Prevalence of Caries among Siblings with and without Asthma

Objective: Link between dental caries and long-time exposure to anti-asthma medications has biological credibility, but there is limited research support for such an association. This pilot study aimed to evaluate the caries status of asthmatic children and their non-asthmatic siblings. Methods: 234 asthmatic and non-asthmatic children, 2-17 years old, were recruited. Inclusion criteria for the study: medically diagnosed asthma, current treatment for asthma, asthma medication use for a minumum of one year, and a non-asthmatic sibling (1-2 years younger or older) for comparison. Caries status was determined by number of decayed, missing, and filled surfaces in permanent (DMFS) and deciduous (dfs) dentition through clinical examination by calibrated examiners, using modified International Caries Detection and Assessment System (ICDAS) scoring criteria . Mann-Whitney-U test was used to compare the DMFS and dfs of children with and without asthma (a=0.05; n=117/group). Results: When the two groups were compared on d₁₂fs (D₁=non-cavitated caries, D₂=cavitated), the caries prevalence was statistically significantly (p<0.001) higher  in asthmatic children (d₁₂fs=18.0±17.6) than their non-asthmatic siblings (d₁₂fs =8.6±13.6). Cohen's d analysis demonstrated a medium to large effect size (d=0.61) indicating the difference to be clinically significant. With D₁₂MFS,  asthmatic (13.3±11.5), non-asthmatic (6.8±9.8), p<0.001 and d=0.61 (medium-to-large effect size) indicating both statistical and clinical significant difference. On comparing the two groups on D₁₂MFS_total (combined primary/permanent teeth), asthma (41.0±25.1), non-asthma (32.0±27.1), p<0.05 and d=0.34 (small to medium effect size) indicating both statistical and clinical significant difference. Separating the data for D₁₂MFS_total into D₁MFS_total and D₂MFS_total, each outcome variable, show significantly (p<0.001) higher scores for asthmatic children (D₁MFS_total=21.3±14.3; D₂MFS_total=11.4±12.8) than non-asthmatic siblings (D₁MFS_total=14.0±12.1; D₂MFS_total=7.2±9.5). For D₁MFS_total, d=0.55 (roughly medium), and for D₂MFS_total, d=0.38 (small-to-medium). Thus, in terms of statistical and clinical significance, both outcomes favor non-asthmatic children. Conclusion: This pilot study highlights the possible influence of asthma treatment on caries susceptibility of children.