Condição bucal em pacientes com transtorno do espectro autista (TEA): uma revisão sistemática de estudos observacionais com grupo controle

Abstract

Individuals with autism spectrum disorder (ASD) may be more susceptible to developing chronic non-communicable oral diseases when compared to individuals without other conditions or neuroatypia. This may be due to food selectivity, medication use, and behavioral patterns associated with harmful oral behaviors. The aim of this study was to systematically review the literature in order to compare caries, oral hygiene, periodontal diseases, bruxism, malocclusion, tooth loss and salivary alterations between subjects with ASD and control subjects without other conditions or neuroatypia. Electronic searches were performed in EMBASE, Latin American and Caribbean Health Sciences (LILACS), PubMed, PsycINFO, Scopus, Web of Science databases, in addition to gray literature (Google Scholar and ProQuest) without restriction of publication period. Manual search for additional studies was also performed. EndNote and Rayyan software were used to manage references and assist in removing duplicates. Only observational studies (cross-sectional, cohort and case-control) that evaluated oral conditions in the ASD population compared to control subjects without ASD or any other neuroatypia presenting clinical measures of oral outcomes were included. Two independent reviewers carried out the selection of studies in two phases, extracting data with a standardized form and evaluating the methodological quality of the studies using the NewcastleOttawa scale. Meta-analyses of standardized mean differences (SMD) and relative risk/prevalence ratio (RR/PR) were performed. 42 studies comprising a total of 7217 subjects were included in the review. Meta-analyses revealed that autistic subjects had significantly greater caries severity in primary teeth (SMD 0.29, 95% CI 0.04-0.53), greater severity of untreated caries lesions (SMD 0.27, 95% CI 0.06 to 0.48, I² 88%) , higher prevalence (RR 2.46, 95% CI 1.23 to 4.91, I² 83%) and severity (SMD 0.59, 95% CI 0.24 to 0.94) of worse oral hygiene and gingivitis condition (RR 1.31, 95% CI 1.02 to 1.70 ) (SMD 0.45, 95% CI 0.02 to 0.88, I² 95%), significantly lower salivary pH (SMD -0.62, 95% CI -0.99 to -0.26, I² 46%), higher prevalence of bruxism (RR 4.52, 95 % CI 2.07 to 9.86, I² 85%), increased overjet (RR 2.16, 95% CI 1.28 to 3.64, I² 89%), increased overbite (RR 1.62, 95% CI 1.02 to 2.59, I² 80%), crossbite ( RR 1.48, 95% CI 1.02 to 2.13, I² 57%) and open bite (RR 2.37, 95% CI 1.46 to 3.85, I² 54%) when compared to neurotypical control subjects. Higher means of filled teeth and surfaces were significantly found in control subjects (SMD -0.30, 95% CI -0.49 to -0.10, I2 85%). In general, subgroup analyzes involving studies with a high risk of bias and absence of matching variables strengthened the associations. Our findings suggest that autistic individuals have worse oral health status when compared to neurotypical controls.