Oral Health among Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade
Creators: name: Anouti, Fatme
name: Abboud, Myriam
name: Papandreou, Dimitrios
name: Rizk, Rana
name: Mahboub, Nadine
name: Haidar, Suzan
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences
subject: Life Sciences

description: Oral Health among Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade Review team details 1. Review team members and their organizational affiliations: Fatme Al Anouti: Department of Health, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates Rana Rizk: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-Lb), Beirut, Lebanon Suzan Haidar: Lebanese International University, Beirut, Lebanon Nadine Mahboub: Lebanese International University, Beirut, Lebanon; Maastricht University, Maastricht, The Netherlands Myriam Abboud: Department of Health, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates Dimitrios Papandreou: Department of Health, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates 2. Funding source: College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates. The funding body will not be involved in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript 3. Conflicts of interest: None. Review methods 4. Context: Oral diseases encompass a range of conditions including dental caries, periodontal disease, tooth loss, and birth defects with dental disease associations such as cleft lip and palate (World Health Organization, 2021). These diseases affecting 3.5 billion people (GBD, 2017), and posing serious health and economic burdens (Peres et al., 2019) are undoubtedly a universal public health problem (Peres et al., 2019). Fortunately, oral diseases are largely preventable (Peres et al., 2019), since their modifiable risk factors include mainly unhealthy diets high in simple sugars (World Health Organization, 2021) within an environment of enamel adherent, acid‐producing bacteria (Tinanoff et al., 2019). Oral diseases in the pediatric population are a major concern. Specifically, dental caries is the most common chronic disease that occurs in childhood (Benzian et al., 2017). The global prevalence of childhood caries among 4-years-old ranges from 12% to 98% (Tinanoff et al. 2019). Although the prevalence and severity of dental caries among 5 to 12-year-olds has declined over the last four decades, the decay-component remains very high (Frencken et al., 2017). While not life-threatening, oral diseases are associated with a wide range of clinical consequences amongst children, ranging from pain, discomfort, and lack of sleep (Guarnizo-Herreno and Wehby, 2012), to negative impact on self-esteem, eating ability, compromised nutrition and health (Balappanavar, 2020), to increased absences from school and decreased academic performance (Rebelo et al., 2019), as well as decreased quality of life for both the children and their caregivers (Peres et al., 2019). Furthermore, children with dental caries are at an increased risk of adulthood caries (Manton et al., 2018). Oral health is, thus, a cornerstone for wellbeing, quality-of-life, and health in the pediatric population. In high-income countries, the current approach to tackle oral diseases is trapped in a treatment-dominated, high-technology interventionist cycle that does not address the determinants of the disease (Watt et al., 2019). Even with a decreased overall disease prevalence in the pediatric population, the progressive and cumulative nature of oral diseases into adult life remains a main issue (Watt et al., 2019). Among all the diseases that affect children in the United Arab Emirates (UAE), oral disease, specifically early childhood caries, is the most common (Kowash et al., 2017). Available evidence indicates that, despite improvement in the provision of oral health services, dental caries remains a pediatric national health problem (Al-Bluwi, 2014; El Nadeef et al., 2009). Among children aged between 4 and 6 years, Al-Bluwi (2014) reported that the number of decayed, missing or filled permanent teeth (DMFT) ranged between 5.1 and 8.4, and the prevalence of dental caries ranged between 72.9% and 76.1% in Ajman, and 78.85% and 95% in Abu Dhabi. Among older children, a national survey published in 2009 revealed that 54% of 12-year-olds had caries in their permanent dentition, with a mean DMFT of 1.6 per child. Prevalence of dental caries estimates ranged between 43% in Sharjah and Umm Al Quwain and 89% in Western Region. Among 15-year-olds, the