Obesity and dental caries in early childhood: A systematic review and meta-analyses

Trajectories of Sugar-Sweetened Beverage Intake in Early Life: Evidence from a Birth Cohort Study

Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children's SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.

Obesity/overweight and dental caries experience in children and adolescents: an umbrella review

PURPOSE

The present umbrella review aimed to synthesize and critically assess the methodological and reporting quality of previous systematic reviews about the potential relationship between obesity or overweight and caries dental experience in pediatric patients.

METHOD

Electronic database and manual searches were conducted in PubMed, Embase, and Cochrane Library up to July 2023. The risk of bias assessment of eligible systematic reviews was performed using the Risk Of Bias In Systematic reviews (ROBIS) tool. A systematization of the results was carried out in order to understand the possible relationship between the two conditions.

RESULTS

Electronic and manual searches identified 136 titles and abstracts. After the removal of duplicates, 15 full-text articles were assessed for eligibility. Six studies were excluded, resulting in 8 systematic reviews and 1 scoping review that met the inclusion criteria. Five were systematic reviews without meta-analysis and the rest were conducted with quantitative analysis.

CONCLUSION

Conflicting findings to date from this umbrella review suggest that the relationship between obesity and dental caries in children is still inconclusive and likely to be complex.

Prevalence of obesity and associated sociodemographic and lifestyle factors in Ecuadorian children and adolescents

BACKGROUND

Given the increasing prevalence of obesity in young people in Ecuador, there is a need to understand the factors associated with this condition. The aim of this study was to assess the prevalence of obesity in Ecuadorian children and adolescents aged 5-17 years and identify its associated sociodemographic and lifestyle factors.

METHODS

This cross-sectional study was conducted using data from the Encuesta Nacional de Salud y Nutrición (ENSANUT-2018). The final sample consisted of 11,980 participants who provided full information on the variables of interest.

RESULTS

The prevalence of obesity was 12.7%. A lower odd of having obesity was observed for adolescents; for those with a breadwinner with an educational level in middle/high school or higher; for each additional day with 60 or more minutes of daily moderate-to-vigorous physical activity; and for those with greater daily vegetable consumption (one, two, or three or more servings). Conversely, there were greater odds of obesity in participants from families with medium, poor, and very poor wealth and those from the coast and insular region.

CONCLUSIONS

The high prevalence of obesity in Ecuadorian children and adolescents is a public health concern. Sociodemographic and lifestyle behavior differences in young people with obesity should be considered when developing specific interventions.

IMPACT

As the prevalence of obesity among children and adolescents increases in Latin America, with a particular focus on Ecuador, it becomes crucial to delve into the factors linked to this condition and identify the most successful strategies for its mitigation. The elevated prevalence of obesity among young individuals in Ecuador raises significant public health concerns. To develop targeted interventions, it is crucial to account for sociodemographic variables and lifestyle behaviors that contribute to obesity in this population.

Secular trends of dental caries and association with nutritional status: a retrospective analysis of 16,199 Chinese students from three successive national surveys from 2010 to 2019

Introduction

The prevalence of dental caries (DC) among students in developing countries has increased at an alarming rate, and nutritional status has been shown to be associated with DC in children and adolescents with inconsistent conclusions. We aimed to understand the trends of DC prevalence in students aged 7, 9, 12, and 14 years and to explore the relationship between DC prevalence and nutritional status.

Methods

We recruited 16,199 students aged 7, 9, 12, and 14 years in China by multi-stage, stratified, random sampling methods from 2010 to 2019. Permanent caries were measured using the Decay, Loss, and Filling (DMF) index and prevalence rate. Deciduous caries were measured using the decay, loss, and filling (dmf) index and prevalence rate. Nutritional status was assessed using body mass index (BMI) and hemoglobin levels. Logistic regression analysis was used to assess the association between nutritional status and the DC prevalence in children and adolescents, incorporating information concerning family-related factors.

Results

The results indicated that DC prevalence increased from 39.75% in 2010 to 53.21% in 2019 in Henan province, with deciduous teeth and permanent teeth being 45.96 and 27.18%, respectively, in 2019. The total caries rate decreased with age (p < 0.05), and the caries rate of girls was higher than that of boys in 2019 (55.75% vs. 50.67%) (p < 0.001). The prevalence of dental caries among primary and secondary school students in areas with medium economic aggregate was the highest, followed by cities with the best economic development level, and cities with low economic levels have a lower prevalence of dental caries. The dental caries prevalence was negatively correlated with body mass index. In the fully adjusted model, underweight children had a higher caries prevalence (OR = 1.10, 95%CI: 0.86-1.41). Children with anemia had a higher prevalence of dental caries (OR = 1.18, 95%CI: 0.98-1.42).

Conclusion

The DC prevalence of students in Henan Province was high, with a tendency to increase. Females, young individuals, and those with a higher economic level showed a positive correlation with the prevalence of caries. In the process of economic development, particular attention should be paid to early childhood caries prevention. Nutritional status should be taken seriously among children and adolescents, and the oral health system should be improved to keep pace with economic development.

Association between more complex special care needs and overweight status and adolescents' difficulty with dental caries

OBJECTIVE

Little is known about dental caries experience in adolescents with overweight and complex special health care needs (SHCNs).

METHODS

Adolescent data (10-17 years) from the 2016-2020 National Survey of Children's Health (n = 91,196) was analyzed. The sample was grouped into the following: more complex SHCN and overweight, more complex SHCN without overweight, less complex SHCN and overweight, less complex SHCN without overweight, no SHCN but with overweight, and neither SHCN nor overweight. A multivariable-adjusted logistic regression model was conducted.

RESULTS

Adolescents with more complex SHCNs with (OR: 1.82, 95% CI: 1.44-2.30, p < 0.001) or without overweight (OR: 1.51, 95% CI: 1.30-1.76, p < 0.001) were at higher odds of experiencing dental caries compared to healthy adolescents. No significant associations were observed between adolescents with less complex or no SHCN regardless of the overweight status with healthy adolescents.

CONCLUSIONS

Adolescents with more complex SHCNs, irrespective of overweight status, experienced a higher caries severity than adolescents with no SHCNs or overweight.

Intake and serum levels of micronutrients and chronic oral diseases burden

OBJECTIVE

To investigate pathways from micronutrient intake and serum levels to Chronic Oral Diseases Burden.

