Table 1.

Characteristics of the included studies.

Type of Study	Author/Year	Objetives	Drugs	Study Design	Main Findings	References
Case—control	Sivasithamparam et al./2002	To determine the incidence of dental erosion in asthmatic and non-asthmatic patients.	Salbutamol	Subjects were examined by recording tooth wear patterns.	There was a higher incidence of dental hypersensitivity, xerostomia, salivary gland abnormalities, gastric discomfort, and self-induced vomiting in asthmatic patients compared to the control group.	[40]
Retrospective study	Dugmore et al./2004	To analyze the relationship of possible etiological factors for the presence of dental erosion.	Terbuline Salbutamol	The erosion index used was based on the 1993 Children’s Dental Health Survey.	At 12 years, significant positive associations were found between the experience of erosion and decay (odds ratio [OR] = 1.48), drinking fruit juice (OR = 1.42) or soft drinks (OR = 1.59–2.52, depending on quantity and frequency).	[41]
Case—control	Ersin et al./2006	To investigate the dental caries risk of asthmatics in relation to dental plaque indices, salivary flow rate, pH and buffering capacity, saliva composition, and salivary levels of Streptococcus mutans compared to healthy subjects.	Inhaled corticosteroids B2 agonists Leukotrienes	The World Health Organization criteria were used for dental examinations and the Silness and Löe plaque index was used for plaque indices.	Children in the asthmatic group aged 6 to 10 years had a significantly higher prevalence of dental caries compared to the control group of the same age.	[33]
Randomized clinical trial	Huchon et al./2009	To evaluate lung function and asthma control with beclomethasone and formoterol in a single inhaler.	Beclamoentasone/formoterol inhaled	Patients received extrafine fixed combination treatment of beclomethasone dipropionate 200 mg/formoterol 12 mg twice daily, or beclomethasone dipropionate and formoterol.	The combination of beclomethasone dipropionate/formoterol through a single inhaler or through separate inhalers improved morning lung function.	[42]
Case—control	Botello et al./2011	To evaluate the dental caries risk of asthmatic patients based on the levels of Streptococcus mutans and lactobacillus in saliva samples, as well as the index of oral hygiene and dental caries.	Beclomethasone Budesonide Ciclesonide Fluticasone propionate Mometasone furoate	Parents were interviewed about factors related to oral health. WHO criteria for dental examinations were used.	No differences were observed between the asthma and control groups for the prevalence of dental caries in children aged 3 to 6 years and 7 to 10 years, except for severe cases in the younger group.	[32]
Cross-sectional study	Stensson et al./2011	To study oral health in young adults with long-term controlled asthma.	Salmeterol/Fluctisona Formoterol/budenoside	A clinical examination was performed to determine the prevalences of dental caries, erosions, gingival inflammation, cervicular fluid, and presence of periodontal pockets and the rate of plaque formation.	The asthmatic participant group had more gingivitis (p = 0.01) and a lower stimulated salivary secretion rate than the controls (p = 0.01). Asthmatics also had a somewhat lower initial pH value, although not statistically significant.	[34]
Case—control	Boskabady et al./2012	To examine the relationship between type of inhaled medication, duration of use, dosage, technique of inhaler use, and severity and duration of disease on dental caries in asthmatic patients.	Corticosteroids β2-adrenergic receptor agonists	In asthmatic patients, the type, dose, duration of medication, technique of inhaler use, and severity and duration of the disease were recorded. Dental health status, including DMFT index, was examined. In addition, pulmonary function tests (PFTs) were performed for both groups.	All dental cavity rates in the asthmatic group were higher than those of the controls. There was no significant correlation between dental cavity rates and disease duration, PFT values; medication dose or inhaler use technique.	[43]
