A longitudinal study of the relationship between dental caries and obesity in late childhood and adolescence

Burden of oral diseases predicts development of excess weight in early adolescence: a 2-year longitudinal study

Dental caries, gingivitis, and excess weight are highly prevalent, interconnected chronic conditions. The association of oral health with the development of adiposity among children is sparsely addressed. We examined the association of oral health to the development of excess weight and central obesity in early adolescence during a 2-year follow-up period. This prospective study was conducted with 2702 children aged 9-12 years at baseline from the Finnish Health in Teens study. Their weight development was followed up for 2 years. Body mass index with age- and sex-specific cut-offs and the waist-height ratio indicated weight status and central obesity. Oral health data (caries experience and gingivitis/calculus) were collected from outpatient records of public dental services. Having both caries experience and gingivitis/calculus was considered burden of oral diseases. Of the sample, 74% were caries-free but 70% exhibited gingivitis and/or calculus, and 20% had both caries experience and gingivitis/calculus. During the follow-up period, 5.3% (n = 124) and 4.7% (n = 118) of the children became overweight/obese or centrally obese, respectively. Having both caries experience and gingivitis/calculus associated with the development of excess weight in a fully adjusted model (HR 1.75, 95% CI 1.03-2.97) but not of central obesity. Caries experience or gingivitis/calculus alone did not associate with adiposity development.

CONCLUSION

Having burden of oral diseases without excess weight at early adolescence could imply future weight gain; thus, normal-weight individuals with both caries experience and gingivitis/calculus could be targeted with preventive measures. Our findings warrant further research to explore whether oral diseases and the development of obesity merely share risk factors or if their relationship is of causal nature.

WHAT IS KNOWN

• Association of excess weight with caries experience and gingivitis is known to exist both cross-sectionally and longitudinally in children and adolescents.

WHAT IS NEW

• Burden of oral diseases, that is, having both caries experience and gingivitis/calculus, was associated with becoming overweight or obese 2 years later during early adolescence. • Normal-weight individuals with burden of oral diseases at early adolescence could be targeted with preventive measures against excess weight gain.

Prevalence of Obesity and Dental Caries in High School Adolescents during the First Decade of Saudi Vision 2030: A Cross-Sectional Study

Saudi Vision 2030 was launched in 2016. Obesity and dental caries are both highly prevalent in Saudi adolescents and have been targeted by the Vision's health initiatives. The aim is to assess their prevalence in adolescents during the first decade since the launch of the Vision. This cross-sectional study was conducted in Jeddah, Saudi Arabia using a stratified sample of 571 high school students, with an average age of 16.7 (0.6). Their height and weight were measured, and their body mass index (BMI) was calculated. The decayed, missed, and filled scores (DMFTs) were recorded after an oral examination. Non-parametric tests were used to assess the associations of DMFT with BMI, sex, and school type; and its predictors were assessed. One-third of males were overweight/obese compared with 22% of females. Males exhibited higher DMFTs than females. DMFTs were higher among public school students than among their private school counterparts. No significant association was observed between DMFT and BMI. Sex and school type were significant predictors of DMFT. The prevalence of obesity has slowly decreased in adolescents, but the prevalence of dental caries has not. There was no significant relationship between these conditions. Saudi Vision 2030's current preventive/educational initiatives may be more effective in combating obesity than dental caries.

Childhood dental caries and obesity: Opportunities for interdisciplinary approaches to prevention

Dental caries and obesity are prevalent and preventable chronic childhood diseases. Evidence shows a strong connection between these two diseases, with overlapping common risk factors, including diet as a key driver of risk. Dental professionals are well-positioned to perform nutritional counseling and obesity prevention in dental clinic settings, but training and clinical integration remain key challenges. This paper highlights the potential for leveraging the common risk factor approach (CRFA) framework and its principles to reduce the impact of childhood dental caries and obesity. Strategies and methods are provided to integrate meaningful didactic and clinical training experiences in dental academia, and the need to include effective and evidence-based nutritional counseling techniques in dental settings is also described. Additionally, the potential for integrating CRFA and engaging health care providers across the spectrum of care, including primary care settings, to reduce the prevalence of these diseases in pediatric populations is highlighted. Finally, the authors propose future directions for multidisciplinary research to advance the scientific knowledge in this area and to inform effective and comprehensive interventions for dental settings.

