The effect of asthma and its medication on dental caries in children: a systematic review and meta-analysis

Abstract

Asthma and dental caries are prevalent chronic conditions in children, with evidence suggesting a possible link via asthma-related physiological changes and medications. Reduced salivary flow and altered oral environments may increase caries risk; however, findings are inconsistent. This study aimed to synthesize evidence on the prevalence and risk of dental caries in children with asthma or using asthma medications. We searched PubMed, Scopus, Embase, and Google Scholar for cohort and case-control studies published between December 2024 and May 2025. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects models estimated pooled prevalence and effect sizes. Heterogeneity was evaluated using Cochran’s Q test and I² statistic, with subgroup analyses by continent and medication type. Twenty studies involving 16,916 children (7,513 with asthma) were included. The pooled prevalence of dental caries among asthmatic children was 73% (95% CI: 50–95%), with higher odds of caries than non-asthmatic peers (OR = 2.39, 95% CI: 1.12–5.07) and higher mean DMFT scores (MD = 2.21, 95% CI: 0.62–3.80). Use of anti-asthmatic medications, especially β₂-agonists, further increased caries risk (OR = 3.13; OR = 10.04). Asthma medication use was associated with dental caries, although the findings should be interpreted cautiously given the variability among the studies included. These findings highlight the importance of considering oral health in patients receiving long-term asthma treatment and support appropriate preventive dental care alongside asthma management.