Case—control	Ehsani et al./2013	To investigate oral health indices in healthy children and children with mild to moderate asthma.	Salbutamol Inhaled corticosteroids Fluctisone Beclomentasone Systemic corticosteroids Antihistamines Theophylline	Dental plaque, gingival inflammation, mouth breathing and dental caries were assessed by a trained examiner according to the World Health Organization criteria.	The results indicated no significant differences between the children with asthma and those without asthma regarding (decayed, missing, filled, teeth) dmft index (mean of 3.34 in asthmatic children and 3.0 in the control group).	[44]
Case—control	Godara et al./2013	To examine the potential link between dental caries and the specific use of dust inhalers in patients with bronchial asthma.	B2 agonists Inhaled corticosteroids	A clinical examination performed, which included the DMFT index to assess the presence of dental caries.	Asthmatic subjects exhibited a higher incidence of dental caries compared to the control group, but the difference was not statistically significant.	[45]
Case—control	Alaki et al./2013	To investigate the prevalence and severity of dental caries in children with a history of asthma.	Inhaled corticosteroids β2-agonist inhalers Anti-asthma 2 agonist inhalers and antihistamines combined with corticosteroids	Interviews and questionnaires were completed by the parents of the children involved and dental examinations were performed. Stimulated salivary samples were collected to determine salivary flow rate, buffering capacity, and salivary levels of Streptoccocus mutans and Lactobacillus.	No significant differences were found in the DMFT index or community periodontal index scores between cases and controls.	[19]
Case—control	Prasanthi et al./2014	Evaluation of the effect of diuretics on oral health status with respect to pH, buffering, total protein content, various ion concentrations, and oral mucosal lesions.	Agonists of β2-adrenergic receptors.	Unstimulated and stimulated saliva was collected for further evaluation. Dental caries and periodontal status were measured using the DMFT index and Russell’s periodontal index, respectively.	Prevalence was found for dental caries (p < 0.01), periodontal status (p < 0.001), and mucosal lesions (p < 0.01).	[46]
Case—control	Monadi et al./2015	To investigate the effect of inhaled corticosteroids on bone mineral density.	Inhaled corticosteroids	Bone mineral density in the lumbar spine (LS) and femoral neck (FN) was measured by dual energy X-ray absorptiometry (DEXA).	Compared to controls, bone mineral density decreased only in patients < 50 years in both spine (11.3%, p = 0.013) and hip (8.8%, p = 0.044), while in patients ≥ 50 years, BMD did not decrease significantly.	[47]
Retrospective-prospective study	Brigic et al./2015	Cariogenic potential of inhaled anti-asthmatics	Inhaled anti-asthmatics	200 patients, aged 7 to 14 years, divided into two groups: the control group (n1 = 100) was made up of healthy children and the experimental group was made up of children suffering from asthma (n2 = 100). In both groups of respondents, the following were found inthe DMFT index: the plaque index value and the hygienic-dietary habits by means of the questionnaire.	The subjects in the control group had a significantly higher DMFT index than the subjects in the experimental group (p = 0.004). It is determined that there are no significant differences in plaque index values (p > 0.05).	[31]
Retrospective-prospective study	Brigic et al./2015	Asthma/dental caries	Inhaled anti-asthmatics	The study sample consisted of 200 patients, aged from 7–14 years, divided into two groups: the control group (n1 = 100) consisted of healthy children and the experimental group consisted of children suffering from asthma (n2 = 100). In both groups of respondents, the following were determined in the DMFT index: plaque index value and hygienic-dietary habits using the questionnaire.	The results of this research have once again confirmed that the dental caries is a disease with multifactorial etiology in which mutual relationships and interactions between numerous etiological factors contribute even more to the complexity to estimate the of cavity risk problem.	[30]