METHODS

We analyzed cross-sectional data from NHANES III (n = 7936) and NHANES 2011-2014 (n = 4929). The exposure was the intake and serum levels of vitamin D, calcium, and phosphorus. Considering the high correlation of those micronutrients in the diet, they were analyzed as a latent variable dubbed Micronutrient intake. The outcome was the Chronic Oral Diseases Burden, a latent variable formed by probing pocket depth, clinical attachment loss, furcation involvement, caries, and missing teeth. Pathways triggered by gender, age, socioeconomic status, obesity, smoking, and alcohol were also estimated using structural equation modeling.

RESULTS

In both NHANES cycles, micronutrient intake (p-value < 0.05) and vitamin D serum (p-value < 0.05) were associated with a lower Chronic Oral Diseases Burden. Micronutrient intake reduced the Chronic Oral Diseases Burden via vitamin D serum (p-value < 0.05). Obesity increased the Chronic Oral Diseases Burden by reducing vitamin D serum (p-value < 0.05).

CONCLUSION

Higher micronutrient intake and higher vitamin D serum levels seem to reduce Chronic Oral Diseases Burden. Healthy diet policies may jointly tackle caries, periodontitis, obesity, and other non-communicable diseases.

Healthy Life Habits in Caregivers of Children in Vulnerable Populations: A Cluster Analysis

Intervention programs aimed at mitigating the effects of chronic noncommunicable disease (CNDs) focus on promoting healthy lifestyle habits (HLH), especially in the early stages of life. Because of this, different typologies of caregivers have been identified according to HLH during middle childhood and adolescence. However, the available studies have focused on aspects such as nutrition, physical activity, and rest, ignoring other HLHs that are equally important for children's well-being. Likewise, few studies address HLH during the first five years of life and how caregivers affect children's health. In a sample of 544 caregivers of children aged zero to five years from low-income Colombian communities, we established a typology of attitudes toward different HLHs. The results indicate the presence of three clusters that grouped caregivers with (1) positive attitudes toward all HLHs, (2) toward some HLHs, and (3) relatively low positive attitudes toward all HLHs. Membership in clusters with less positive attitudes toward HLHs was also found to be associated with low educational levels and living in rural areas. This study detected profiles of caregivers who may have unhealthy lifestyles, so the results would allow social workers to design differential interventions on HLHs in non-industrialized countries.

Descriptive study of the oral health status of disadvantaged mexican populations in relation to their adherence to the mediterranean diet

BACKGROUND

Obesity in Mexico is an alarming problem that has been increasing in recent decades. Dietary factors make this pathology more common at younger ages and closely related to oral health. This study attempts to investigate the association between the oral health status of a Mexican population in the state of Yucatan and their dietary habits.

OBJECTIVE

This study explores the relationship between oral health-related quality of life and adherence to the Mediterranean diet in a disadvantaged population in the state of Yucatan, Mexico.

METHODS

The research was conducted in July 2023 in Merida, Yucatan (Mexico). The sample consisted of 109 individuals aged between 4 and 72 years old. Data analysis focused on factors such as body mass index (BMI), oral health-related quality of life, and adherence to the Mediterranean diet.

RESULTS

A notable presence of caries is observed in individuals with low adherence to the Mediterranean diet (Correlation coefficient 0.040, p=0.682). This underscores the potential interaction between oral health, obesity, and dietary habits. The mean Oral Health-Related Quality of Life (OHIP-14Sp) score was 13.19 ±13.57, median 8.00.

CONCLUSIONS

This research adds to the increasing evidence that highlights the significance of a balanced diet in enhancing the oral quality of life for people. More research is necessary to explore preventive measures and treatment to raise awareness about oral health within the community.

Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Association between dental caries and adherence to the Mediterranean diet, dietary intake, and body mass index in children

BACKGROUND

Children with healthier nutritional status are less likely to develop severe caries than those with a high-sugar content diet. Studies evaluating dental caries and nutritional status in school-age children have generally focused on dietary intake, diet quality, or anthropometric measures, and the number of studies evaluating them together is limited.

OBJECTIVE

It was aimed to evaluate the relationship between dental caries adherence to the Mediterranean Diet (MD), dietary intake, and Body Mass Index (BMI) in school-age children.

MATERIALS AND METHODS

This study was conducted with 300 healthy children (52.0% boys, 48.0% girls) aged between 6 and 12 years. The data collection forms included sociodemographic characteristics, oral health practices of children, Mediterranean Diet Quality Index for children and adolescents (KIDMED), and food consumption records. Anthropometric measurements (body weight and height) of the children were taken. Dental examinations were performed by a pediatric dentist.

RESULTS

While the DMFT mean score of the children was 1.7 ± 2.09, the mean dft score was 2.9 ± 3.29. The mean of KIDMED scores was 5.9 ± 3.32. DMFT and dft scores decreased statistically as maternal education increased (p < 0.05). DMFT and dft scores were not statistically different between BMI groups according to gender and age (p > 0.05). DMFT scores differed statistically between KIDMED groups (p < 0.05). This difference was between low-optimal and low-improvement-needed groups. While there was a low negative correlation (r=-0.169) between calcium intake and DMFT score, a low positive correlation was found between glucose (r = 0.172) and fructose (r = 0.149) intake and dft score (p < 0.05). In regression analysis, while the children's age related DMFT scores positively, maternal education and KIDMED scores related DMFT scores negatively. Also, children's age and maternal education related dft scores negatively.

CONCLUSION

In this study, adherence to the MD rather than nutrients was found to be important in dental caries. Also maternal education level was also found to be a determinant factor in dental caries in children. DMFT and dft did not differ between BMI groups.Further studies should be conducted to assess the impact of the MD on dental caries in children to develop dietary interventions for preventative purposes.

Combined effect of dietary calcium consumption and physical activity on dental caries in children and adolescents: a study of the NHANES database

BACKGROUND

Calcium (Ca) is a nutritional factor that associated with dental caries. A recent study showed that in the case of adequate Ca intake, a higher level of physical activity may contribute to bone mass accumulation. However, the combined effect between Ca intake and physical activity on caries experience is unclear. Herein, we aimed to explore the above combined effect on dental caries in children and adolescents.

METHODS

Data of 5,917 children and adolescents were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2015-2020 in this cross-sectional study. The NHANES assessed the dietary Ca intake through the 24-hour dietary recalls, and the physical activity level was self-reported using the questionnaires. Also, the dental caries was diagnosed according to the Decayed, Missing and Filled Teeth/Surfaces (DMFT/S) index. Weighted univariate and multivariate logistic regression analyses were utilized to screen the covariates and to investigate the associations of dietary Ca intake and physical activity with dental caries, respectively, and assess the combined effect between dietary Ca intake and physical activity on dental caries. The evaluation indexes were odd ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, obesity, and total sugar intake were also performed.

