Do clinical consequences of pulp involvement due to dental caries cause impact on quality of life of children and adolescents?

Abstract

A Commentary on

Reis P P G, Jorge R C, Marañón-Vásquez G A, Fidalgo T K D S, Maia L C, Soviero V M.

Impact of clinical consequences of pulp involvement due to caries on oral health-related quality of life in children and adolescents: a systematic review and meta-analysis. Caries Res 2025; 59: 71–83.

Data sources

Six electronic databases (PubMed, Scopus, Web of Science, Embase, BBO/VHL and Cochrane Library) and Google Scholar were searched in August 2022. Handsearching of the reference lists in the included studies were also carried out.

Study selection

Observational studies that assessed children/adolescents with clinical consequences of pulp involvement due to dental caries compared with those without them and its impact on their oral health-related quality of life (OHRQoL) were included. Pulp involvement should have been clinically assessed as pulp exposure (both vital and necrotic), abscess or fistula. Two review authors independently scanned the titles and available abstracts of all the articles identified through the electronic searches. The full text of studies that appeared to meet the inclusion criteria or for which there were insufficient data in the title and abstract were obtained to make a definitive decision. A third review author was consulted in cases of disagreement. All rejected studies and reasons for excluding them were recorded in the table for the list of excluded publications.

Data extraction and synthesis

Data were independently extracted from the included studies by two review authors using data extraction tables. The methodological quality assessment was conducted using the JBI critical appraisal checklist for analytical cross-sectional studies. The studies were grouped according to participants’ age range (preschoolers, schoolchildren and adolescents) and instruments used to measure OHRQoL. To be included in the meta-analyses, the studies should have used PUFA index. The mean differences (MD) or the standardised mean differences (SMD) were calculated for numerical outcome and odds ratio (OR) was calculated for dichotomous outcome. Robustness, heterogeneity, certainty of evidence and publication bias were assessed.

Results

All 29 included studies were cross-sectional and the sample sizes ranged from 30 to 1794 participants. Fourteen studies assessed preschoolers, nine assessed schoolchildren, four assessed adolescents and two assessed children and adolescents. Most studies used PUFA index to assess the exposure. ECOHIS (preschoolers) and CPQ (children/adolescents) were the main tools used to assess the outcome. Only five articles fully adhered to the quality criteria. The meta-analyses revealed the following main results: (a) preschoolers: MD −10.79 (95% CI −16.50 to −5.09); (b) schoolchildren: MD −5.12 (95% CI −7.51 to −2.72); (c) adolescents: MD −1.86 (95% CI −4.59 to 0.87); (d) overall impact: SMD −2.18 (95% CI −3.21 to −1.15) and OR 0.52 (95% CI 0.30–0.90).

Conclusions

Clinical consequences of pulp involvement negatively impacted the OHRQoL of children. In adolescents, this impact was not observed. However, these results must be interpreted with caution due to the very low certainty of evidence, as well as the presence of risk of bias and considerable heterogeneity, indicating inconsistency in the results.