| کلیدواژههای انگلیسی مقاله |
Dental Caries, Dental Decays, DMFT, Meta-Analysis, Iran, IntroductionDental caries, also known as tooth decay, is a dynamic biological process of irreversible destruction of susceptible dental hard tissues because of acids produced by bacterial glycolysis of dietary carbohydrates [ 1,]. According to the World Health Organization (WHO) report, approximately 60% to 90% of school-aged children and nearly all adults have dental caries at some point in their life span [ 2,]. Several etiological factors include fermentable carbohydrates, qualitative bacterial components, oral colonization by cariogenic bacteria, a susceptible tooth (host), amount and components of saliva, poor oral hygiene, and time are contributed in the onset and progression of dental caries [ 3,, 4,]. Usually, dental caries in epidemiologic surveys evaluated according to the WHO criteria using dmft (the decayed, missing, filled teeth for primary teeth) and DMFT (the decayed, missing, filled teeth for permanent teeth) indices, which measure caries at cavitation level [ 5,, 6,]. Dental caries can cause pain, inflammation and gingival bleeding, abscess formation, tooth loss, and subsequently loss of available space in the arch[ 7,]. It is also expensive to treat and may cause oral malodor, leads to lost productivity, causes harm to nutrition and affects overall health and quality of life [ 8,]. Furthermore, it is linked to some systemic diseases such as cardiac problems, stroke, and respiratory disease since it may cause chronic infections in the body [ 9,]. Several studies have shown that dental caries affects all ages, races, and socioeconomic groups and reported the correlation between children&apos,s dental caries withsome demographic and socioeconomic factors including age, sex, level of parents&,rsquo education, the family income, and socioeconomic backgrounds [ 10,, 11,]. Despite the application of multiple health programs to improve oral health, dental caries is still considered as a global health concern therefore, it is necessaryto assess the strategies for primary prevention of this disease and to implement health promotion programs. The measurement of oral health status and conducting accurateand up-to-date research is important for understanding natural history and biological processes of a disease for projecting and assessing health services. There are a number of studies with various populations done in Iran regarding the prevalence of dental caries or DMFT/dmft data therefore, an overall estimation of the prevalence is needed to help understanding the status of caries by synthesizing available studies in our country more clearly. In addition, the format of a systematic review is very effective in collecting a large amount of data, understanding the breadth and quality of conducted studies, and analyzing simultaneously. With this background, performing a systematic review and meta-analysisseems to be necessary. To the best of our knowledge from indexed literature, a meta-analysis of dental caries prevalence, experience, or incidence in Iran has yet to be reported. Therefore,the main purpose of this study was to identify the dental caries status and/or DMFT/ dmft data in Iran. We also considered the effect of demographic and socioeconomic factors on oral health.Materials and MethodSearch methods for identification&,nbsp of studiesElectronic searches were carried out for related Persian and English articles (up to October 2018) with existent documents in national and international online databases. Searching was done using keywords and search terms including &,laquo dental caries&,raquo , &,laquo dental decays &,raquo , &,laquo dental missing&,raquo , &,laquo dental filling&,raquo , &,laquo DMFT&,raquo , &,laquo dmft&,raquo , &,laquo dft&,raquo , &,laquo dmfs&,raquo , &,laquo dfs&,raquo , &,laquo Iran&,raquo , &,laquo Iranians&,raquo and &,laquo Persia&,raquo through international databases, PubMed, the Scopus databases, ScienceDirect, and Google Scholar. The national databases (SID, Noormag, Magiran, Iranmedex, and Irandoc) were also searched using all probable combinations of the Persian equivalents of identified keywords. We completed our electronic search with hand searches of reference lists of all primary studies and review articles to identify any studies that could have remained unidentified in the previous step. Only published and accessible papers were considered.Inclusion and exclusion criteriaRecords of all references obtained through the search strategy were combined in the reference management software, EndNote X4 (Thomas Reuters, Philadelphia, PA, USA), and duplicate items were deleted using the features of this software. All types of studies, including observational longitudinal, cross-sectional, cohort and case-control studies reporting dental caries prevalence, experience, or incidence in Iran were reviewed. The inclusion criteria were, original studies, studies including caries prevalence and/or DMFT/dmft data studies conducting in healthy participants who had not previous history of systemic disease and were not being under orthodontic treatment studies measuring untreated caries and/or DMFT/dmft data through clinical examination by appropriately qualified practitioner/researchers or through health records databases were included. Only studies fulfilling all of these criteria and published in full text were included in the qualitative and quantitative synthesis. In cases of multiple publications from the same population or cohort, only the largest study was included. Studies that were meta-analyses or systematic considerations, and those that presented insufficient data were excluded.Data ExtractionThe data and information were extracted from eligible articles based on a