RESULTS

Among the eligible participants, 2,687 had caries experience. After adjusting for the covariates, we found that children and adolescents who not reach the recommendation level of Ca intake combined with physical activity less than 7 time in 1 week seemed to have higher odds of dental caries [OR = 1.77, 95%CI: (1.38-2.27)], compared with those who reached the standards. In addition, this potential combined effect was also found in age < 12 years old [OR = 1.62, 95%CI: (1.23-2.14)], non-obesity [OR = 1.88, 95%CI: (1.49-2.35)], and total sugar intake (all P < 0.05) subgroups.

CONCLUSIONS

Ca intake and physical activity had a potential combined effect on dental caries in children and adolescents, but the causal relationships between them needed further clarification.

The changes on salivary flow rates, buffering capacity and chromogranin A levels in adults after bariatric surgery

OBJECTIVES

This study aimed to investigate changes in salivary flow rates, buffering capacity, and salivary chromogranin A (CHGA) levels in adults undergoing bariatric surgery (BS) compared with a non-obese control group.

MATERIALS AND METHODS

Salivary analyses were performed on 62 participants aged over 50 years, stratified into two groups matched for age and gender-individuals who had undergone bariatric surgery (BS) (n = 31) and a corresponding healthy control group (n = 31). Before saliva collection, participants completed a comprehensive 11-point visual numerical rating scale (NRS 0-10) xerostomia questionnaire, assessing subjective perceptions of two key aspects: dryness of the oral mucosa and resultant impact on oral functional ability. Three distinct saliva measurements were obtained: unstimulated whole saliva (UWS), stimulated whole saliva (SWS), and unstimulated upper labial saliva (ULS). The buffering capacity of unstimulated saliva was assessed using pH indicator strips, and concentrations of salivary Chromogranin A (CHGA) were quantified in stimulated saliva via enzyme-linked immunosorbent assay (ELISA).

RESULTS

After BS, more than 40% of BS group patients reported xerostomia, with 16.1% experiencing only mild symptoms without significant functional impact (p = 0.009). The prevalence of xerostomia and tongue dryness was higher in the BS group compared to the control group (p = 0.028 and p = 0.025, respectively). The comparative analysis unveiled no statistically significant differences in flow rates of unstimulated upper labial saliva (ULS), unstimulated whole saliva (UWS), and stimulated whole saliva (SWS) between the control group and patients who underwent bariatric surgery. However, in patients undergone BS with xerostomia, both ULS and UWS flow rates were significantly lower than in controls with xerostomia (p = 0.014 and p = 0.007, respectively). The buffering capacity was significantly lower in patients undergone BS than in controls (p = 0.009). No differences were found between groups regarding CHGA concentration and output values, nevertheless, higher values of CHGA concentrations were significantly correlated to lower flow rates.

CONCLUSION

According to the results, this study suggests that individuals undergoing BS may exhibit altered salivary buffering capacity and reduced unstimulated salivary flows in the presence of xerostomia. Additionally, the findings suggest that elevated concentration of salivary CHGA might be associated, in part, with salivary gland hypofunction.

CLINICAL RELEVANCE

The clinical significance of this study lies in highlighting the changes in salivary functions after BS. The identified salivary alterations might be attributed to adverse effects of BS such as vomiting, gastroesophageal reflux, and dehydration. Understanding these changes is crucial for healthcare professionals involved in the care of post-BS patients, as it sheds light on potential oral health challenges that may arise as a consequence of the surgical intervention. Monitoring and managing these salivary alterations can contribute to comprehensive patient care and enhance the overall postoperative experience for individuals undergoing BS.

Not Only Metabolic Complications of Childhood Obesity

The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

Obesity and Dental Caries in School Children

(1) Background: Childhood obesity and dental caries are common chronic conditions with multiple contributing factors, linked to negative health consequences and significant expenses in healthcare. The aim of this study was to assess the correlation between obesity and dental caries in school-aged children; (2) Methods: Data from 3323 6-12-year-old children from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 were analyzed. The NHANES was conducted at the Centers for Disease Control and Prevention (CDC) in the United States. The CDC standard was used to define obesity. Dental caries was measured during clinical examinations and summarized using DMFT scores for caries experience and prevalence (dt > 0) for untreated caries. The study examined the correlation between obesity and dental caries using regression models that considered demographic variables, family socioeconomic status, and the child's intake of added sugars as controlling factors; (3) Results: The association between obesity and dental caries was not significant in either unadjusted or adjusted models; and (4) Conclusion: The data indicate that untreated caries and caries experiences are not directly correlated with childhood obesity. There are, however, common causes of poor dental health and childhood obesity: culture, poverty level, lifestyle, and family traditions and habits. Dentists must be aware of factors influencing the development of childhood caries so that they can intervene as early as possible.

The relationship between obesity and oral-health status in North African adults: A comparative study

INTRODUCTION

The strength of the association between obesity and oral health is still indecisive.

OBJECTIVE

The objectives of the study were to compare some oral-health data between two groups involving obese (OG) and normal weight (NWG) participants and determine the influencing factors of the periodontal probing depth (PPD).

METHODS

This was a cross-sectional study including 67 Tunisian adults [OG (n = 33, body mass index (BMI) > 30 kg/m2 ), NWG (n = 34, BMI: 18.5-25.0 kg/m2 )]. The plaque level was recorded using the plaque index (PI). Gingival index (GI) was used to evaluate gingival inflammation. The depths of the sulci/pockets were probed using a periodontal probe. Stimulated saliva was collected for 5 min, and salivary flow rate (SFR) was determined. Salivary baseline pH (SBpH) was measured. A multivariable regression analysis was performed between PPD and some independent variables [i.e. obesity status, age, sex, socioeconomic status, systemic diseases and PI data].

RESULTS

The OG and NWG were age- and sex-matched and included comparable percentages of participants with systemic diseases (27.3 vs. 29.4%, respectively). The OG included a higher percentage of participants having a low socioeconomic status (87.9 vs. 64.7%, respectively). Compared with the NWG, the OG: (i) had comparable values of daily toothbrushing frequency, PI, GI and tooth mobility, (ii) included comparable percentages of irregular brushers, of participants with periodontitis, PI classes [0-1]and [1-2]; and GI classes [0-1], [1-2] and [2, 3]; (iii) had a higher PPD (2.02 ± 0.41 vs. 2.35 ± 0.22 mm, respectively), (iv) had lower SBpH (7.59 ± 0.21 vs. 7.45 ± 0.22, respectively) and SFR (1.98 ± 0.28 vs. 1.60 ± 0.32 mL/mn, respectively) and (v) included a higher percentage of participants having a PI class [2, 3] (67.6 vs. 87.9%, respectively). The multivariable regression analysis revealed that only obesity status, age and PI classes influenced the PPD, altogether explained 29.62% of the PPD variance.

