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Caries and developmental defect of enamel prevalence in adults with cystic fibrosis
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Date
2024
Authors
O'Leary, Fiona
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Objectives
This research had five objectives.
1. To evaluate the available literature regarding oral disease in people with cystic fibrosis specifically caries and developmental defects of enamel.
2. To ascertain the current practices and attitudes of dental practitioners regarding the provision of oral care for people with cystic fibrosis.
3. To ascertain the current practices and attitudes of dental practitioners regarding the provision of dental treatment pre and post solid organ transplantation.
4. To assess a cohort of people with cystic fibrosis for the presence of developmental defects of enamel and compare the results with a control group of people without cystic fibrosis.
5. To measure caries experience in a cohort of people with cystic fibrosis and compare the results with a control group of people without cystic fibrosis.
Methods
Objective 1
A systematic review of the available literature was conducted for caries experience in people with cystic fibrosis. A second systematic review was conducted assessing the prevalence of developmental defects of enamel in people with cystic fibrosis.
Objective 2 & 3
A questionnaire was developed following PPI (patient and public involvement) with representatives of the dental profession and patient advocates from Cystic Fibrosis Ireland. The questionnaire consisted of 56 questions and multiple-choice questions related to cystic fibrosis manifestations and management, dental health certification for solid organ transplantation, and the dental management of people with cystic fibrosis and recipients of solid organ transplants. Dentists were invited to complete the anonymised survey online. Data was collected from 135 dental practitioners. Data was qualitatively analysed.
Objective 4 & 5
A total of 92 people with cystic fibrosis and 92 people without cystic fibrosis were recruited for this cross-sectional study. Each participant completed the World Health Organisation's ‘Oral Health Questionnaire for Adults’. Individuals with cystic fibrosis in the study group completed additional questions specifically related to cystic fibrosis diagnosis, treatment and management. All participants underwent an oral examination, performed by two calibrated examiners to assess for the presence of developmental defects of enamel (DDE index), to measure caries experience (DMF) and other clinical variables (periodontal assessment using the CPI-modified index, and oral hygiene status using the Greene–Vermillion index). Collected data was statistically analysed with help from statisticians from the Cystic Fibrosis Registry of Ireland.
Results
Objectives 1
Studies included in the systematic review demonstrated a trend that caries levels in paediatric populations with cystic fibrosis are lower when compared to a population without cystic fibrosis. Caries levels are higher in adults with cystic fibrosis when compared to populations without cystic fibrosis. Similarly, the majority of included studies indicate that people with cystic fibrosis have a higher prevalence of developmental defects of enamel.
Objective 2 & 3
Twenty-four percent (n=32) of dental practitioners were currently providing care for people with cystic fibrosis, 13% (n = 17) did not know, and 63% (n = 85) were not currently providing care for this population. 72% (n = 97) of respondents reported that they were comfortable treating people with cystic fibrosis, 28% (n = 38) said that they were not comfortable treating these patients.
Thirty four percent of respondents currently or had previously provided care for recipients of solid organ transplants. 29% (n=36) of dentists had provided dental health certification for individuals undergoing transplantation, only 11% (n=4) had received correspondence or guidance from the patient’s medical team. 88% of respondents consider the currently available literature providing guidance for the provision of dental health certification inadequate.
Objective 4 & 5
Sixty-four percent (n=59) of people with cystic fibrosis had developmental defects of enamel, compared to 30% (n=28) of people without cystic fibrosis. The median number of teeth affected by enamel defects in the study group was 1.5, compared to 0 in the control group.
The percentage of people with cystic fibrosis with untreated dental caries present was 38% (n=35) compared to 13% (n=12) of people in the control group. The mean DMFT values were higher in the study group compared to the control group but only the decayed value (DT) was statistically significantly higher (0.99 vs. 0.18; (p= <0.001)).
Conclusions
Objective 1
While there is not a unanimous agreement across all studies, there is a consistent pattern that the prevalence of enamel defects is higher in people with cystic fibrosis compared to individuals without cystic fibrosis. While a pattern emerged that children with cystic fibrosis had lower levels of dental caries compared to healthy children, adults with cystic fibrosis had higher levels of caries compared to adults without cystic fibrosis.
Objective 2 & 3
The results from the survey indicate a wide variety in the knowledge, attitudes and practices of dental practitioners regarding the oral health of people with cystic fibrosis. Similarly, the data indicates a wide variation in the provision of treatment for patients undergoing or in receipt of a solid organ transplant. There are currently no guidelines for the provision of dental treatment for people with cystic fibrosis or people pre/post solid organ transplantation. Future research should focus on the development of such guidelines to aid dental practitioners and ensure that patients receive an appropriate standard of care.
Objective 4 & 5
In this study the cohort of adults with cystic fibrosis had a higher DMFT when compared to a control population without cystic fibrosis. Adults with cystic fibrosis had a statistically higher prevalence of developmental defects of enamel compared to the control group.
Description
Keywords
Cystic fibrosis , Oral health , Public health , Dental caries , Enamel defects
Citation
O'Leary, F. 2024. Caries and developmental defect of enamel prevalence in adults with cystic fibrosis. PhD Thesis, University College Cork.