Body mass index and dental caries in children and adolescents: a systematic review of literature published 2004 to 2011

U-shaped association between untreated caries and body mass index in adults at Rabat dental University hospital, Morocco: cross sectional study

Background

Many previous studies estimating the relationship between body mass index (BMI) and dental decay are conflicting. Most studies, however, examine the relationship using BMI as a categorical variable. This study evaluated the non-linear association between body mass index as a continuous variable and untreated dental decay.

Methods

Cross-sectional study of adults free of diseases attending a tertiary dental clinic was conducted. The number of untreated caries at the time of consultation was assessed using the WHO criteria. A multivariable Poisson regression model for severity of untreated dental decay was first established. Restricted cubic spline functions were used to consider potential non-linear associations between BMI and untreated dental caries.

Results

After multivariable adjustment, the prevalence ratios (PR) for the number of dental decay remained significantly associated with the age at beginning tooth brushing (PR = 1.15, 95% CI 1.05–1.25), BMI < normal (PR = 1.66, 95% CI 1.30–2.12), BMI > normal (PR = 1.30, 95% CI 1.03–1.65), SDI (PR = 0.61, 95% CI 0.50–0.75) and GI (PR = 1.59, 95% CI 1.30–1.94). When BMI was evaluated as continuous variable, it exhibited a significant U-shaped pattern with the number of untreated dental decay both in univariable and multivariable analysis.

Conclusion

The rate of untreated tooth decay was associated with both under- and overweight status.

Dental caries and weight among children in Nuuk, Greenland, at school entry

OBJECTIVE

To explore the possible association between weight class and prevalence of caries among children born 2005-2007, living in Nuuk, Greenland, at time of school entry.

DESIGN

A cross-sectional register study based on data from electronic medical records(EMR) and oral health data from public health and dental care facilities.

METHODS

Data from routine examinations of children at time of primary school entry, including height and weight, were obtained from the EMRs. Dental charts recording oral health and caries were collected from public dental healthcare service. The prevalence of caries was calculated as the proportion of included children with dft score (decayed and/or filled non-permanent teeth) ≥1.

RESULTS

55%(373/681) had relevant data recorded in EMRs and dental charts, and could be included in the study. The prevalence of dental caries was 57.1%(213/373). The prevalence of caries increased with higher weight class,but no statistically significant trend was observed(p=0.063).

CONCLUSIONS

Increasing prevalence of caries with increasing weight class was observed in this study. A linear trend could not be confirmed statistically. The high prevalence of caries and overweight indicate the need for continued focus on preventative initiatives and monitoring. A combined strategy targeting both caries and overweight may be considered.

Relationship between caries, body mass index and social class in Spanish children

OBJECTIVE

To determine the association between caries, body mass index (BMI) and social class in child population of the Valencia region (Spain) at 6, 12 and 15 years, and study.

METHODS

In a cross sectional study of 1326 children aged 6 (n=488), 12 (n=409) and 15 years (n=433) who took part in the 2010 Oral Health Survey of the Valencia region, the ICDAS II criteria were employed for diagnosing and coding all the teeth examined. The quantitative BMI values on a continuous scale were grouped into 3 categories (normal weight, overweight, obese) based on a table adjusted for age and gender. The highest-ranking occupation of the parents was taken to indicate the social class of the child.

RESULTS

The mean BMI was 17.21 at 6 years, 21.39 at 12 years and 22.38 at 15 years. No significant differences in caries indexes (DMFT or dft) by degree of obesity stratified by social class were found in any of the age groups studied. There was no significant correlation between BMI and DMFT-dft in any of the age groups.

CONCLUSIONS

Obesity is not associated with dental caries in schoolchildren of this population.

Relationship between body mass index and dental caries in children, and the influence of socio-economic status

OBJECTIVES

To determine the association of body mass index (BMI) with dental caries in Indian schoolchildren, and to analyse the influence of socio-economic status (SES).