CONCLUSION

Obesity poses a risk for oral health, and obese adults had altered PPD and lower BSpH and SFR. Dentists should make obese patients aware of the health risks of obesity in an attempt to reduce the potential oral complications associated with this epidemic.

Motivational interviewing for preventing oral morbidities in adults: Systematic review and meta-analysis

OBJECTIVE

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) effectively prevents oral morbidities in adults.

METHODS

Studies considered were randomized controlled trials, cluster-randomized controlled trials and community-based randomized trials assessing interventions based on MI or indicating that a counselling technique based on the principles developed by Miller and Rollnick was used. Controls were any type of oral health education or negative controls. Participants were 18-60 years old. The main outcome was any oral morbidity. From 602 studies identified in MEDLINE, Scopus, Web of Science and LILACS databases, seven studies were included in the synthesis.

RESULTS

Studies included only evaluated periodontal outcomes, no studies were found for other oral morbidities. Patients' mean age was 43.7 years, and the follow-up time after MI or MI-based intervention varied between 1 month and 1 year. The total study population was 272 people with moderate-to-severe periodontitis; other groups analysed were pregnant women (n = 112) and patients with mental disorders and alcohol problems (n = 60). Meta-analysis for the plaque index (four studies, n = 267), bleeding on probing (two studies, n = 177) and gingival index (two studies, n = 166) were carried out. The summary effects for the random-effects model were estimated respectively as -3.59 percentage points (CI: [-11.44; 4.25] for plaque index, -6.41 percentage points (CI: [-12.18, -0.65]) for bleeding on probing and -0.70 (CI: [-1.87; 0.48]) for gingival index, marginally favouring the MI group. The reduced number of studies, the non-disclosure of some aspects of the data and the heterogeneity among them undermine the precision of the estimates.

CONCLUSION

The current evidence available is limited to periodontal outcomes, and it is not possible to determine whether MI effectively prevents oral morbidities in adults.

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.

The Effect of Saliva and Dental Caries of the Patients with Hashimoto Thyroiditis on Cytokine Levels

BACKGROUND

This study aimed to evaluate the effect of dental caries and oral health of patients on salivary cytokine levels with Hashimoto's thyroiditis (HT).

MATERIAL AND METHODS

The study included 30 patients (n = 30) diagnosed with HT. The standardization of the participants was achieved with specific biochemical parameters, and the sociodemographic information of the patients was obtained through anamnesis. A pH meter was employed for salivary pH measurement. After determining the oral problems of the patients, necessary treatments were applied. Following 3 months of treatment, saliva samples were taken to evaluate cytokine levels (TNF-α, IL-6, IL-8, and CRP) and for ELISA analyses. The Wilcoxon test was used for pairwise comparison of nonparametric data, and the Chi-square test was employed to analyze categorical variables at P < 0.05.

RESULTS

There was a significant decrease in salivary TNF-α, IL-6, IL-8, and CRP levels between the measurements before and after 3 months of treatment (P < 0.05). In addition, a significant increase was found in salivary pH (P < 0.05).

CONCLUSIONS

The salivary cytokine levels decrease and the inflammatory response improves when the inflammation in the periodontal tissues and dental caries is treated.

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Prevalence of temporomandibular disorders (TMD) in obesity patients: A systematic review and meta-analysis

OBJECTIVE

Obesity is a growing epidemic in the world. It increases the risk for severe health conditions, including diabetes, heart disease and stroke. Recent research has found that obesity is associated with an increased risk for temporomandibular disorders (TMDs). The purpose of this literature review with meta-analysis is to analyse the possible association between obesity and temporomandibular disorders.

MATERIALS AND METHODS

Pubmed, Web of Science and Lilacs were systematically searched until 01/03/2000. Articles dealing with TMD and obesity were selected, and numbers that might be useful in the meta-analysis were extracted.

RESULTS

Fifty articles were chosen after using all three search engines. Thirty-five articles were considered during the initial screening step. Four papers were chosen for title and abstract screening based on the PECO model. A manual search of bibliographies and the Cochrane database was also carried out, but no publications that matched the inclusion criteria were located. The articles and meta-analysis did not show a clear association between obesity and temporomandibular disorders.

CONCLUSION

There is no evidence regarding the reliability of either method. Both have superimposable results.

Early Childhood Caries and Nutritional Status of Children: A Review

BACKGROUND

Early childhood caries (ECC) is a serious public health issue affecting children around the world. Severe symptoms and complications commonly found with ECC are adverse effects on health and growth retardation triggered by sensitivity, pain, and abscesses associated with decayed teeth, premature tooth loss, and insufficient food intake due to difficulty in chewing and keeping food in the mouth.

OBJECTIVE

This article aims to provide an overview of the most recent and current evidence on the association between ECC and nutritional status with an aim to stimulate further research and to identify the impact of nutritional status on ECC and vice versa.

METHODS

PubMed, Web of Science, and Google Scholar databases were used to search the studies conducted between 2016 and 2022. The included studies were searched using some keyword combinations and saved in Mendeley Desktop for review and referencing. All books, policy briefs, thesis/dissertations, and non-peer-reviewed articles were excluded, and 47 studies were selected for this narrative review.

RESULTS

Many studies have identified long-term, frequent, and nocturnal bottle-feeding and breastfeeding as well as frequent consumption of sugary food and beverages as high-risk factors for ECC. Adverse nutritional status assessed by anthropometric measures, vitamin D status, and iron-deficiency anemia have been studied as risk factors for ECC.

CONCLUSIONS

Most of the prevailing studies are either case-control or cross-sectional studies, which are unable to provide strong evidence to prove the direction of causality. Thus, further prospective studies are needed to clarify the association between ECC and the nutritional status of children.

The relationship between blood biochemical parameters and oral health in children with obesity/overweight

Aim The purpose of this study was to evaluate the effects of obesity and overweight on the oral/dental health and blood biochemistry parameters in children.Methods A total of 87 children (29 boys, 58 girls) aged 1-18 presenting to our paediatric endocrinology outpatient clinic were included in the study. The patient group consisted of children with obesity/overweight and the control group consisted of children with normal weight. Paediatric patients were examined simultaneously by a paediatrician and a paediatric dentist. Oral/dental health examinations of all children included in the study were performed by a specialist paediatric dentist and dmft/DMFT (decayed, missing and filled teeth) values were calculated separately in the mixed dentition period. The Community Periodontal Index of Treatment Needs 23 index and the dental plaque 35 index were evaluated at oral/dental health examinations. Oral and dental health examination findings and blood biochemistry parameters were compared between the two groups.Results While DMFT, dental plaque index, blood c-reactive protein (CRP) and parathyroid hormone (PTH) levels were significantly increased in children with overweight/obesity compared to children with normal weight, there was no difference in terms of daily toothbrushing habits and last dental examination times. Overweight/obesity was found to be associated with the dental plaque and DMFT/dmft index, and elevation in the blood biochemistry parameters CRP and PTH among the children in this study.Conclusion The observation of significant elevation in DMFT and dental plaque indices and numbers of filled deciduous teeth showed that oral/dental health problems and dental decay may emerge more frequently in children with overweight/obesity. Children with overweight should be routinely provided with dental care as part of a multidisciplinary team that includes paediatricians and dentists.

