Association Between Iron Deficiency Anemia and Dental Caries in Children: A Systematic Umbrella Meta‐Analysis

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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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