METHODS

The study population consisted of 11- to 14-year-old children from Medak District in Telangana State, India. The Indian Academy of Paediatrics 2015 growth charts were used to categorise children as underweight, overweight, normal or obese, based on their BMI. Data on the SES of the family were collected through questionnaires. Clinical examination for dental caries was performed by a single examiner.

RESULTS

A total of 1,092 subjects returned questionnaires and were clinically examined (giving a response rate of 85%). There were no significant differences in caries prevalence and experience across the categories of BMI. However, caries prevalence and experience in overweight children were 24.8% and 0.69 ± 1.51, respectively, while the corresponding values in normal-weight children were 35% and 0.85 ± 1.50, respectively. Among children of high-SES families, overweight children had approximately 71% fewer caries than did those who were normal weight [incidence rate ratio (IRR) = 0.29; 95% CI: 0.11-0.78)].

CONCLUSIONS

BMI was not associated with dental caries prevalence and experience in this population. The association of BMI with dental caries varied across SES categories. In the high-SES category, overweight children experienced fewer caries than did normal-weight children.

The short-term effects of television advertisements of cariogenic foods on children's dietary choices

OBJECTIVE

To investigate the short-term influence of the advertising of cariogenic foods on children's dietary preferences, and the possible moderating effect of several factors on this influence.

METHODS

One-hundred and eighty-three children, 11-12 years of age, were exposed to advertisements showing sugary food and non-food items, in a within-subject counterbalanced design. Their preferences for unhealthy and healthy foods, and their ability to recall or recognise the advertisements, were measured following both sessions. Information on their dietary habits, leisure activities and sociodemographic details were obtained through a questionnaire completed by their parents. Their decayed, missing and filled teeth (DMFT) index, body weight and height were also recorded. A generalised linear mixed model was used to examine the differences in food preferences between experimental conditions, and the associations between children's preferences and the other factors assessed.

RESULTS

Exposure to food advertisements significantly decreased the selection of healthy foods. Children with a higher DMFT index chose a higher percentage of unhealthy foods, and children who spent more time watching television chose an increased number of healthy foods, after their exposure to food advertisements. Regardless of condition, girls selected fewer foods than boys. Children with a higher DMFT index selected more unhealthy foods than children with a lower DMFT index. Obese children chose an increased number of healthy foods than those who were overweight and normal weight.

CONCLUSIONS

Food advertisements can divert, for a short time, children's preference over healthy food choices, and could lead to changes in their eating habits, which may put them at higher risk of dental diseases and obesity.

Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10-12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach

BACKGROUND

The aim of this study was to assess the associations between nutrition and dental caries in permanent dentition among schoolchildren.

METHODS

A cross-sectional survey was undertaken on 698 schoolchildren aged 10 to 12 yr from a random sample of primary schools in Kermanshah, western Iran, in 2014. The study was based on the data obtained from the questionnaire containing information on nutritional habits and the outcome of decayed/missing/filled teeth (DMFT) index. The association between predictors and dental caries was modeled using the Zero Inflated Generalized Poisson (ZIGP) regression model.

RESULTS

Fourteen percent of the children were caries free. The model was shown that in female children, the odds of being in a caries susceptible sub-group was 1.23 (95% CI: 1.08-1.51) times more likely than boys (P=0.041). Additionally, mean caries count in children who consumed the fizzy soft beverages and sweet biscuits more than once daily was 1.41 (95% CI: 1.19-1.63) and 1.27 (95% CI: 1.18-1.37) times more than children that were in category of less than 3 times a week or never, respectively.

CONCLUSIONS

Girls were at a higher risk of caries than boys were. Since our study showed that nutritional status may have significant effect on caries in permanent teeth, we recommend that health promotion activities in school should be emphasized on healthful eating practices; especially limiting beverages containing sugar to only occasionally between meals.