Association between nutritional status and children and adolescents' dental caries experiences: an overview of systematic reviews

An increasing number of systematic reviews (SR) has investigated the association between dental caries and nutritional status in children and adolescents, thus requiring an overview to compile the information in a single piece of evidence. Therefore, this study aimed to evaluate and summarize evidence from published SR on the association between dental caries and nutritional status in children and adolescents. A wide search was conducted on May 29, 2023, in six databases (Medline via PubMed, Scopus, Web of Science, Cochrane library, Embase, and the Virtual Health Library - VHL). An additional search was performed in the gray literature (Open grey and Google Scholar), SR registration databases, and the list of references of the included SR. Our inclusion criteria were based on acronym PECOS. Overall, two reviewers independently extracted the data, evaluated the risk of bias (ROBIS), and assessed the quality of the chosen studies (AMSTAR-2). Data from the included meta-analysis were summarized and certainty of evidence using the GRADE approach was performed. After removing duplicates and applying our eligibility criteria, 19 SR from 2006-2022 were included. We found that 17 SR showed high risk of bias and critically low methodological quality. We observed an association between dental caries experiences and nutritional status since seven SR found an association between obesity/overweight and dental caries; one, an association between underweight and dental caries; and eleven, no associations. The meta-analysis showed divergent results according to the study designs, used indices, and participants' age group, and were scored as having a very low certainty of evidence. Therefore, based on the high risk of bias, low methodological quality, and very low certainty of evidence of the chosen SR, most studies found no association between children and adolescents' nutritional status and dental caries experience.

Association between obesity and dental caries among adolescents in UAE: a pilot cross sectional study

Background

Obesity and dental caries among adolescents is a growing worldwide public health issue. They share some common and modifiable influences. The objective of this study was to evaluate the association between obesity and dental caries among adolescents in the United Arab Emirates (UAE).

Methods

This pilot cross-sectional study enrolled 161 adolescents 13-19 years old from private and public schools in the UAE. Participants were classified as normal weight, underweight, overweight or obese. Dental caries was diagnosed according to the criteria recommended by the World Health Organization (WHO). Independent t-tests were used to compare average number of decayed, missing and filled surfaces (DMFS) by age, sex, school type, mothers' employment, BMI categories, waist circumference, oral health habits and plaque index. Additionally, a multiple linear regression model was applied to analyze the association between BMI, waist circumference and dental caries, adjusted for confounding factors considered in this study.

Results

The average age of the participants was 16.2 ± 1.4 years old. The prevalence of overweight/obesity was 42% (N = 68) measured by BMI. In addition, 82% (N = 132) had average waist circumference and 18% (N = 29) with above average waist circumference. Overall, the average DMFS score was 4.35 ± 4.5, with significantly lower dental caries rates among girls ([3.3 (SD:4.0)] than boys (6.7 (SD:5.3), (p < 0.05). The linear regression model revealed that, being a male, attending a public school and having average waist circumference were all positively and significantly associated with dental caries (p < 0.05).

Conclusion

Obesity measured by waist circumference was significantly associated with dental caries among adolescents in the UAE. Further research is required to investigate the complex association between obesity and dental caries and how dietary habits, oral hygiene habits, and parental socioeconomic status mediate the association between obesity and dental caries.

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial

BACKGROUND

Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health.

METHODS

We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care.

RESULTS

In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (β = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children.

CONCLUSIONS

Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting.

TRIAL REGISTRATION

ISRCTN 15177479.

Geographic Information Systems (GIS) to Assess Dental Caries, Overweight and Obesity in Schoolchildren in the City of Alfenas, Brazil

Childhood-related obesity and overweight are increasing concerns for the health and well-being of children. Dental caries (decay) is the most prevalent oral disease during childhood, and several studies have suggested that nutritional status and dental caries are associated in children. Therefore, this study aimed to determine the geographic distribution of childhood overweight/obesity and dental caries in a medium-sized Brazilian city. This cross-sectional study was conducted with 269 children of both genders enrolled in four public schools in the city of Alfenas. The children were clinically examined to assess cavitated dental caries and nutritional status (overweight and obesity). In addition, the GIS was used for the geospatial clustering analyses. A heat map was created by the Kemel method to estimate the concentration of the outcomes. The cavitated dental caries and overweight/obesity were also pointed out by dots on the map. However, of the 269 children, 118 were boys (43.87%) and 151 were girls (56.13%). One hundred fifty-seven children (58.4%) were classified as having "non-cavitated caries," while 112 (41.6%) were classified as having "cavitied caries." In the nutritional status assessment, 204 children (75.84%) were classified as "eutrophic," while 65 children (24.16%) were classified as "overweight/obesity," A geographical correlation of dental caries with overweight/obesity may exist in the northeast and southwest areas. In conclusion, a geographical concordance between the dental caries and the occurrence of overweight/obesity among the schoolchildren from Alfenas may exist in some areas. Future studies are necessary.

Role of oral and gut microbiota in childhood obesity

Childhood obesity not only causes damage to children's respiratory, cardiovascular, endocrine, motor, and other systems but also is a significant risk factor for metabolic diseases such as obesity in adulthood, which has become one of the serious public health problems worldwide. The etiology and pathogenesis of obesity are complex. In addition to genetic and lifestyle factors, recent studies have found that the microbes in the digestive tract play a crucial role in the occurrence and development of obesity. Among them, the gut microbiota has been confirmed to be one of the important pathogenic factors of obesity, which can mediate the occurrence and development of obesity by interfering with the balance of host energy metabolism and inducing low-grade chronic inflammation throughout the host. Targeting the gut microbiota to treat obesity through various methods such as fecal microbiota transplantation, dietary intervention, and probiotic supplementation has become a research hotspot in obesity treatment. In addition, the oral microbiota is also considered closely related to the occurrence and development of obesity due to its regulatory effect on the balance of gut microbiota. Exploring the relationship between oral and gut microbiota and childhood obesity elucidates the pathogenesis and treatment concepts of childhood obesity from a new perspective. It may provide new methods for the prevention and treatment of childhood obesity in the future.

