Supplementary Material for: Dental caries in children with attention deficit/hyperactivity disorder: a meta-analysis

Objectives: To evaluate whether children with attention deficit/hyperactivity disorder (ADHD) are more affected by dental caries than children without ADHD by means of a systematic review and meta-analysis.
Design: Electronic searches was performed in four databases (PubMed, Embase, Scopus, and Web of Science) in July 2021. Grey literature search in OpenGrey, a search in Google Scholar, and searches in the reference list of included articles were also conducted. The eligibility criteria were observational studies in which children with ADHD were compared with children without ADHD with respect to the dental caries. Study selection, data extraction, and risk of bias assessment, applying the Joanna Briggs tool were performed by two reviewers independently. Meta-analysis and assessment of heterogeneity among studies were conducted with the meta-package of RStudio using the R programming language (R Core Team, Vienna, Austria). Results of meta-analysis were provided in mean difference (MD), odds ratio (OR), and confidence intervals (CI). For assessment of heterogeneity, Baujat plot and influence analysis plot were obtained.
Results: Thirteen studies were included and 10 were incorporated into meta-analyses. The meta-analysis showed that children with ADHD had a higher decayed, missing, and filled teeth (DMFT) index than their peers without ADHD (I²=42%; MD=0.75 [0.38-1.13]). For decayed, missing, and filled surfaces (DMFS) (I²=0; MD=0.39 [-0.02-0.80]) and decayed surfaces (DS/ds) (I²=0%; MD=0.35 [-0.63-1.33]), no difference between groups was observed. In addition, children with ADHD had higher odds of having dental caries than their healthy peers (OR = 3.31 [1.25, 8.73]; I² = 0%). After assessment of heterogeneity among studies, sensitivity analysis was conducted for DMFT. One study was removed and the significant difference between groups remained. Children with ADHD had a significantly higher DMFT index than their peers without ADHD (MD = 0.98 [CI = 0.75, 1.20]; I² = 0%) Risk of bias ranged from low to high.
Conclusion: The main shortcoming of the included studies is the high risk of bias regarding the strategies to deal with confounding factors. Within its limitations, this systematic review and meta-analysis demonstrated that children with ADHD were more likely to develop dental caries than their healthy counterparts.
Funding: No funding
Registration: CRD42021238923

研究目的：本研究旨在通过系统评价与Meta分析（Meta-analysis），评估注意缺陷多动障碍（Attention Deficit/Hyperactivity Disorder, ADHD）儿童是否比非ADHD儿童更易罹患龋齿。
研究设计：2021年7月于4个数据库（PubMed、Embase、Scopus及Web of Science）开展电子检索；同时进行灰色文献检索（检索平台为OpenGrey）、谷歌学术（Google Scholar）检索，以及纳入文献的参考文献列表检索。纳入标准为：针对ADHD儿童与非ADHD儿童的龋齿情况开展对比的观察性研究。由2名评价者独立完成文献筛选、数据提取及偏倚风险评估，评估工具采用乔安娜·布里格斯量表（Joanna Briggs tool）。采用R编程语言结合RStudio的meta包开展Meta分析及研究间异质性评估。Meta分析结果以均数差（mean difference, MD）、比值比（odds ratio, OR）及置信区间（confidence interval, CI）呈现。异质性评估采用Baujat图及影响分析图。
研究结果：共纳入13项研究，其中10项纳入Meta分析。Meta分析结果显示，ADHD儿童的龋失补牙数（decayed, missing, and filled teeth, DMFT）指数显著高于非ADHD儿童（I²=42%；MD=0.75，95%CI：0.38~1.13）。在龋失补牙面数（decayed, missing, and filled surfaces, DMFS）（I²=0%；MD=0.39，95%CI：-0.02~0.80）及龋面数（decayed surfaces, DS/ds）（I²=0%；MD=0.35，95%CI：-0.63~1.33）方面，两组未观察到统计学差异。此外，ADHD儿童罹患龋齿的比值比显著高于健康对照儿童（OR=3.31，95%CI：1.25~8.73；I²=0%）。完成研究间异质性评估后，针对DMFT指数开展敏感性分析：剔除1项研究后，两组间的差异仍具有统计学意义，ADHD儿童的DMFT指数仍显著高于非ADHD儿童（MD=0.98，95%CI：0.75~1.20；I²=0%）。纳入研究的偏倚风险等级从低至高不等。
研究结论：纳入研究的主要局限性在于，在处理混杂因素的策略方面存在较高的偏倚风险。尽管存在上述局限性，本系统评价与Meta分析仍表明，ADHD儿童相较于健康对照儿童更易发生龋齿。
资金支持：无资金支持
注册编号：CRD42021238923