Dental Health Status of HIV-Positive Patients and Related Variables in Southeast Iran

Background

Different factors can be responsible for the increased prevalence of dental caries and missing teeth in HIV-positive patients.

Objectives

This study evaluates dental health status and its relationship with social, behavioral, and medical factors in HIV-positive patients under the coverage of Zahedan University of Medical Sciences in Southeast Iran.

Patients and Methods

In a cross-sectional study, the dental health status of 119 HIV-positive patients was assessed in accordance with WHO indices and included decayed, missing, and filled teeth (DMFT). A questionnaire on different social, behavioral, and medical variables was filled out for every case and the relationship and correlation of the variables to dental health status were investigated using One-way ANOVA, the Kruskal Wallis test, the t-test, the Mann-Whitney test, Spearman’s rho correlation coefficient, and Pearson correlation.

Results

The mean value of DMFT index was 11.87 ± 8.08, where the mean values of decayed and missing teeth were 8.42 ± 5.44 and 3.43 ± 4.07, respectively. DMFT index, decayed, and missing teeth correlated only with age (P < 0.0001, P = 0.009, P < 0.0001) and duration of HIV involvement (P = 0.004, P = 0.031, P = 0.007).

Conclusions

The dental health status of HIV-positive patients in this region was almost inappropriate. Most social, behavioral, and medical factors had no influence on dental health; only a correlation between dental health, age, and duration of HIV involvement was observed.

Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review

Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. The recommendations presented represent a comprehensive review of current evidence as well as expert opinion. The goal of this review is to highlight the importance of conducting a targeted physical examination during pediatric weight management visits.

Re-Examining the Association between Vitamin D and Childhood Caries

Background

Previous studies have reported an inverse association between vitamin D and childhood dental caries, but whether this is causal is unclear.

Objective

To determine the causal effect of circulating 25-hydroxyvitamin D concentration on dental caries experience, early caries onset and the requirement for a dental general anesthetic.

Design

A Mendelian randomization study was undertaken, using genetic variants known to be associated with circulating 25-hydroxyvitamin D concentrations in 5,545 European origin children from the South West of England. Data on caries and related characteristics were obtained from parental and child completed questionnaires between 38 and 91 months and clinical assessments in a random 10% sample at 31, 44 and 61 months.

Results

In multivariable confounder adjusted analyses no strong evidence for an association of 25-hydroxyvitamin D with caries experience or severity was found but there was evidence for an association with early caries onset, or having a general anesthetic for dental problems. In Mendelian randomization analysis the odds ratio for caries experience per 10 nmol/L increase in 25-hydroxyvitamin D was 0.93 (95% confidence interval: 0.83, 1.05; P = 0.26) and the odds ratio for dental general anaesthetic per 10 nmol/L increase in 25-hydroxyvitamin D was 0.96 (95% confidence interval: 0.75, 1.22; P = 0.72).

Conclusions

This Mendelian randomization study provides little evidence to support an inverse causal effect of 25-hydroxyvitamin D on dental caries. However, the estimates are imprecise and a larger study is required to refine these analyses.

Weighing in on pediatric obesity: Weight screening at the dental visit

BACKGROUND AND OVERVIEW

Pediatric obesity is a public health concern requiring an interprofessional approach to care. Weight screening in the dental office can promote healthy behaviors to improve weight and oral health status and reduce systemic and oral health risks.

CONCLUSIONS

Oral health care professionals can perform weight screenings quickly. Routine weight screening of pediatric patients and early intervention through education and referral of patients to a registered dietitian nutritionist and a physician for more in-depth evaluation may help reduce disease risk.

PRACTICAL IMPLICATIONS

Oral health care professionals can measure a patient's height and weight and can easily calculate body mass index percentile according to a patient's age and sex to detect weight status that does not fall within the normal range. Oral health care professionals should refer patients who are underweight, overweight, or obese to a registered dietitian nutritionist and the patient's physician for follow-up.