Systems mapping of multilevel factors contributing to dental caries in adolescents

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.

Conclusions

Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.

Childhood caries is associated with poor health and a faster pace of aging by midlife

OBJECTIVES

Childhood caries is associated with poorer self-rated general health in adulthood, but it remains unclear whether that holds for physical health and aging. The aim of this study was to identify whether age-5 caries is associated with (a) biomarkers for poor physical health, and (b) the pace of aging (PoA) by age 45 years.

METHODS

Participants are members of the Dunedin Multidisciplinary Health and Development Study birth cohort. At age 45, 94.1% (n = 938) of those still alive took part. Data on age-5 caries experience and age-45 health biomarkers were collected. The PoA captures age-related decline across the cardiovascular, metabolic, renal, immune, dental and pulmonary systems from age 26 to 45 years. We used (a) generalized estimating equations to examine associations between age-5 caries and poor physical health by age 45 years, and (b) ordinary least squares regression to examine whether age-5 caries was associated with the PoA. Analyses adjusted for sex, perinatal health, childhood SES and childhood IQ.

RESULTS

High caries experience at age-5 was associated with higher risk for some metabolic abnormalities, including BMI ≥30, high waist circumference, and high serum leptin. Those with high caries experience at age-5 were aging at a faster rate by age 45 years than those who had been caries-free.

CONCLUSIONS

Oral health is essential for wellbeing. Poor oral health can be an early signal of a trajectory towards poor health in adulthood. Management for both conditions should be better-integrated; and integrated population-level prevention strategies should be foundational to any health system.

Associations between dental caries and systemic diseases: a scoping review

BACKGROUND

The objective of this study was to evaluate and present evidence from animal and human clinical studies on associations between dental caries and systemic diseases, and to suggest potential mechanisms that might explain such associations.

METHODS

An electronic search was conducted of PubMed, Embase and Cochrane Central Register of Controlled Trials for articles published from 2010 to 2020 in the English language. From the initial search, 404 full-text studies were assessed for eligibility. After excluding studies for technical and study limitations, a total of 67 studies were included in the summary tables and additional studies were included in the review to support evidence.

RESULTS

Few systemic disease and conditions were found to be clinically meaningfully associated with caries experience. Best evidence from human and animal studies described association between metabolic diseases and dental caries. Several interesting animal studies were noted that could generate clinical hypotheses and further investigations in rodent models for cardiovascular injury and hyperglycemia. Inadequate data was found to suggest any modifications to current clinical practice or prevention guidelines.

CONCLUSIONS

Limited clinical evidence was found connecting several systemic diseases and dental caries. Inadequate data was found to suggest any modifications to current clinical practice or prevention guidelines.

CLINICAL SIGNIFICANCE

Understanding of associations between dental caries and systemic diseases play a crucial role in the treatment planning and education of the dental patient.

Association of Body Mass Index and Waist Circumference With Dental Caries and Consequences of Untreated Dental Caries Among 12- to 14-Year-old Boys: A Cross-Sectional Study

OBJECTIVE

To evaluate the association between body mass index (BMI) and waist circumference (WC) and dental caries (DC), and the clinical consequences of untreated dental caries (U-DC) among 12- to 14-year-old male public-school adolescents in the Northern Province, Saudi Arabia.

METHODS

The demographic and anthropometric measurements of 302 boys 12 to 14 years of age (mean: 12.5 years) were recorded. BMI and central obesity (based on WC) were measured. The decayed-missing-filled teeth (DMFT) index was used to record DC. The pulp involvement, ulceration, fistula, abscess (PUFA) index was used to quantify the clinical consequences of U-DC. Multiple logistic regression analysis was performed to evaluate the risk factors related to DC and clinical consequences of U-DC.

