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Association Between Iron Deficiency Anemia and Dental Caries in Children: A Systematic Umbrella Meta-Analysis
Mohammed Taib Fatih1, Mohammed Khalid Mahmood2, Yad Mariwan Mohammed Ali3
1Department of Dentistry, Komar University of Science and Technology, Sulaymaniyah, Iraq.
Insights
Children with iron deficiency anemia (IDA) are over three times more likely to develop dental caries. This systematic review highlights a significant association between IDA and increased risk of dental caries in pediatric populations.
Area of Science:
- Pediatric Health
- Nutritional Deficiencies
- Oral Health
Background:
- Dental caries and iron deficiency anemia (IDA) are significant public health concerns, particularly in developing children.
- Emerging evidence suggests a potential link between IDA and the prevalence of dental caries.
Purpose of the Study:
- To systematically evaluate the association between iron deficiency anemia and dental caries in children and adolescents.
- To conduct an umbrella meta-analysis of existing meta-analyses to synthesize current evidence.
Main Methods:
- A comprehensive search of PRISMA-compliant databases (PubMed, Scopus, Web of Science, Google Scholar) was performed for studies published before January 2025.
- Included meta-analyses focused on children and adolescents (<18 years). Statistical measures included odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI).
- Heterogeneity was assessed using I² and Cochran's Q tests, publication bias using Egger's test, study quality via AMSTAR 2, and certainty of evidence with GRADE.
Main Results:
- Five meta-analyses were included in the review.
- Children with IDA were over three times more likely to have dental caries (OR = 3.64, 95% CI: 2.45 to 5.40).
- Pooled analysis indicated a tendency for lower serum ferritin and hemoglobin levels in children with caries, though not statistically significant. MCV levels also showed a non-significant trend towards lower values in children with caries.
Conclusions:
- Dental caries is significantly more prevalent in anemic children compared to non-anemic children.
- The overall certainty of evidence for the association between IDA and dental caries is low, warranting further investigation.
Background:
Dental caries and iron deficiency anemia (IDA) are prevalent especially in developing children. There seems to be an association between these two variables.
Objective:
To evaluate this association among children and adolescents using a systematic review and umbrella meta-analysis technique.
Methods:
The PRISMA reference databases like PubMed, Scopus, Web of Science and Google Scholar were searched for all records published before January 2025. Meta-analyses that evaluated the association among < 18-year-olds were included. Parameters like odds ratio (OR) and mean difference (MD) with the 95% confidence interval (CI) were used to compare between the groups. I² and Cochran's Q (χ²) tests were used for measuring heterogeneity, whereas Egger's test was utilised to measure publication bias. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to assess the quality of the meta-analyses. The degree of certainty of the outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.
Results:
A total of five meta-analyses were included. Children with IDA were significantly over three times more likely to have dental caries than children without anemia (OR = 3.64, 95% CI: 2.45 to 5.40, p < 0.0001. Heterogeneity: I² = 80%, p = 0.007. Publication bias: p = 0.14.
Grade:
Moderate). The pooled analysis for serum ferritin showed a tendency toward lower ferritin level in children with caries; but without statistical significance (MD = -3.96, 95% CI: -8.48 to 0.57, p = 0.087. Heterogeneity: I² = 66.3%, p = 0.031. Publication bias: p = 0.003.
Grade:
Very low). Children with dental caries had lower haemoglobin levels, but the finding was not significant with high level of heterogeneity and publication bias (MD = -2.20 g/dL, 95% CI: -4.59 to 0.19, p = 0.071. Heterogeneity: 80.%, p = 0.006. Publication bias: p = 0.005.
Grade:
Very low). Children with caries had lower MCV, but this result was non-significant with evidence of heterogeneity and publication bias (MD = -1.96 fL, 95% CI: -4.02 to 0.10, p = 0.062. Heterogeneity: I² = 57.2%, p = 0.096. Publication bias: p = 0.041.
Grade:
Very low).
Conclusion:
Dental caries was more prevalent among anemic children compared to non-anemic ones with a low level of certainty.
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