) compared with 0.33 (IQR 0.125-0.33) in the non-CF group. However, periodontal disease levels were significantly lower in the CF group. Gingivitis (bleeding on probing ≥ 10% sites) was seen in 67.4% of the CF group, compared with 83.7% of the non-CF group, OR 0.365 (95% confidence interval [CI] 0.181-0.736), relative risk (RR) 0.779 (95% CI 0.655-0.928). Mild periodontitis (periodontal probing depth [PPD] < 5 mm) was seen in 15.2% of the CF group, compared with 31.5% of the non-CF group, OR 0.390 (CI 0.190-0.800), RR 0.483 (95% CI 0.273-0.852). Severe periodontitis (PPD ≥ 6 mm) was seen in 0% of the CF group, compared with 9.8% of the non-CF group. There was a tendency, albeit non-significant, towards reduced periodontitis in PWCF who regularly took antibiotics, particularly azithromycin.

CONCLUSIONS

In this study, adults with CF had poor oral hygiene practices, with high levels of plaque and calculus. Despite this finding, adults with CF had lower levels of clinical gingivitis and periodontitis than seen in a non-CF control group. Further study is required to examine the causes of this phenomenon.

The prevalence of developmental defects of enamel in people with cystic fibrosis: a systematic review

BACKGROUND

Oral health impacts systemic health, individual well-being, and quality of life. It is important to identify conditions that may exacerbate oral disease to aid public health and policy development and promote targeted patient treatment strategies. Developmental defects can increase an individual's risk of dental caries, hypersensitivity, premature tooth wear, erosion, and poor aesthetics. As part of an ongoing study assessing oral health in adults with cystic fibrosis at Cork University Dental School and Hospital, a systematic review of available literature was conducted to assess the prevalence of enamel defects in people with cystic fibrosis.

AIMS

To critically evaluate the literature to determine if the prevalence of developmental defects of enamel is higher in people with cystic fibrosis (PwCF).

METHODS

Data Sources: Three online databases were searched Embase, Scopus, and Web of Science Core Collection. Studies that examined an association between cystic fibrosis and developmental defects of enamel were included in this systematic review.

RESULTS

The initial search identified 116 publications from the following databases Embase, Web of Science Core Collection, and Scopus. Eleven studies were included for qualitative analysis. Nine studies concluded that PwCF had a higher prevalence of enamel defects than control people and one study found no difference in cystic fibrosis (CF) status. All studies had a risk of bias that may influence study results and their interpretation.

CONCLUSIONS

The results of the systematic review show a consistent pattern that PwCF have a higher prevalence of DDE than people without CF. Genetic dysfunction, chronic systemic infections, and long-term antibiotic use are possible aetiological causes. This review highlights the need for future studies to investigate if DDEs are caused by the underlying CFTR mutation or as a consequence of disease manifestations and/or management.

Oral care considerations for people with cystic fibrosis: a cross-sectional qualitative study

OBJECTIVES

To investigate the attitudes of adults with Cystic Fibrosis (CF) towards dental attendance and any perceived barriers to treatment.

METHODS

A cross sectional survey in the form of a structured, anonymous questionnaire was used to obtain information regarding adults with CF's feelings towards dentists and dental treatment. The final version of the questionnaire was based on a collaborative effort between researchers at Cork University Dental School and Hospital and Cystic Fibrosis (CF) patient advocates from CF Ireland. Participants were recruited via CF Ireland's mailing list and social media channels. The responses underwent descriptive statistical analysis and inductive thematic analysis.

RESULTS

A total of 71 people (33 Male: 38 Female) over the age of 18 living with CF in the Republic of Ireland responded to the survey. 54.9% of respondents were unhappy with their teeth. 63.4% felt that CF had an impact on oral health. 33.8% were anxious about attending their dentist. Respondents believed that CF has impacted on their oral health due to the medications and dietary requirements involved, as well as tiredness and other side effects of CF. Reasons for being anxious about attending the dentist included cross infection concerns, issues with the dentist, with tolerating treatment, and with the teeth themselves. Respondents wanted dentists to be aware of the practicalities of dental treatment for people with CF, especially their discomfort with lying back. They also want the dentist to be aware of the impact that their medication, treatment and diet has on their oral health.

CONCLUSIONS

Over one third of adults with CF reported anxiety about attending the dentist. Reasons for this included fear, embarrassment, cross infection concerns and problems with treatment, especially being in the supine position. Adults with CF want dentists to be aware of the impact that CF can have upon dental treatment and oral health care.