RESULTS

A high prevalence of DC was found in adolescents who were underweight according to BMI and nonobese based on WC (46.7% vs 34.5%). The association between underweight (BMI) and obese (WC) with DC (odds ratio [95% CI]) was 1.91 (0.87, 4.18) and 0.34 (0.18, 0.63), respectively, while with PUFA (adjusted odds ratio [AOR]; 95%CI), it was 1.76 (0.76, 4.09) and 0.19 (0.06, 0.63) respectively. The logistic regression model showed that consuming sugar more than once a day led to a 2.87-fold greater likelihood of DC (AOR [95% CI] = 2.87 [1.68, 4.88]) and a 3.91-fold greater likelihood of mean PUFA score (AOR [95% CI] = 3.91 [2.05, 7.44].

CONCLUSION

High risks for DC and clinical consequences of U-DC were observed among underweight and nonobese adolescent males. The frequency of sugar consumption was significantly associated with both conditions.

Childhood obesity and dental caries: an ecological investigation of the shape and moderators of the association

BACKGROUND

Despite sharing a common risk factor in dietary sugars, the association between obesity and dental caries remains unclear. We investigated the association between obesity and dental caries in young children in England in an ecological study.

METHODS

We analysed data from 326 lower tier English local authorities. Data on obesity and dental caries were retrieved from 2014/15 to 2016/17 National Child Measurement Programme and 2016/17 National Dental Epidemiology Programme. We used fractional polynomial models to explore the shape of the association between obesity and dental caries. We also examined the modifying effect of deprivation, lone parenthood, ethnicity, and fluoridation.

RESULTS

Best fitting second order fractional polynomial models did not provide better fit than the linear models for the association between obesity and prevalence and severity of dental caries; therefore, the linear model was found suitable. Despite significant association, after adjusting for the effect of deprivation, obesity was neither associated with prevalence (coefficient = 0.2, 95% CI - 0.71, 0.75), nor with severity (coefficient = 0.001, 95% CI - 0.03, 0.03) of dental caries. In fully adjusted models, the proportion of white ethnicity and being in fluoridated areas were associated with a decrease in dental caries. The association between obesity and dental caries was moderated by the effect of deprivation, white ethnicity, and lone parenthood.

CONCLUSIONS

The association between obesity and dental caries was linear and moderated by some demographic factors. Consequently, interventions that reduce obesity and dental caries may have a greater impact on specific groups of the population.

The association between nutritional status and dental caries in low-income children: A multilevel analysis

BACKGROUND

The possible association between obesity, underweight, and dental caries remains in debate. In addition, the role of sugar consumption on the abovementioned relationship was little explored.

AIM

This study aimed to investigate the relationship between nutritional status and dental caries in 12-year-old low-income children.

DESIGN

This cross-sectional school-based study involved 406 12-year-old children living with limited economic resources. Dental caries was assessed using the decayed component of DMFT and PUFA/pufa index. Children were weighed and measured to assess nutritional status according to z-score/body mass index. Data on socio-economic and demographic characteristics, sugar consumption, sedentary behaviour, and psychosocial factors were collected through validated questionnaires. Multivariable multilevel Poisson regression was performed.

RESULTS

Underweight children had 60% (RR = 1.60; 95% CI 1.13-2.57) higher mean of decayed teeth and had mean PUFA/pufa 2.8 times higher than children with normal nutritional status. Underweight children with high annual sugar intake had a greater mean of decayed teeth (RR = 2.72; 95% CI 1.46-5.06) than underweight children with low sugar intake.

CONCLUSIONS

Our findings suggest that malnutrition is associated with dental caries among children from low-income families.