[The impact of dental caries prevention program on the anthropometric measurements of preschool children]

THE AIM OF THE STUDY

Was to compare body mass indices (BMI) of children receiving and not receiving dental caries prevention program in preschool institutions at the age of 3-6 years.

MATERIAL AND METHODS

The study comprised163 children (76 boys and 87 girls) initially examined at the age of 3 years in nurseries of the Khimki city region. In one of the nurseries 54 children received dental caries prevention and educational program for 3 years. Other 109 children not receiving any special programs served as controls. Data on caries prevalence and intensity as well as weight and height were collected at baseline examination and 3 years after. BMI was calculated by standard formula and WHO criteria for weight deficiency, normal weight, overweight and obesity for children aged 2-5 and 6-17 years were applied.

RESULTS

Caries prevalence in 3-years-old was 34.1% with dmft median of 1.4 teeth. After 3 years the prevalence of dental caries reached 72.5% in controls and was almost twice as low in the main group (39.3%). Caries intensity growth was also significantly higher in controls (p<0.0001). There was statistically significant difference on the rate of underweight and normal weight in children receiving and not receiving dental caries preventive program (p<0.05). The rate of normal and low BMI in the main group was 82.6% (vs. 66% in controls) and 7.7% (vs. 22%), correspondingly. The higher the caries intensity the more is the risk for being underweight (11.5% in caries-free children vs 25.7% in having DMFT+dft more than 4, p=0.034).

CONCLUSION

Our study showed positive impact of dental caries prevention program on the anthropometric measurements of children aged 3-6 years which increases the significance of this type of programs in pre-school institutions.

The Relationship between Obesity and Childhood Dental Caries in the United States

Background: Childhood obesity and dental caries are prevalent chronic, multifactorial conditions with adverse health consequences and considerable healthcare costs. The aims of this study were: (1) to evaluate the relationship between obesity and dental caries among young children using multiple definitions for both conditions, and (2) to evaluate the role of family socioeconomic status (SES) and the child’s intake of added sugars in explaining this association. Methods: Data from 2775 2−5-year-olds children from the National Health and Nutrition Examination Survey (NHANES) 2011−2018 were analysed. Three different international standards were used to define obesity, namely the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the International Obesity Task Force (IOTF). Dental caries was measured during clinical examinations and summarised as counts (dt and dft scores) and prevalence (untreated caries [dt > 0] and caries experience [dft > 0]). The association of obesity with dental caries was assessed in regression models controlling for demographic factors, family SES and child’s intake of added sugars. Results: In crude models, obesity was associated with greater dt scores when using the IOTF standards (RR: 2.43, 95% CI: 1.11, 5.29) but not when using the WHO and CDC standards; obesity was associated with greater dft scores when using the WHO (1.57, 95%CI: 1.11−2.22), CDC (1.70, 95%CI: 1.17−2.46) and IOTF standards (2.43, 95%CI: 1.73−3.42); obesity was associated with lifetime caries prevalence when using the WHO (1.55, 95%CI: 1.05−2.29), CDC (1.73, 95%CI: 1.14−2.62) and IOTF standards (2.45, 95%CI: 1.61−3.71), but not with untreated caries prevalence. These associations were fully attenuated after controlling for demographic factors, family SES and child’s intake of added sugars. Conclusions: The relationship between obesity and dental caries in primary teeth varied based on the definition of obesity and dental caries used. Associations were observed when obesity was defined using the IOTF standards and dental caries was defined using lifetime indicators. Associations were fully attenuated after adjusting for well-known determinants of both conditions.

Self-determination theory guided oral self-care training for adolescents-A cluster randomised controlled trial

Quality oral self-care is a key element in maintaining oral health, which is important for students' general health, their overall well-being and learning. The cluster randomised controlled trial tested the following hypotheses: (1) self-determination theory (SDT)-guided dental education is superior to conventional dental instruction in modifying oral self-care in adolescents; (2) after the discontinued dental education, improved oral self-care is only maintained for short rather than long term and (3) multiple predictors explain variations in adolescents' oral self-care at different observation periods. The intervention group (N = 97) received three face-to-face educational sessions to facilitate adolescents' intrinsic motivation, while the control group (N = 99) had one conventional dental instruction session. Dental plaque scores (% of tooth area covered by dental plaque) indicated a lack of oral self-care. Linear multivariable models tested the following predictors of oral self-care at different observation periods: socio-demographics (sex, socio-economic status, school) and self-determination attributes (autonomy, relatedness, competence). Results indicated that from baseline to the 6-month follow-up, dental plaque scores decreased (oral self-care improved) in the intervention group but not in the control group. At the 12-month follow-up point, there were no significant differences in mean plaque scores between the study groups. Baseline plaque levels (β = 0.807), the type of dental instruction (theory guided vs. conventional) (β = 0.208), relatedness (β = 0.106) and competence (β = 0.102) were significant predictors that explained 67.6% of the variance in dental plaque scores at the 12-month follow-up point. The theory-guided education was superior to conventional verbal instruction in improving adolescent oral self-care; however, this improvement was only maintained short term. Variations in adolescent oral self-care at short- and long-term observation points were explained by baseline oral self-care levels and two SDT components: relatedness and competence.

Childhood obesity: overcoming the fear of having healthier weight conversations with families

Introduction Clinicians may find raising the issue of weight with patients or carers and having healthier lifestyle conversations uncomfortable, out of fear or experience of causing offence. A two-cycle audit was completed in a specialist paediatric dental service to ascertain whether healthier weight conversations were being had with patients and their carers.

Materials and methods The inclusion criteria for the audit were paediatric patients who were having a general anaesthetic assessment for dental extractions as a result of dental caries. A gold standard was set that all patients having a general anaesthetic assessment should have their body mass index (BMI) calculated and healthier weight conversations should be had with patients and carers and families signposted for further support when necessary.

Results Results for the first cycle found that only 7% of patients had their BMI recorded and there was no record of healthier weight conversations for any patient. After the results of the first cycle were shared and ways in which to have a helpful healthy weight conversation discussed, a second cycle was carried out. A significant improvement was made, with clinicians calculating the BMI for 65% of the patients and a healthier weight conversation being had when necessary.

Discussion Many of the clinicians voiced that as calculating a BMI and having healthier weight conversations is not something that they had previously routinely done, they often forget to do this. Others stated that they felt uncomfortable bringing up the topic in a way that wouldn't offend the patient or parent, so avoided doing so.

