DMF scores in patients with diabetes mellitus: A systematic review and meta-analysis of observational studies

OBJECTIVE: The aim of this systematic review(SR) is to comprehensively and critically summarise and synthesise the available scientific evidence from observational studies that use the decayed-missed-filled(DMF) index to determine caries experiences among adult patients with diabetes mellitus (DM) as compared to individuals without DM(non-DM). DATA: Indices that present examinations of decayed-filled-surfaces(DFS), decayed-missed-filled-surfaces(DMFS), and decayed-missed-filled-teeth(DMFT) established from observational studies were considered. SOURCES: MEDLINE-PubMed and Cochrane Central databases were searched through 1 February 2023 to identify studies that evaluate DMF indices for adult patients with DM compared to non-DM. The reference lists of the selected studies were reviewed to identify additional potentially relevant studies. STUDY SELECTION: All studies were independently screened by two reviewers. Included papers were critically appraised using pre-designed forms, and the risk of bias was assessed. Data as means and standard deviations were extracted. A descriptive data presentation was used for all studies. If quantitative methods were feasible, then a meta-analysis was performed. It was decided 'a priori' to perform a sub-analysis on type of DM(I or II). The quality of the studies was assessed. RESULTS: Initially 932 studies were found, and screening resulted in 13 eligible observational studies. The total number of subjects included in this SR is 21,220. A descriptive analysis of the comparisons demonstrated that eight studies provided data and demonstrated higher DFS (1/2), DMFS (2/3) and DMFT (5/8). This was confirmed by the meta-analysis difference of means(DiffM), which was 3.01(95%CI:1.47,4.54,p=0.0001) for DMFT and 10.30(95% CI:8.50,12.11,p<0.00001) for DMFS. Subgroup analysis showed that this difference is irrespective to the type of DM(DiffM=3.09;95%CI:2.09,4.09,p<0.00001). CONCLUSION: There is moderate certainty for a higher DMF index score in DM patients as compared to those without DM disease. CLINICAL SIGNIFICANCE: This SR indicates a higher DMF index in DM patients. Oral disease prevention should be the focus of the dental care practitioner in this patient category.