Supplementary Material for: 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

Introduction: Dental caries with pulp involvement potentially impacts the oral health related quality of life (OHRQoL). This meta-analysis aimed to evaluate whether clinical consequences of pulp involvement due to dental caries impacts OHRQoL of children and adolescents. Methods: Observational studies evaluating children/adolescents (Population) with pulp involvement due to caries (Exposition) compared with those without it (Comparison) have more negative impact on their OHRQoL (Outcome). A systematic search was undertaken in August 2022 in seven databases. Alerts were set until August 2023. JBI Critical Appraisal toll for cross-sectional studies was used for methodological quality assessment. Random-effects meta-analyses were performed to calculate mean differences (MD) or standardized mean differences (SMD) of impact on OHRQoL. For studies with dichotomous outcome, meta-analysis calculated the odds ratio (OR). Robustness, heterogeneity, certainty of evidence, and publication bias were evaluated. Confidence interval was 95%. Results: From 29 included studies, 14 assessed preschoolers, nine assessed schoolchildren, four assessed adolescents, and two assessed children/adolescents. PUFA was the main index used 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 found the following main results: a) preschoolers: MD -10.79 (-16.50; -5.09); b) schoolchildren: MD -5.12 (-7.51; -2.72); c) adolescents: MD -1.86 (-4.59; 0.87); d) overall impact: SMD -2.18; (CI: -3.21;-1.15) and OR 0.52 (CI: 0.30; 0.90). Conclusion: Pulp involvement impacted OHRQoL of children negatively. In adolescents, this impact was not observed. Results must be interpreted with caution due to very low certainty of evidence.