Randomized clinical trial	Reddel et al./2017	To analyze the benefits of initiation of inhaled corticosteroid therapy for mild asthma on symptom frequency.	Inhaled corticosteroids	Study of treatment with inhaled steroids as regular therapy (START) of 3 years, conducted in 32 countries, with clinical visits every 3 months.	Of 7138 patients (n = 3577 budesonide; n = 3561 placebo), the initial frequency of symptoms was 0 to 1 days per week for 2184 (31%) participants, more than 1 and less than or equal to 2 days of symptoms per week for 1914 (27%) participants, and more than 2 days with symptoms per week for 3040 (43%) participants.	[48]
Case—control	Arafa et al./2017	To evaluate oral health status and salivary composition in a group of children with bronchial asthma.	Inhaled corticosteroids β2-agonist inhalers	The children were clinically examined to assess their dental cavity experience, dental erosion status, and gingival status.	The results of this study revealed that asthmatic children presented a significantly higher mean DMFT index, dental erosion status, and gingival status compared to the control groups.	[27]
Case—control	Rodríguez et al./2018	To determine whether oral health is a risk factor for community-acquired pneumonia in asthmatic patients undergoing inhaled therapy.	Inhaled anti-asthmatics	The main study factor was the general oral health assessment index (GOHAI) score.	Bivariate analysis shows a statistically significant association of community-acquired pneumonia with a GOHAI ≤ 57 points (poor oral health) (OR 1.69).	[49]
Case—control	Ashuja et al./2018	To evaluate and compare Streptococcus mutans (SM) and plaque lactobacilli and C. albicans counts in saliva samples from asthmatic adults with controls during the course of medication longitudinally.	Budesonide Methylprednisolone Formoterol	Samples were collected from twenty newly diagnosed asthmatic adults and twenty controls for estimation of microbial counts at baseline and at three and six months after initiation of medication.	Asthmatics at baseline had higher microbial counts than controls, but the difference was not statistically significant.	[50]
Cohort	Wu et al./2019	Asthma/caries	Inhaled corticosteroids Bronchodilator agents: short or long-acting b2 agonists	Investigating the correlation between asthma medications and dental caries among children in Taiwan.	The prevalence of caries in children without asthma was 85.2% and that of children with asthma was 90.0%, children who received asthma medication have a higher prevalence of dental caries and a higher rate of severe caries than children without asthma.	[22]
Cross-sectional study	Rezende et al./2019	To evaluate caries, erosion, and enamel defects in children with and without asthma.	Salbutamol	The assessment consisted of an oral examination and a structured interview with the children’s parents/guardians.	Of 112 asthmatic children, 63 (51.2%) had dental caries and 25 (53.2%) had enamel defects. In the adjusted analysis, dental caries and salbutamol use were associated (PR = 1.32, 95% CI = 1.01–1.72).	[39]
Retrospective study	Hu et al./2019	To assess the characterization of oral candidiasis and the species profiles in such patients.	Corticosteroids, vasoconstrictors, and antihistamines	Over a period of four consecutive years, patients with oral mucosal diseases were screened for oral candidiasis through a combination of clinical presentation and laboratory findings.	In total, 9769 (6.09%) of the 160,357 patients examined were diagnosed as having oral candidiasis on the basis of both clinical manifestations and laboratory tests.	[51]
Case—control	Hassanpour et al./2019	To determine and compare the frequency of dental caries among asthmatic children, with asthmatic children who inhaled corticosteroid treatment and healthy children.	Inhaled corticosteroids	An examination for the diagnosis of dental caries was performed using the DMF index.	The mean DMF index score in each of the subscales of decayed teeth (D/d), missing teeth (P/p), and filled teeth (O/o), was higher in asthmatic children compared to healthy children (p < 0.05).	[52]
Case—control	Khassawneh et al./2019	To study the association between bronchial asthma (BA) and periodontitis.	Oral corticosteroids and inhaled corticosteroids	AB cases were diagnosed by a physician and subjects had been prescribed anti-asthma medications for ≥12 months. Periodontitis was defined as the presence of ≥4 teeth with ≥1 site with probing depth (PPD) ≥ 4 mm and clinical attachment level (CAL) ≥ 3 mm.	Periodontitis was present in 52 (40.0%) patients with AB and 26 (20.0%) in the control group, p < 0.005.	[53]
