Cárie dentária e alterações periodontais em crianças e adolescentes com respiração bucal: uma revisão sistemática

Abstract

Mouth breathing is identified when a significant portion of air is inhaled through the mouth instead of the nose due to pathologies and/or airway obstruction. This condition, in addition to affecting cognitive and learning functions, also leads to a greater propensity for the development of malocclusions and a compromised quality of life. Furthermore, the literature indicates that mouth breathers have a greater predisposition to salivary pH imbalance, biofilm accumulation, and, consequently, a higher risk of dental caries, periodontal diseases, and gingivitis. This study aimed to evaluate the possible associations between mouth breathing and the main dental manifestations in children and adolescents: dental caries and periodontal outcomes. This review was registered in PROSPERO (CRD42024536891). For eligibility criteria, the study attempted to find answers to the research question: "Are children and adolescents with mouth breathing more likely to exhibit dental caries and periodontal disorders than children and adolescents with nose breathing?", structured according to the PECOS framework: P (Population): children and adolescents, of both sex, aged 19 years or younger; E (Exposure): mouth breathing; C (Comparison): no mouth breathing; O (Outcomes): dental caries and periodontal outcomes; S (Study design): observational studies. The review was registered in PROSPERO (CRD42024536891). Searches were conducted in five databases: PubMed, Embase, OVID, Scopus, and Web of Science, as well as in Google Scholar and OpenGrey, with no restrictions regarding the language or year of publication. The risk of bias in the studies was assessed using the Newcastle-Ottawa Scale. Meta-analyses were performed, and results were presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Certainty of evidence was assessed using GRADE. Initially, 838 studies were retrieved, and 11 cross-sectional studies were included in the review. Individuals with mouth breathing showed greater alterations in gingival bleeding, plaque accumulation, and gingival changes. Regarding dental caries, alterations were observed in initial lesions and in ICDAS scores 5 and 6. Meta-analyses indicated a higher, albeit not statistically significant, mean Plaque Index (SMD=2.46 [95% CI: 0.04–4.96], I²=98%) and Gingival Inflammation Index (SMD=0.47 [95% CI: -1.33 2.26], I²=97%) in mouth breathers. In conclusion, children and adolescents with mouth breathing may be associated with gingival changes and plaque accumulation. For dental caries, the evidence, although limited, suggests an association with initial and advanced caries lesions.