ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dental Crowding as a Risk Factor for Caries Is Yet To Be Established Due to Insufficient and Contradictory Evidence
Clinical Question Are people with dental crowding more at risk for dental caries?
Clinical Bottom Line A definitive association between dental crowding and caries risk cannot be established due to conflicting evidence, confounding variables, and lack of longitudinal studies.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22999666Hafez/20128 studies/9,266 patients reportedSystematic review of cross-sectional studies
Key resultsFour of the eight studies found no statistically significant correlation between dental caries and crowding, two studies reported caries and crowding to be inversely related, and one study observed a significant correlation between interproximal caries and crowding specific to the anterior maxillary teeth. One study found a negative relationship between crowded maxillary posterior teeth and interproximal caries, but a positive relationship between crowded mandibular anterior teeth and interproximal caries.
#2) 22779379Buczkowska-Radlinska/2012225 Polish children with primary, mixed, or permanent dentitionCross-sectional study
Key resultsIn the permanent dentition group (15-19 years old), children with anterior crowding were more likely to have caries (OR = 3.71, 95% CI = 1.27-10.85, p = 0.016) compared to those without anterior crowding. Neither the primary dentition (mean DMFT = 1.55) nor mixed dentition (mean DMFT = 0.76) groups with anterior crowding had significantly more caries than those without crowding (.85, .52 respectively; p = .162, .089 respectively).
Evidence Search ("Dental Caries"[Mesh] AND "Malocclusion"[Mesh])
Comments on
The Evidence
Validity: Hafez did not disclose magnitudes of association nor was a meta-analysis performed due to varied indexes of outcome measurements. Sample sizes of subgroups were not reported for many studies and were small for those that were reported, with the exception of one large study. Baseline oral health status was not reported for all studies. Buczkowska-Radlinska had small subgroups; n=34 for permanent dentition with anterior crowding, and n=33 for permanent dentition without anterior crowding. This result may not be generalized since the children had high caries prevalence across all ages. Perspective: Further research is recommended that uses longitudinal studies, larger sample sizes, minimal confounding variables, and standardized measurements of outcome.
Applicability It has always been assumed that dental crowding is a risk factor for dental caries because of its potential to inhibit proper and adequate oral hygiene, thus causing increased plaque retention in areas of crowding. Although there is insufficient evidence in support of this longstanding assumption, it may be advisable that dental practitioners should still base their oral hygiene counseling on this assumption until it is either proven or refuted.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Dental caries, dental crowding, malocclusion
ID# 3064
Date of submission: 04/01/2016spacer
E-mail TenorioM@livemail.uthscsa.edu
Author Melody Tenorio
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, PhD, MS, BDS
Faculty mentor/Co-author e-mail Amaechi@uthscsa.edu
Basic Science Rationale
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