Comparing caries risk profiles between 5- and 10- year-old children with cleft lip and/or palate and non-cleft controls

BACKGROUND

Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model.

METHODS

The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the child's oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low".

RESULTS

Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p < 0.05) and displayed less good oral hygiene (p < 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67% but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95% CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk.

CONCLUSION

Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.

Are overweight/obese children at risk of traumatic dental injuries? A meta-analysis of observational studies

BACKGROUND/AIM

Observational studies which investigated the association between overweight/obesity and traumatic dental injuries (TDI) reported contrasting results. Thus, this meta-analysis was designed to investigate such an association with the highest possible levels of internal and external validities.

MATERIAL AND METHODS

A comprehensive literature search was performed through PubMed, ISI Web of Science, Cochrane Library, Scopus, Google scholar to ensure generalizability. Eligible studies reported clear case and control definitions, exposure assessment. Where possible, odds ratio (OR) adjusted for covariates was extracted. Study quality was assessed through Newcastle-Ottawa Scale (NOS). Only fair-to-good quality studies with NOS scores ≥4 were selected. The method to assess the pooled OR was based on the level of between-study heterogeneity, estimated through the Cochran's Q. Reliability of the pooled OR was improved by controlling for publication bias, sensitivity analysis to study inclusion, and subgroup analyses according to tooth type (permanent vs primary teeth) and country where the study was performed (Brazilian studies vs studies from other countries).

RESULTS

Seventeen studies were selected from America, Asia, and Europe, their NOS scores ranged between 4 and 8. Overall, there were almost 28,000 patients, 7400 of them with TDI. The level of publication bias was minimal, and no adjustment was necessary. Between-study heterogeneity was high, and the random-effects method was used to assess the pooled OR, which resulted 1.30 (95% confidence interval, 1.11-1.53; P < 0.05). Sensitivity and subgroup analyses corroborated this estimate.

CONCLUSION

The choice to increase internal and external validity levels decreased the precision of the pooled OR (i.e., confidence intervals were relatively wide). The statistically significant overweight/obesity-TDI association, together with the so-called counterfactual condition (i.e., TDI prevalence was higher among overweight/obese children than among lean children), suggests that causal association between these two conditions is plausible.

A systematic map of systematic reviews in pediatric dentistry--what do we really know?

OBJECTIVES

To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry.

METHODS

A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps.

RESULTS

Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low.

CONCLUSION

There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.

Anthropometric measurements and dental caries in children: a systematic review of longitudinal studies

There is growing interest in the association between anthropometric measurements and dental caries in childhood over time (life-course studies). The aim of this review was to identify and systematically review the evidence of the association between anthropometric measurements and dental caries in childhood over time. PubMed, Institute for Scientific Information (ISI) Web of Knowledge, the Cochrane Library, and 6 other databases were searched to identify effective articles. A systematic approach involving critical appraisal was conducted to examine the relation between anthropometric measurements and dental caries in preschool- and school-aged populations from longitudinal studies. An initial search identified 1338 studies, with 59 potentially effective studies (κ = 0.82) and 17 effective studies (κ = 0.88). The quality of reporting among the studies ranged from 19.5 to 30.0 according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) criteria. Among the effective studies, 2 studies in which caries was used to predict anthropometric measurements consistently found an inverse association and 15 studies in which anthropometric measurements were used to predict caries were inconsistent, with results appearing to be influenced by nonuniformity of assessments, setting, and procedure of measurements; age and ethnicity of participants; and confounders of dental caries. In conclusion, among >1000 studies identified, 17 informed this systematic review. The quality of reporting of these studies varied considerably. Evidence of the association between anthropometric measurements and dental caries is conflicting and remains inconclusive.