Severe dental caries is associated with incidence of thinness and overweight among preschool Chinese children

Objective: To examine the association of incidence and baseline prevalence of severe dental caries with incidences of thinness and overweight among pre-school Chinese children.Materials and methods: A longitudinal study design was used. A total of 772 children recruited from 15 kindergartens in Liaoning Province who completed baseline and follow-up assessments were included. The age range of children at baseline was 24.6-71.1 months. BMI-for-age z-score was calculated to estimate incidence of thinness and overweight. Severe dental caries was indicated by pulpal involvement, ulceration, fistula or abscess (pufa). Baseline prevalence of severe caries included children with pufa ≥1, incidence included those who changed from pufa = 0 to ≥1 at follow-up. Logistic regression was constructed to assess the association of baseline prevalence and incidence of severe caries with each of incidence thinness and overweight.Results: Children with incidence of severe caries had higher odds for incidence thinness (OR: 4.08; 95% CI: 1.08, 15.41). Baseline prevalence of severe caries was not significantly associated with incidence thinness. Participants with severe caries at baseline had higher odds for incidence overweight (OR: 2.33; 95% CI: 1.17, 4.63). The relationship between incidence of severe caries and incidence overweight was insignificant.Conclusions: The findings suggest a U-shaped relationship between severe dental caries and both ends of anthropometric measures among pre-school Chinese children. The findings highlight the importance of integrating oral and general health promotion policies. Primary health care providers are encouraged to incorporate dental screening, counselling and referral for treatment for severe caries to promote appropriate growth and overall health of children.

Overweight/obese children are associated with lower caries experience than normal-weight children/adolescents

AIM

To compare (a) enamel carious (EC) and dentin carious (DC) lesions and (b) caries risk, between normal-weight (NW) and overweight/obese (OW) children/adolescents.

DESIGN

In this cross-sectional study, 91 participants aged 6-12 years were classified according to the body mass index (BMI): NW (n = 50) and OW (n = 41). Caries experience was evaluated using the International Caries Detection and Assessment System (ICDAS) with two thresholds: "EC/DC" (ICDAS 1-3/4-6) and "DC" (ICDAS 4-6). Caries risk was determined by the Caries Management by Risk Assessment (CAMBRA) system. A logistic regression analysis was performed to determine the association among OW, caries thresholds, and caries risk.

RESULTS

Caries experience was similar for both groups at the "EC/DC" threshold (P = .477) and higher for the NW group at the "DC" threshold (P = .009). For CAMBRA, caries risk classification was similar for both groups (P = .082). The logistic regression showed the OW group was less likely to exhibit radiographically visible proximal carious lesions (odds ratio [OR] of 0.330, P = .019), thick biofilm visible on the tooth surface (OR = 0.360, P = .019), high caries risk (OR = 0.367, P = .039), and moderate-to-high caries levels (OR = 0.190, P = .022).

CONCLUSION

OW children/adolescents had lower caries experience, at both ICDAS thresholds, and lower caries risk, compared to NW children/adolescents.

Are dental caries and overweight/obesity interrelated? A cross-sectional study in rural and urban preschool children

BACKGROUND

Obesity and dental caries are two distinct diseases which are somewhat preventable through a common risk factor approach, as they have common underlying etiological factor, i.e., high sugar intake.

AIM

The aim of the study is to examine the correlation between dental caries and body mass index (BMI) in rural and urban areas of Hisar (Haryana, India) and intercompare their correlations.

SETTINGS AND DESIGN

This was a cross-sectional study in rural and urban preschool children of Hisar, Haryana.

METHODS

A total of 500 urban and 500 rural children (age group 3-6 years) were selected from schools of Hisar and the values of their mean BMI and mean decayed, missing, and filled teeth (dmft) (using the World Health Organization criteria, 2005) were compared using independent sample t-test among different groups and subgroups. Pearson correlation coefficients between dmft and BMI were calculated for groups and subgroups and intercompared.

RESULTS

Males had significantly higher BMI than females (P < 0.05) and urban preschool children had significantly higher BMI than rural preschool children (P < 0.05). Mean deft was statistically non-significant across the genders and both geographical areas. Non-significant negative correlation was observed between dmft and BMI across different areas and genders. The overall prevalence of obesity/overweight was 20.2% (25.6% urban preschool children; 14.8% rural preschool children). More rural preschool children were underweight (23.8%) than urban preschool children (14.4%) with the overall prevalence of underweight being 19.1%.

CONCLUSIONS

There was no significant correlation between dental caries and BMI in preschool children of rural and urban areas. Obesity/overweight was more prevalent in urban preschool children, whereas rural preschool children predominantly were underweight.