THE ORAL CAVITY AS A SITE FOR DEVELOPING A HETEROGENEOUS BACTERIAL POPULATION IN PATIENTS WITH CYSTIC FIBROSIS

Cystic fibrosis is an important medical and social problem. Despite significant advances in modern science and practice, bacterial complications are still among the main causes of patient mortality. One of the crucial bacterial pathogens in cystic fibrosis is Pseudomonas aeruginosa, which can lead to rapidly decreased pulmonary function. At the same time, the lungs are not the only site for microbial colonization. The oral cavity can also serve as a reservoir for initial entry and adaptation of microbial strains, which, however, were only sparsely investigated. A clinical case of isolated heterogeneous microbial population of P. aeruginosa from various loci of the oral cavity and sputum of a patient with cystic fibrosis is described. A proteomic mass-spectrum analysis obtained from eleven isolates as well as their mutual comparison with the control strain of P. aeruginosa ATCC 27853 visualized with CCI matrix was performed. As a result, a high level of heterogeneity of the studied population was revealed, while high CCI Score values were obtained only for individual pairs of isolates. It was shown that the bacterial strains isolated from the patient sputum turned out to be more homogeneous in protein profiles than cultures detected from various oral sites. At the same time, in case of isolated several morphotypes of P. aeruginosa from single oral site, no closely related strains were found. Thus, it is shown that the oral cavity is more important viewed from microbial dissociation in cystic fibrosis, which may be due to more diverse microecological conditions. Representatives of the microbiological community can recolonize the tracheobronchial tree through microaspiration, thereby contributing to the maintenance of infectious inflammation in the lower respiratory tract and partially accounting for ineffectiveness of nebulized antibacterial therapy. At the same time, clones adapted to the lung tissue upon coughing up sputum are able to colonize oral sites. The data obtained actualize the question of the need for a comprehensive microbiological approach while examining patients to increase effectiveness of eradication measures in cystic fibrosis.

Self-reported dental attendance, oral hygiene habits, and dietary habits of adults with cystic fibrosis

AIMS

To evaluate the dental attendance, oral hygiene habits, and dietary habits of adults with Cystic Fibrosis in the Republic of Ireland.

METHODS AND RESULTS

A cross-sectional study was carried out using a structured anonymous questionnaire. A total of 71 adults with Cystic Fibrosis responded. While the majority of respondents (66.2%) saw a dentist in the preceding year, 15.5% had not attended a dentist for over 2 years. Smoking and alcohol consumption levels were low. 63.4% brushed twice or more daily, with 70.4% using a Fluoride containing toothpaste. 62% did not use any interdental cleaning aid. 5.6% changed their toothbrush at least once a month, but for 22.5% it was over 6 months. 70.4% used fluoride toothpaste. 38% snacked three or more times daily and 29.5% consumed fizzy drinks at least once daily.

CONCLUSIONS

The alcohol and tobacco consumption in this study group was low. However, a large proportion frequently consumed sugar-rich foods, and they did not change their toothbrush, brush their teeth, or attend the dentist as regularly as is advised. More targeted advice may be necessary to improve the oral hygiene habits of adults with Cystic Fibrosis.

Oral Hygiene and Periodontal Treatment Needs in Adult Patients with Cystic Fibrosis (CF)

Cystic Fibrosis (CF) is an autosomal multisystem recessive genetic disease. Patients with Cystic Fibrosis, oral bacteria related to dental and periodontal diseases that can also inhabit the lungs, increases the risk for systemic complications. Our study aimed at assessing oral hygiene status of cystic fibrosis adult patients. The study was conducted on 40 patients diagnosed with CF and 40 healthy participants. The following indices were included: Simplified Oral Hygiene (OHI-S), Approximal Plaque Index (API), Community Periodontal Index of Treatment Needs (CPITN), and a questionnaire. Obtained results proved that the API was 44.63% in the study group, indicating sufficient hygiene, and 37% in the control group, indicating quite good hygiene. Significantly higher OHI-S was found in the study group. It was found based on the analysis of treatment needs that home care and professional instructions on proper oral hygiene were more often needed in the control group compared to CF patients. In conclusion, the obtained API and OHI-S values in adult CF patients were indicative of satisfactory oral hygiene. Periodontal treatment needs assessed based on the CPITN index in patients with CF indicated the need for professional preventive treatments. An interdisciplinary dental care to support oral health could be recommendable in individuals with chronic respiratory diseases such as Cystic Fibrosis.

Oral Health-Related Quality of Life in Patients With Chronic Respiratory Diseases-Results of a Systematic Review

Background: This systematic review evaluates the oral health-related quality of life (OHRQoL) of patients with chronic respiratory diseases.

Methods: A systematic literature search was performed based on the PubMed, Medline, Web of Science, and Scopus, using the search terms: “oral health-related quality of life” and “respiratory disease” or “lung” and “oral health-related quality of life.” Full-text articles published until June 30, 2021 and reporting any OHRQoL measurement in children or adults with a chronic respiratory disease or condition were included and analyzed qualitatively.

Results: A total of seven out of 44 studies were included, of which four studies examined adults and three studies investigated children. The respective diseases were chronic obstructive pulmonary disease (COPD) (n = 2), sleep apnea (n = 2), severe asthma (n = 1), cystic fibrosis (n = 1), and lung transplantation (n = 1). Four studies confirmed a worse OHRQoL in the respiratory diseased group compared to healthy controls. The overall OHRQoL was reduced in the included studies. Oral health, health-related quality of life, and disease-related parameters were rarely examined with regard to OHRQoL.

Conclusion: Patients with chronic respiratory diseases show a reduced OHRQoL. Oral health should be fostered in these individuals to support their OHRQoL.