prevalence of dental caries was 65%, with a mean DMFT of 2.5 (El Nadeef et al., 2009). As part of improving pediatric oral health status, it was thus recommended to conduct routine epidemiological studies to assess oral health and understand its determinants, encourage and support school-based preventive programs, and take into account trends in dental caries in national preventive strategies, while focusing on the important role of local legislation in each Emirate in decreasing the risk of oral diseases (Al-Bluwi, 2014; El Nadeef et al., 2009). So far, numerous public health initiatives have been launched with the aim of improving pediatric oral health in the UAE, such as the Community Dental Services (CDS)’s national oral diseases preventive program “Dubai Smiles Healthy” in schools and health centers (Shihab AlMashhadani, 2021a), and the “Abu Dhabi Smiles”, which is a school-based program launched in 2012 to provide awareness and advice on good oral hygiene practices for both parents and children whose ages range between 5 and 11 years (Department of Health, 2020). 5. Review aim: Oral health has been a top priority in the UAE and improving its status is one of the key public health goals (Department of Health, 2020; Shihab AlMashhadani, 2021b). The latest available literature review on the topic was published in 2014; it included studies published up to the year 2011, was limited to few databases, and focused only on dental caries in children younger than 13 years of age (Al-Bluwi, 2014). The current systematic review aims to give a comprehensive overview on oral health among children and adolescents in the UAE over the last decade, for policy and research considerations. Providing such information is crucial for planning and evaluating oral health programs. The review also aims to identify gaps in the recent research related to oral health status in the UAE. 6. Condition being studied: The authors aim to explore: 1) the national or Emirate-specific prevalence and patterns of oral diseases in children and adolescents, including dental caries, periodontal disease, tooth loss, noma and birth defects with dental disease associations (World Health Organization, 2021); 2) determinants of poor oral health; 3) pertaining clinical, quality-of-life, and economic implications; 4) oral hygiene knowledge and practices of children and their caregivers; 5) utilization of dental services among healthy children and adolescents, and those with disease; and 6) the effectiveness of programs and interventions aiming to improve oral health in the target population. 7. Population: Children and adolescents (healthy or with disease), and their caregivers. 8. Types of study to be included initially: Observational and interventional studies. 9. Searches: The authors will run searches on PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO, EMBASE via Ovid, the Cochrane Library, and the Index Medicus for the Eastern Mediterranean Region (IMEMR) databases. The authors will also hand search the references of included articles and previous relevant reviews. In the search strategy, the authors will consider three key concepts: 1) United Arab Emirates, 2) children and adolescents, and 3) oral health. For each concept, Medical Subject Headings (MeSH) and keywords will be mapped. The authors will not apply any language restriction to the search. 10. Inclusion criteria: Included studies should be 1) original articles (non-original studies such as editorials, case reports, case series, and reviews will be excluded); 2) address oral health in the pediatric population (i.e. in people aged less than 19 years); 3) report data specific for UAE’s citizens irrespective of their nationality (nationals and/or expatriates), or sex (female or male); 4) written in any language; 5) published after 2010. 11. Study selection, data extraction, and data synthesis: The authors will screen titles and/or abstracts from electronic scientific databases using EndNote, version X6, and identify studies that potentially meet the inclusion criteria outlined above. The full texts of potentially eligible studies will be retrieved in addition to the records identified through the gray literature search. Then, the authors will assess the retrieved records for eligibility, and will extract data from eligible studies using a data extraction form. Finally, the authors will provide a narrative synthesis of the findings from the studies including the author-recorded characteristics of the study, details of the population included, as well as the study’s methodology and main findings. Calibration exercises will be conducted before each step of this process, and each step will be conducted independently by pairs of authors. Discripencies will be solved through discussions or with the help of a third reviewer. 