Sociobehavioral factors associated with caries increment: a longitudinal study from 24 to 36 months old children in Thailand

The aim of this study is to investigate sociobehavioral risk factors from the prenatal period until 36 months of age, and the caries increment from 24 to 36 months of the child in Thailand. The data utilized in this study come from the prospective cohort study of Thai children (PCTC) from prenatal to 36 months of the child in Mueang Nan district, Northern Thailand. The total sample size recruited was 783 infants. The sample size with dental caries data was 603 and 597, at 24 months and at 36 months, respectively. The sample size of having two assessment points with a dental examination (at 24 months and at 36 months) was 597. Results indicate that the caries increment was 52.9%, meaning from 365 caries free children at 24 months 193 had developed dental caries at 36 months. The prevalence of dental caries was 34.2% at 24 months (n = 206) and 68.5% at 36 months of age (n = 409). In bivariate analysis, higher education of the mother, lower household income, bottle feeding of the infant, frequent sweet candy consumptions, and using rain or well water as drinking water were associated with dental caries increment, while in multivariate conditional logistic regression analysis lower household income, higher education of the mother, and using rain or well water as drinking water remained associated with dental caries increment. In conclusion, a very significant increase in caries development was observed, and oral health may be influenced by sociobehavioural risk factors.

Dental caries and growth in school-age children

BACKGROUND AND OBJECTIVE

Dental caries in young children is commonly untreated and represents a public health problem. Dental caries in children is reported to affect their anthropometric outcomes, but the evidence is conflicting. Some studies found no association, whereas others found that caries was associated with underweight or overweight. The objective was to assess the relationship between dental caries status and height and weight in 6- to 8-year-old Saudi children with high caries prevalence.

METHODS

This study was a cross-sectional survey in schoolchildren aged 6 to 8 years attending military primary schools in Jeddah, Saudi Arabia. Caries status was assessed by using the dmft (decayed, missing, filled, teeth [primary teeth]) index. Height and weight were assessed by using z scores of height-for-age (HAZ), weight-for-age (WAZ), and BMI-for-age (BAZ) calculated by World Health Organization standardized procedures. Relationships between caries and HAZ, WAZ, and BAZ were assessed by using regression models.

RESULTS

A total of 417 of the 436 eligible schoolchildren with complete data were included, with a response rate of 95.6%. Their mean dmft index was 5.7 ± 4.2. There was an inverse linear relationship between caries status and children's HAZ, WAZ, and BAZ and significantly lower anthropometric outcomes for children at each consecutive group with higher levels of caries. The associations remained significant after adjusting for dental, social, and demographic variables.

CONCLUSIONS

The inverse linear association between dental caries and all anthropometric outcomes suggests that higher levels of untreated caries are associated with poorer growth in Saudi schoolchildren.

Correlation between dental caries and nutritional status: preschool children in a Brazilian municipality

INTRODUCTION: Dental caries and nutritional status in children in preschool age are serious public health problems, with multifactorial etiology, with diet as a common risk factor. OBJECTIVE: This cross-sectional study assessed the relationship between dental caries and nutritional status of preschool children attending public schools in a city in the State of Sao Paulo. MATERIAL AND METHOD: The study population was comprised of 3-5 year-old preschool children (n = 229) attending public schools, in which dmft (decay, missing, filled, teeth) was used for dental caries assessment and Body Mass Index (BMI) was used for nutritional status in accordance with the recommendations of the World Health Organization. Statistical analysis was performed in a descriptive way through absolute and relative frequencies and Spearman Correlation test and Kruskal Wallis (P<0.05). RESULT: A dmft of 1.65 (2.87) and a SiC index (Significant Caries Index) of 4.88 (3.20) have been found, indicating polarization of dental caries. It was observed that 66.81% of children presented with nutritional status within the normal range and children with malnutrition had a mean dmft of 4.0 (3.66), which is two times higher than the other categories of nutritional status. No statistically significant correlation has been found by correlating dmft and components with Body Mass Index. CONCLUSION: This research did not identify a significant correlation between the occurrence of dental caries and nutritional status of preschool children, researches should be conducted to elucidate this relationship.