Conclusions As a result of the audit, it was strongly encouraged that all clinicians continue to calculate BMI as it was found to be a useful tool for introducing healthier weight conversations when necessary. The subject of healthier weight needs to be acknowledged in the dental setting and discussed with families in a non-judgemental and sensitive way. This paper aims to guide clinicians in how to sensitively broach this subject with children and carers and when and where to signpost if extra support is needed.

Childhood obesity is increasing as a result of the COVID-19 pandemic and childhood obesity is linked with dental decay.

Clinicians struggle to have the 'healthier weight' conversation with children and their carers out of fear of causing offence.

Further training and advice on how to sensitively broach the conversation regarding childhood obesity with carers may be necessary so that children and carers can receive support when needed.

Prevalence of dental caries in the permanent dentition amongst 12-year-olds in Africa: a systematic review and meta-analysis

BACKGROUND

Dental caries (DC) is highly prevalent condition affecting mostly young children. There has been no systematic review done on the prevalence of DC amongst 12-year -olds in Africa. Although some African countries have reported a decrease in DC prevalence, others have shown an increase and it is essential to measure current trends in order to identify strategies and programmes that could assist in reducing DC in Africa. The aim of this systematic review was to determine the prevalence of DC (condition) amongst the permanent dentition of 12-year-old children (population) in Africa (context).

METHODS

A systematic review and meta-analysis was performed. Peer reviewed cross-sectional articles from January 2000 until December 2021 was searched and this included the following databases: Pubmed (Medline); SCOPUS; CINAHL (via EBSCOhost); Academic Search Complete (via EBSCOhost); Dentistry and Oral Sciences Sources (via EBSCOhost); and Science Direct. The search was last updated on the 10th January 2022. Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. Prevalence figures were stratified by Urban/Rural status, country and time using a random-effects model. All studies performed on children 12-year-olds on the African continent were included. The prevalence of DC and the DMFT scores were the primary and secondary outcome measures, respectively. Only articles consisting of 12-year-old children who reside in Africa were included in this study. The systematic review was registered with Prospero CRD42021293666.

RESULTS

18,080 participants were included in this review. A total of thirty studies were included in the review. The pooled effect size of dental caries severity was 1.09 (CI 0.91-1.27) and the overall prevalence was 36% (CI 29.4-41.7%). Eritrea (78%) had the highest prevalence of DC while Zambia had the lowest (11%); Eritrea also had the highest DMFT score (2.5) with Sudan having the lowest score (0.49). Urban cities had the highest DMFT score (1.32, CI 0.97-1.68), compared to rural cities (1.13, CI 0.86-1.4) and there was an increasing trend in DC prevalence over time from 28% (CI 23-34%) in 2000 to 2005 to 57% (CI 43-72%) in studies conducted after 2015. The risk of bias was very low where majority of the studies scored more than 50% in the JBI critical appraisal tool.

CONCLUSIONS

There was a wide discrepancy in the DC prevalence and scores across the different countries, settings (rural versus urban) and there was an increase in the prevalence over time. This review was self-funded.

Regulations on nutrition in Indonesia and its relation to early childhood caries

There is a close relationship between food and nutrition policies and oral health. The relationship between nutrition and dental problems has been widely discussed, including the major dental problem in children: early childhood caries (ECC). Health-oriented national policies are the main principles of public health welfare. This article is a policy brief that provide a review of the food and nutrition policies in Indonesia that may have a relationship with ECC. It is concluded that some policies support the efforts to prevent ECC however, other technical explanations are still needed for health workers and especially parents regarding its simple implementation in everyday life. Multisectoral approaches that includes health, nutrition and education are needed to address ECC.

Early childhood caries, obesity and anthropometric measurements: Is there a relationship?

This brief research report explored the relationship among obesity, anthropometric measurements, and early childhood caries (ECC), in 3–5 years-old children. Three hundred and ninety-one Brazilian preschoolers were given anthropometric examinations for the assessment of general, peripheral, and central adiposity, by the following measures: body mass index (BMI), hip circumference, and waist circumference. Obesity status was determined by BMI according to WHO standards. Parent's age and BMI were assessed by questionnaire, and sucrose exposure was tracked by means of a food diary. For the assessment of ECC, dental examinations were performed according to modified WHO criteria. Also, the presence of dental biofilm in maxillary incisors was detected. A direct association between BMI and ECC was found in the bivariate analysis and the best possibility of logistic regression model showed that hip circumference (HC) values ≥62 centimeters (OR = 1.63; p = 0.033) jointly with the presence of dental biofilm (OR = 2.38; p = 0.000), children's ages ≥37 months (OR = 5.09; p = 0.012), and mothers younger than 35 years (OR = 1.96; p = 0.004) were significantly connected with ECC. In conclusion, peripheral adiposity (represented by HC) in young children was in fact associated with ECC. Thus, hip circumference might be a valuable tool for exploring the relationship between caries and obesity in the early years of life.

Salivary Biomarkers as Predictors of Obesity and Intermediate Hyperglycemia in Adolescents

Introduction

Childhood obesity presents a major risk for metabolic diseases in adulthood. Noninvasive methods are needed for predicting the course of obesity in children and its complications. Using blood for longitudinal analyses of biomarkers to predict disease in children is not a convenient method. Saliva presents a noninvasive platform to detect inflammatory changes in biomarkers as possible predictive measures of future pathological events.

Objectives

The aim of this study was to evaluate the relationship between specific salivary biomarkers, obesity, and intermediate hyperglycemia in children. We also investigated the longitudinal association between the salivary biomarkers and change in Body Mass Index-for-age percentile scores (BMIz).

Methods

Data on 353 adolescents were collected from the individuals recruited for seven years in an ongoing Kuwait Healthy Life Study cohort. BMIz was measured at 10, 12, and 17 years of age. Interleukin (IL)-6, IL-8, IL-10, Leptin, C-Reactive Protein (CRP), Insulin, Vascular Endothelial Growth Factor (VEGF), and Monocyte Chemoattractant Protein-1 (MCP-1) were measured in saliva and serum. Additionally, fasting blood plasma glucose levels were recorded. Multilevel longitudinal regression modeling, mediation analyses, and logistic regression were used to determine the predictive value of salivary biomarkers in obesity and hyperglycemia.

Results

Longitudinal analyses showed that with each one-unit increase of salivary CRP and insulin, there was a 3.5 kg/m² and 3.2 kg/m² increase in BMIz, respectively. Comparable to serum CRP and insulin, higher salivary CRP and insulin OR 4.94 [95%CI: 1.66,14., OR 2.64 [95%CI: 1.09, 6.38], respectively) were predictive of hyperglycemia and obesity (OR 4.53 [95%CI: 2.40,8.50], OR 3.29 [95%CI: 1.82,5.97], respectively). Insulin was a strong mediator in the relationship between obesity and hyperglycemia.