12. Quality of reporting: The authors will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) checklist for the literature searching component of the systematic review (Rethlefsen et al., 2021), and the PRISMA statement for the reporting of the systematic review (Moher et al., 2010). 13. Keywords: Oral health; Tooth diseases; Periodontal diseases; Dental care for children; Child; Adolescent; United Arab Emirates; Systematic review. References Al-Bluwi GS. Epidemiology of dental caries in children in the United Arab Emirates. International dental journal. 2014 Aug 1;64(4):219-28. Balappanavar AY. Tea and Oral Health. InTea-Chemistry and Pharmacology 2020 Apr 29. IntechOpen. Benzian H, Garg R, Monse B, Stauf N, Varenne B. Promoting oral health through programs in middle childhood and adolescence. 2017: 211-20. Department of Health. Abu Dhabi Smiles: Oral Health Program [Internet]. https://www.doh.gov.ae/. 2021 [cited 11 April 2021]. Available from: https://www.doh.gov.ae/programs-initiatives/abu-dhabi-smiles-oral-health-program#:~:text=Improving%20the%20oral%20health%20status,DoH's%20key%20Public%20Health%20Goals.&amp;text=A%20school%2Dbased%20program%2C%20it,for%20both%20parents%20and%20children. El Nadeef MA, Al Hussani E, Hassab H, Arab IA. National survey of the oral health of 12-and 15-year-old schoolchildren in the United Arab Emirates. EMHJ-Eastern Mediterranean Health Journal, 15 (4), 993-1004, 2009. 2009. Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis–a comprehensive review. Journal of clinical periodontology. 2017 Mar;44:S94-105. GBD 2017 Oral Disorders Collaborators, Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, Amini S, Arabloo J, Arefi Z, Arora A. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study. Journal of dental research. 2020 Apr;99(4):362-73. Guarnizo-Herreno CC, Wehby GL. Children's dental health, school performance, and psychosocial well-being. The Journal of pediatrics. 2012 Dec 1;161(6):1153-9. Kowash MB, Alkhabuli JO, Dafaalla SA, Shah A, Khamis AH. Early childhood caries and associated risk factors among preschool children in Ras Al-Khaimah, United Arab Emirates. European Archives of Paediatric Dentistry. 2017 Apr 1;18(2):97-103. Manton DJ. Child dental caries–a global problem of inequality. EClinicalMedicine. 2018 Jul 1;1:3-4. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med. 2009 Jul 21;6(7):e1000097. Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, Listl S, Celeste RK, Guarnizo-Herreño CC, Kearns C, Benzian H. Oral diseases: a global public health challenge. The Lancet. 2019 Jul 20;394(10194):249-60. Rebelo MA, Rebelo Vieira JM, Pereira JV, Quadros LN, Vettore MV. Does oral health influence school performance and school attendance? A systematic review and meta‐analysis. International journal of paediatric dentistry. 2019 Mar;29(2):138-48. Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, Koffel JB. PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Systematic reviews. 2021 Dec;10(1):1-9. Shihab AlMashhadani S. United Arab Emirates - Dental Public Health Programs implemented by Dental Services Department, Dubai [Internet]. Capp.mau.se. 2021a [cited 11 April 2021]. Available from: https://capp.mau.se/bank-of-ideas/united-arab-emirates-dental-public-health-programs-implemented-by-dental-services-department-dubai/ Shihab AlMashhadani S. United Arab Emirates - MY SMILE” - tooth brushing program for school children in Dubai, UAE. [Internet]. Capp.mau.se. 2021b [cited 11 April 2021]. Available from: https://capp.mau.se/bank-of-ideas/united-arab-emirates-my-smile-tooth-brushing-program-for-school-children-in-dubai-uae/ Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. International journal of paediatric dentistry. 2019 May;29(3):238-48. Watt RG, Daly B, Allison P, Macpherson LM, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreño CC, Celeste RK, Peres MA. Ending the neglect of global oral health: time for radical action. The Lancet. 2019 Jul 20;394(10194):261-72. World Health Organization. Oral health [Internet]. Who.int. 2021 [cited 11 April 2021]. Available from: https://www.who.int/health-topics/oral-health/#tab=tab_1