standard protocol. Study characteristics (the name of first author, publication year, the year and place of the study), demographic features (sample size, age group) the dental variables, socioeconomic parameter, and study type were extracted from each trial. Reported estimates for dental caries were the prevalence/incidence of untreated caries (DMFT/dmft being &,gt 0), the prevalence of caries experience (percentage of a population with any caries experience), the caries experience (average DMFT/dmft indexes). Literature review identified key confounders that affect the caries incidence these items included age, sex, socio-economic status, parent&,rsquo s educational level, parent&,rsquo s occupation, the number of children in family, dental visits, and so on. To explore the effects of these factors on the caries incidence, we extracted the reported DMFT/dmft values between the lowest and the highest reported confounder factors and assessed the differences between them. Next, data extraction forms were designed, filled out, and imported into Microsoft Excel. The articles&,rsquo authors were contacted for supplementary data or further elucidation, if data were missing or for clarifications.Quality assessment of the selected studiesThe quality assessment of the included studies was evaluated using the Newcastle&,ndash Ottawa Scale (NOS) checklist NOS assess the domains of selection bias, comparability of groups and attrition bias, and ascertainment of exposure and outcomes [ 12,]. Study quality was graded on a scoring system. The NOS ranges from zero to nine stars studies with NOS scores of less than 3, from 4 to 6, and more than 7 were considered as having low, moderate, and high methodological quality, respectively. Two reviewers independently performed search process, selection of studies,data extraction, and quality assessment and their findings and results were compared later. Disagreements were resolved by group discussion.Data Synthesis and AnalysisOne of the main objectives of this study was to evaluate the prevalence/incidence of caries therefore, the overall prevalence of dental caries and reported DMFT/dmft values in different studies were extracted to enable quantitative synthesis and analysis. The binomial distribution used to calculate the variance in each study and the weighted mean was used for a combination of prevalence rate in different studies. Each study was given a weight equal to its inverse variance.To explore the effects of confounder factors on the caries incidence, only studies reporting of DMFT/dmft mean were used for quantitative data synthesis. The rates and mean values with a confidence interval of 95% were computed as the effect measure for both individual trials and pooled estimates. Statistical heterogeneity was evaluated in studies using chi-squared test and I2 index. In this meta-analysis, due to the significant heterogeneity of the studies, the random effects model was applied to pool analysis and verses. We undertook subgroup analyses based on sex, age, and region to explore the reasons for heterogeneity. Integrated estimations and the related confidence interval of 95%were evaluated using forest plots as visuals. Funnel plots and Egger test were used to check the possibility of publication bias. Sensitivity analyses were performed to control for the effects of imputing data and to assess the effects of possible publication or reporting bias. Significance was set at p&,lt 0.05 as valid for heterogeneity tests. All analyses were carried out with comprehensive meta-analysis R software version 3.2.1 and STATA (version 11.1).ResultsSelected ArticlesA flowchart describing the systematic review search results is presented in Figure 1,. The literature searches yielded 1,645 articles, of which 317 papers were repetitive and removed from further consideration. We also excluded 1,221 citations after screening the titles and abstracts as clearly irrelevant to study objectives and for failing to meet the eligibility criteria, leaving 107 papers for full-text review. Of the remainder, another 38 articles after full-text screening were excluded finally, sixty-nine papers were potentially relevant and eligible for the final analysis (Figure 1,).Figure 1. Flow diagram of dental caries status and its related factors in Iran.Description of the StudiesThe studies used in this meta-analysis were published between1998-2018 and all were cross-sectional in design (13,81). The general characteristics and findings of the studies that fulfilled the eligibility criteria are summarized in Table 1,. In most reviewed studies, the sampling method was random cluster sampling information and data were collected through interviews and clinical examination by appropriately qualified practitioner/researchers or through health records databases. Data on the dental caries prevalence, experience, or incidence were available for 54 studies and eight studies presented data related to significant caries (Sic). Fifteen studies analyzed decayed, missing or filled teeth in primary teeth (dmft), thirty-five studies analyzed decayed, missing or filled teeth in permanent teeth (DMFT), and sixteen studies investigated both. The quality assessment of the individual studies is summarized in Table 1,.Authors (Reference)Publication yearCitySample sizeDependent Variable (mean&,plusmn SD)NOSBashirian [13,]2018HamedanT,988DMFT,Dmft,9B,503T, 0.79&,plusmn 1.53T, 3.61&,plusmn 3.58G,485B, 0.63&,plusmn 1.17B, 4.04&,plusmn 3.78G, 0.96&,plusmn 1.49G, 3.16&,plusmn 3.31DT, 0.33&,plusmn 0.85dt, 2.68&,plusmn 3.05MT, 0.009&,plusmn 0.13mt, 0.60&,plusmn 1.12FT, 0.44&,plusmn 1.04ft , 0.32&,plusmn 0.93Shaghaghian [14,]2018ShirazT,396DmftDental caries, 69.9% CF, 30.1%8B,202T, 3.88&,plusmn 3.9G,194B, 3.95&,plusmn 4.05G, 3.82&,plusmn 3.75 |