Abstract
Background and objective: Dental caries appears to be related to iron deficiency anemia and to low ferritin levels. In the present meta-analysis, we report salivary and serum iron and ferritin levels in children with dental caries, compared to healthy controls. Materials and methods: We searched in Web of Science, Cochrane Library, Scopus, and PubMed/Medline databases to extract studies published until 25 July 2021. We calculated mean differences (MD) and 95% confidence intervals (CI) of salivary and serum iron and ferritin levels in children with dental caries, always compared to healthy controls. In addition, we applied a trial sequential analysis (TSA). Results: A total of twelve articles covering thirteen studies were included in the meta-analysis. The pooled MD for salivary iron level was −5.76 µg/dL (p = 0.57), and −27.70 µg/dL (p < 0.00001) for serum iron level: compared to healthy controls, children with dental caries did not show different salivary iron levels, while children with caries had significantly lower serum iron levels. The pooled MD of salivary ferritin level was 34.84 µg/dL (p = 0.28), and the pooled MD of serum ferritin level was −8.95 µg/L (p = 0.04): compared to healthy controls, children with dental caries did not have different salivary iron levels, but significantly lower serum ferritin levels. Conclusions: The findings of the present meta-analysis showed that salivary levels of iron and ferritin did not differ between children with and without caries, though compared to healthy controls, children with caries had significantly lower salivary and serum iron and ferritin levels. The results are of practical and clinical importance: Possibly, iron and ferritin supplementation might prevent or attenuate dental caries in children at risk. Further, children with caries might suffer from further iron- and ferritin-related health issues. Lastly, serum blood samples, but not saliva samples inform accurately about the current iron and ferritin concentrations in children with or without caries.
Highlights
Dental caries is caused by the chemical dissolution of tooth tissues as a result of acids produced by bacteria that metabolize carbohydrates from the diet, especially sucrose [1]
Iron and ferritin deficits reflect a major health issue in general and a risk of developing caries, in specific, and this holds true for children. With this background in mind, and given that to our knowledge, there is no meta-analysis evaluating the levels of iron and ferritin among children with and without dental caries the aim of the present meta-analysis was to calculate, if salivary and serum iron and ferritin levels did systematically differ between children with and without caries
A study was relevant if the study met the following inclusion criteria: (1) case-control, cohort, or cross-sectional designs; (2) dental caries was the outcome of interest; (3) reporting salivary and/or serum levels of iron or ferritin; (4) reporting the required data to calculate the mean differences (MDs) with 95% confidence intervals (CIs); (5) including age group of less than 18 years, and (6) including participants with no caries as control group
Summary
Dental caries is caused by the chemical dissolution of tooth tissues as a result of acids produced by bacteria that metabolize carbohydrates from the diet, especially sucrose [1]. A low iron intake can lead to iron deficiency anemia [9,10]; as a result, such an iron and ferritin deficiency appears to further unfavorably impact on the development of caries. Iron and ferritin deficits reflect a major health issue in general and a risk of developing caries, in specific, and this holds true for children. With this background in mind, and given that to our knowledge, there is no meta-analysis evaluating the levels of iron and ferritin among children with and without dental caries the aim of the present meta-analysis was to calculate, if salivary and serum iron and ferritin levels did systematically differ between children with and without caries. An appropriate treatment might attenuate the risk of both caries and iron- and ferritin-related health issues
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