Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis

Gois-Santos, Vanessa Tavares de; Santos, Victor Santana; Tavares, Carolina Santos Souza; Araújo, Brenda Carla Lima; Ribeiro, Karla Maria Nunes; Simões, Silvia de Magalhães; Martins Filho, Paulo Ricardo

doi:10.1590/1807-3107bor-2022.vol36.0039

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Meta-analysis, Pediatric Dentistry • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0039 copy

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2–17 years. Information on DOH was obtained from the verbal report of the children’s parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13–1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00–1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Keywords:
Child; Asthma; Habits; Oral Health

Search databases	Search strategies
PubMed	(Pacifiers [Mesh] OR “Finger Sucking” OR “Sucking, Finger” OR Thumbsucking OR “Thumb Sucking” OR “Sucking, Thumb” OR Fingersucking[Mesh] OR “Biting, Nail” OR Onychophagia OR “Nail Biting”[Mesh] OR “Bottle Feedings” OR “Feeding, Bottle” OR “Feedings, Bottle” OR Bottlefeeding OR “Bottle Feeding”[Mesh]) AND (Asthmas OR “Bronchial Asthma” OR “Asthma, Bronchial” OR Asthma [Mesh])
Scopus	(Pacifiers OR “Finger Sucking” OR Thumbsucking OR “Thumb Sucking” OR Fingersucking OR Onychophagia OR “Nail Biting” OR “Bottle Feedings” OR Bottlefeeding OR “Bottle Feeding”) AND (Asthmas OR “Bronchial Asthma” OR Asthma)
Web of Science	(Pacifiers OR “Finger Sucking” OR Thumbsucking OR “Thumb Sucking” OR Fingersucking OR Onychophagia OR “Nail Biting” OR “Bottle Feedings” OR Bottlefeeding OR “Bottle Feeding”) AND (“Bronchial Asthma” OR “Asthma, Bronchial” OR Asthma)
OpenThesis	(Pacifiers OR “Finger Sucking” OR Thumbsucking OR “Thumb Sucking” OR Fingersucking OR Onychophagia OR “Nail Biting” OR “Bottle Feedings” OR Bottlefeeding OR “Bottle Feeding”) AND (“Bronchial Asthma” OR “Asthma, Bronchial” OR Asthma)
Lilacs	(Pacifiers OR “Finger Sucking” OR Thumbsucking OR “Thumb Sucking” OR Fingersucking OR Onychophagia OR “Nail Biting” OR “Bottle Feedings” OR Bottlefeeding OR “Bottle Feeding”) AND (“Bronchial Asthma” OR “Asthma, Bronchial” OR Asthma)
Google Scholar	(Pacifiers OR “Finger Sucking” OR Thumbsucking OR “Thumb Sucking” OR Fingersucking OR Onychophagia OR “Nail Biting” OR “Bottle Feedings” OR Bottlefeeding OR “Bottle Feeding”) AND (“Bronchial Asthma” OR “Asthma, Bronchial” OR Asthma)

Study	Country	Study design	Age group (y)	Setting	Definition of oral habits	Asthma definition	Sample size
Celedon, 2002²²22 Celedon JC, Litonjua AA, Ryan L, Weiss ST, Gold DR. Bottle feeding in the bed or crib before sleep time and wheezing in early childhood. Pediatrics. 2003;110(6):e77. https://doi.org/10.1542/peds.110.6.e77 https://doi.org/10.1542/peds.110.6.e77...	United States	Cohort	5	Community	Reported by parents	Diagnosis confirmed by a physician	448
Hsu, 2012²¹21 Hsu NY, Wu PC, Bornehag CG, Sundell J, Su HJ. Feeding bottles usage and the prevalence of childhood allergy and asthma. Clin Dev Immunol. 2012;2012:158248. https://doi.org/10.1155/2012/158248 https://doi.org/10.1155/2012/158248...	Taiwan	Cross-sectional	2–7	School	Reported by parents	Parents’ report + ISAAC questionnaire	14,862
Lynch, 2016²³23 Lynch SJ, Sears MR, Hancox RJ. Thumb-sucking, nail-biting, and atopic sensitization, asthma, and hay fever. Pediatrics. 2016 Aug;138(2):e20160443. https://doi.org/10.1542/peds.2016-0443 https://doi.org/10.1542/peds.2016-0443...	New Zealand	Cohort	13	Community	Reported by parents	Diagnosis confirmed by a physician	1,013
Morass, 2008¹³13 Morass B, Kiechl-Kohlendorfer U, Horak E. The impact of early lifestyle factors on wheezing and asthma in Austrian preschool children. Acta Paediatr. 2008 Mar;97(3):337-41. https://doi.org/10.1111/j.1651-2227.2007.00633.x https://doi.org/10.1111/j.1651-2227.2007...	Austria	Cross-sectional	5.5 ± 0.8	School	Reported by parents	Diagnosis confirmed by a physician + ISSAC questionnaire	1,761
Ginkel, 2018²⁴24 Ginkel CD, Meulen GN, Bak E, Flokstra-de Blok BM, Kollen BJ, Koppelman GH, et al. Retrospective observational cohort study regarding the effect of breastfeeding on challenge-proven food allergy. Eur J Clin Nutr. 2018 Apr;72(4):557-63. https://doi.org/10.1038/s41430-018-0117-y https://doi.org/10.1038/s41430-018-0117-...	The Netherlands	Cross-sectional	6.3	Primary health care	Reported by parents	Diagnosis confirmed by a physician	649