Case—control	Chumpitaz-Cerrate, et al./2020	To determine the prevalence of dental caries in pediatric asthmatic patients using inhaled drugs.	Budesonide/salbutamol or fluticasone/salmeterol	A medical examination was performed to determine the type, timing, and frequency of treatment and an oral examination to establish the prevalence of dental caries and the decayed, missing, and filled tooth DMFT index.	The prevalence of dental caries was 34.2% in the control group and 28.3% in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32 and in the case group 3.98 ± 0.31 (p = 0.08).	[54]
Cross-sectional comparative study	Bairappan et al./2020	To assess and compare the salivary characteristics and oral health, and to evaluate the impact of asthma and its medication on dental caries among adolescents with and without asthma.	Short-acting beta-agonists, systemic corticosteroids, and anticholinergic drugs	Study was conducted among 50 asthmatic and 50 nonasthmatic adolescents aged 12–15 years. Salivary samples were collected to determine the flow rate, pH, buffering capacity, and Streptococcus mutans and Lactobacilli counts. Oral health assessment was performed using WHO 2013 proforma.	Asthmatic participants had a significantly higher mean number of teeth with dental caries, gingival bleeding, and dental erosion than nonasthmatics (p < 0.05). The prevalence of fluorosis, traumatic dental injuries, and oral mucosal lesions in asthmatics were 34.0%, 38.0%, and 28.0%, respectively. Statistically significant difference was found in the flow rate, pH, buffering capacity, S. mutans and Lactobacilli counts, and decayed, missing, filled teeth (DMFT) index between asthmatic and nonasthmatic participants.	[55]
Cross-sectional study	Brasil-Oliveira et al./2021	To assess oral health-related quality of life (OHRQoL) among individuals with severe asthma, comparing it with that observed among persons with mild to moderate asthma and persons without asthma.	Inhaled corticosteroids	The index of decayed, missing, and filled teeth (DMFT index) was calculated, as well as the periodontal screening and recording index, and salivary flow was determined.	Periodontitis and reduced salivary flow were more common in patients with severe asthma compared to the group of participants with mild to moderate asthma and no asthma.	[56]
Cross-sectional study	Akiki et al./2021	To assess the prevalence of physician-diagnosed asthma and current asthma, and its determinants.	Inhaled corticosteroids, and antihistamines	The questionnaire used collected information on asthma, respiratory symptoms, and risk factors.	The prevalence of physician-diagnosed asthma was 6.7% (95% CI 5–8.7%) and that of current asthma was 5% (95% CI 3.6–6.9%).	[57]
Meta analysis	Slob, et al./2021	To evaluate whether genetic variations were associated with exacerbations in children treated with beta2-agonists from a global consortium.	Long-acting beta2-agonist	To analyze the genome-wide association performed in 1425 children and young adults with asthma (age 6–21 years) withregular use of beta2-agonists.	Genome-wide association results were analyzed for a total of 82,996 common single nucleotide polymorphisms (SNPs, MAF ≥ 1%) with high imputation quality. Eight independent variants were suggestively (p-value threshold ≤ 5 × 10–6) associated with exacerbations despite beta2-agonist use.	[58]
Prospective study	Abidullah et al./2022	This study aimed to estimate salivary Candida Albicans in asthmatic patients taking anti-asthmatics medication.	Anti-asthmatic medicine in doses of 100, 250, or 500 mg	The research comprised a total of 100 individuals, 50 of whom were asthmatics, and 50 healthy controls who were age and sex-matched to the asthmatics.	32 people had candida growth and 18 individuals did not have any candidal development at all. Eighteen people were in the 400 CFU/mL group, and 32 individuals were in the 401 CFU/mL group, respectively. It was 0.000 in the 400 colony forming unit/milliliter group, and 27,200 in the 401 CFU/mL group, with 0.00 being the median. There was a notable difference between study and control groups in terms of colony forming unit per milliliter (p = 0.000).	[59]