Má oclusão em indivíduos com Transtorno do Espectro Autista (TEA): revisão sistemática e meta-análise

Abstract

Malocclusion is the third most prevalent oral condition worldwide. Individuals with autism spectrum disorder (ASD) may have parafunctional oral habits that may act as important causal factors for malocclusions. Literature is still controversial about the higher occurrence of malocclusion in individuals with ASD compared to those without ASD. The aim of this systematic review and meta-analysis was to assess the prevalence of malocclusion in individuals with ASD and to compare malocclusion characteristics between individuals with and without ASD. This systematic review was registered in PROSPERO (CRD42019151794). Epidemiologic studies that evaluated malocclusion clinically in individuals with ASD and/or measured malocclusion in individuals with or without ASD were included. The search was conducted on PubMed, Scopus, Web of Science, Cochrane, Scielo and Lilacs electronic databases. The identified studies were selected and assessed by two researchers independently. The risk of bias was analyzed using the Newcastle Ottawa scale according to the study design. The meta-analysis included the pooled prevalence and 95% confidence interval (CI 95%) of malocclusion characteristics among individuals with ASD. The pooled odds ratio (OR) and 95% CI were estimated to assess the relationship between ASD and malocclusion. Of the 2522 articles identified, 15 studies were included. Regarding the quality of studies, no articles were considered to be of high quality.. The meta-analyses of prevalence and association included 12 and 6 articles, respectively. The prevalence of Class I, II and III in individuals with ASD was 39%, 22% and 8%, respectively. The most prevalent malocclusion characteristic was increased maxillary overjet (39%, 95%CI 23-54) and crowding (38%, 95%CI 22-53%). Individuals with ASD had a 53% greater odds (OR 1.53; 95%CI 1.06-2.21) of increased maxillary overjet, and had 73% higher odds (OR 1.73; 95%CI 1.03 -2.90) of deep bite than those without ASD. Furthermore, individuals with ASD had 20% greater odds (OR 1.20; 95%CI 1.03-1.39) of having at least one type of malocclusion when compared with those without ASD. The available evidence suggests that individuals with ASD are more likely to have malocclusion than individuals without ASD. These findings indicate the importance of a multidisciplinary team in the health care of individuals with ASD as well as the need of providing more guidance for these individuals to prevent and reduce harmful oral habits, with the aim of preventing malocclusion.