Variable		1	2	3	4	5	6	7	8	9	10	11	12	13	14
Study Cohort
	Celedon, 2002²²22 Celedon JC, Litonjua AA, Ryan L, Weiss ST, Gold DR. Bottle feeding in the bed or crib before sleep time and wheezing in early childhood. Pediatrics. 2003;110(6):e77. https://doi.org/10.1542/peds.110.6.e77 https://doi.org/10.1542/peds.110.6.e77...	Y	Y	Y	Y	NR	Y	Y	Y	N	Y	Y	N	Y	Y
	Lynch, 2016²³23 Lynch SJ, Sears MR, Hancox RJ. Thumb-sucking, nail-biting, and atopic sensitization, asthma, and hay fever. Pediatrics. 2016 Aug;138(2):e20160443. https://doi.org/10.1542/peds.2016-0443 https://doi.org/10.1542/peds.2016-0443...	Y	Y	Y	Y	NR	Y	Y	Y	N	Y	Y	N	NR	Y
Cross-sectional
	Hsu, 2012²¹21 Hsu NY, Wu PC, Bornehag CG, Sundell J, Su HJ. Feeding bottles usage and the prevalence of childhood allergy and asthma. Clin Dev Immunol. 2012;2012:158248. https://doi.org/10.1155/2012/158248 https://doi.org/10.1155/2012/158248...	Y	Y	Y	Y	NR	NA	NA	Y	N	NA	Y	N	NA	Y
	Morass, 2008¹³13 Morass B, Kiechl-Kohlendorfer U, Horak E. The impact of early lifestyle factors on wheezing and asthma in Austrian preschool children. Acta Paediatr. 2008 Mar;97(3):337-41. https://doi.org/10.1111/j.1651-2227.2007.00633.x https://doi.org/10.1111/j.1651-2227.2007...	Y	N	N	N	NR	NA	NA	N	N	NA	Y	N	NA	Y
	Ginkel, 2018²⁴24 Ginkel CD, Meulen GN, Bak E, Flokstra-de Blok BM, Kollen BJ, Koppelman GH, et al. Retrospective observational cohort study regarding the effect of breastfeeding on challenge-proven food allergy. Eur J Clin Nutr. 2018 Apr;72(4):557-63. https://doi.org/10.1038/s41430-018-0117-y https://doi.org/10.1038/s41430-018-0117-...	Y	Y	Y	Y	Y	NA	NA	Y	N	NA	Y	Y	NA	Y

Evidence	OR (95%CI)	I²2 Wright RJ. Epidemiology of stress and asthma: from constricting communities and fragile families to epigenetics. Immunol Allergy Clin North Am. 2011 Feb;31(1):19-39. https://doi.org/10.1016/j.iac.2010.09.011 https://doi.org/10.1016/j.iac.2010.09.01...	Risk of bias	Inconsistency	Indirectness	Imprecision	Influence of small trials	Large effect	Plausible confounding^* * In this meta-analysis, we did not rate the influence of all plausible residual confounding;	Potential for dose-response^ Individual studies presented a potential for dose-response relationship between oral habit and asthma in children.	Quality of evidence
Bottle-feeding	1.25 (1.13–1.38)	0%	Not serious	Not serious	Not serious	Not serious	Not applicable	No	No	Yes	⊕⊕⊕◯
Pacifier use	1.11 (1.00–1.24)	0%	Serious	Not serious	Not serious	Not serious	Not serious	No	No	Yes	⊕⊕◯◯

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[1] Corresponding Author: Vanessa Tavares de Gois Santos E-mail: vanodonto@hotmail.com