Malocclusion characteristics amongst individuals with autism spectrum disorders: A systematic review and meta-analysis

Thiago Motta, Janine Owens, Lucas Guimarães Abreu (Collaborator), S, A Teixeira, F Vargas-Ferreira, Mario Vettore (Corresponding)

Research output: Contribution to journalArticlepeer-review


Background: To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to
assess the relationship between ASD and malocclusion.
Methods: We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO
LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two
researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk
of bias were evaluated through the Newcastle–Ottawa scale and ROBINS-E tool. Meta-analyses using random effect
models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD
and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses
were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other
syndromes and medical conditions.
Results: Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional
studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality.
A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in
individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%).
Individuals with ASD had higher odds of Angle’s Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle’s Class III (OR 2.33; 95%
CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21)
than individuals without ASD.
Conclusions: Angle’s Class II, Angle’s Class III, anterior open bite and increased maxillary overjet were more prevalent
in individuals with ASD than those without ASD. Further high-quality studies are needed.
Original languageEnglish
Pages (from-to)1-27
Number of pages27
JournalBMC Oral Health
Issue number341
Publication statusPublished - 10 Aug 2022


  • Autistic disorder
  • Malocclusion
  • Angle Class II
  • Angle Class III
  • Open bite
  • Systematic review
  • Meta analysis


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