Conclusion

Our findings demonstrated that salivary CRP and insulin were associated with hyperglycemia, obesity, and possibly diabetes in adolescents. Salivary biomarkers are a noninvasive approach with significant value for disease risk assessment and prevention.

Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: a controlled clinical study

BACKGROUND

Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion.

OBJECTIVES

To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study.

METHODS

73 adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n=34) followed-up during a 6-months dietary program, and Gastroplasty group (GG; n=39) evaluated immediately before, 3, and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the 4 basic tastes were assessed. Two-way mixed model and sign test were applied.

RESULTS

Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p<0.001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein, and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p<0.05).

CONCLUSION

After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.

Possible Relationship Between the Oral and Gut Microbiome, Caries Development, and Obesity in Children During the COVID-19 Pandemic

The COVID-19 pandemic has brought health damage and socioeconomic disruptions, together with lifestyle disorders around the world. Children are one of the most commonly affected, mainly due to social isolation and changes in eating habits and physical activities. This way, the risk of weight gain and obesity is possibly enhanced, as well as poor oral hygiene conditions and early childhood caries (ECC) development during the lockdown. In children under 6 years of age, ECC is defined as carious lesions in one or more primary teeth, with or without cavitation. Importantly, alterations in the oral microbiome caused by changes in children lifestyles have much more than a local impact on oral tissues, interplaying with the gut microbiome and influencing systemic environments. Recent studies have been exploring the oral health conditions, eating habits, and weight gain in the childhood population during the COVID-19 pandemic; however, there is a lack of information concerning the association among oral and gut microbiome, dental caries, and obesity in the COVID-19 era. In this context, this review aimed at analyzing a possible relationship between the oral and gut microbiome, caries, and obesity in children during the COVID-19 pandemic.

Exploring the Relationship between Salivary Levels of TNF-α, Lactobacillus acidophilus, Lactobacillus gasseri, Obesity, and Caries in Early Childhood

This research aimed to explore the relationship between tumor necrosis factor-α (TNF-α), Lactobacillus acidophilus (L. acidophilus), Lactobacillus gasseri (L. gasseri), obesity, and early childhood caries. After caries and obesity diagnosis based on the WHO criteria, 94 preschoolers were assessed. Unstimulated saliva was collected for analysis of TNF-α by the Milliplex system and for L. acidophilus and L. gasseri using real-time polymerase chain reaction (RT-PCR). In obese children, each unit increase in the body mass index (BMI), and the TNF-α levels was associated with a one-time increase in the number of decayed surfaces (p < 0.05). Meanwhile, in eutrophic preschoolers, the presence of L. gasseri and L. acidophilus was linked, respectively, to an increase of 3.04 and 1.59 times in the number of decayed surfaces (p < 0.05); in obese children, the presence of L. acidophilus was not significant (p > 0.05) and L. gasseri was shown as a possible protective indicator (RR:0.49−p < 0.05). In conclusion, TNF-α and BMI were connected to carious lesions only in obese preschoolers, suggesting that inflammation could be underscored when both pathologies are concomitant. The presence of both species of lactobacilli investigated was connected with early childhood caries in eutrophic children, whereas in obese children only L. gasseri was significant, and in an opposite way, reinforcing that obesity can modulate oral bacteria.

Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity

In this study, we aimed to explore the perceptions of oral health care professionals (OHCPs) on childhood overweight and obesity screening and management in oral health settings in the Greater Sydney region in New South Wales, Australia. OHCPs involved in the Healthy Smiles Healthy Kids (HSHK) birth cohort study were purposively selected for this nested qualitative study. A sample of 15 OHCPs completed the face-to-face interviews, and thematic analysis was undertaken to identify and analyse the contextual patterns and themes. Three major themes emerged: (1) obesity prevention and management in dental practice; (2) barriers and enablers to obesity prevention and management in dental settings; and (3) the role of oral health professionals in promoting healthy weight status. This study found that OHCPs are well-positioned and supportive in undertaking obesity screening and management in their routine clinical practice. However, their practices are limited due to barriers such as time constraints, limited knowledge, and limited referral pathways. Strategies including capacity building of OHCPs, development of appropriate training programs and resources, and identification of a clear specialist referral pathway are needed to address the current barriers. This study provides an insight into opportunities for the oral health workforce in promoting healthy weight status among children.

Difficulty with Oral Health Complications in Adolescents with Developmental Disability and Obesity

INTRODUCTION

Developmental disabilities (DDs), obesity, and dental caries are highly prevalent health conditions among adolescents. Evidence indicates that a significant proportion of adolescents with DDs are obese, and those with obesity and dental caries share common risk factors.

OBJECTIVE

In this first-ever US-based cross-sectional national study, we assessed the likelihood of adolescents with DDs and obesity experiencing chronic difficulty with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition among adolescents with DDs and obesity compared to adolescents with no DDs or obesity.

METHODS

For this secondary data analysis study, we used data of 68,942 adolescents aged 10 to 17 y from the 2016 through 2019 National Survey of Children's Health. Weighted descriptive and bivariate analyses were conducted. Four multiple logistic regression models predicting chronic difficulty in the past 12 mo with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition were conducted, controlling for other variables.

RESULTS

The adjusted odds ratio (aOR) of experiencing chronic difficulty in the past 12 mo for adolescents with no DDs or obesity was significantly lower for decayed teeth (aOR, 0.64; 95% confidence interval [CI], 0.51-0.80; P < 0.0001), toothaches (aOR, 0.43; 95% CI, 0.30-0.60; P < 0.0001), bleeding gums (aOR, 0.48; 95% CI, 0.33-0.70; P < 0.0001), and eating or swallowing due to a health condition (aOR, 0.34; 95% CI, 0.20-0.57; P < 0.0001) compared to adolescents with both DDs and obesity.

CONCLUSIONS

Results from this study indicate that DD adolescents with obesity have more/greater impending oral health needs than adolescents with no DDs or obesity.

KNOWLEDGE TRANSFER STATEMENT

Results of this study highlight the high oral health needs and the chronic difficulty adolescents with developmental disabilities and obesity experience compared to adolescents without developmental disabilities and obesity. Targeted oral health policies and interventions that will promote oral health among this high-risk group are recommended.

Obesity is negatively associated with dental caries among children and adolescents in Huizhou: a cross-sectional study

Background

Obesity and dental caries among children and adolescents are growing worldwide public health problems. They share some common and modifiable influences. The objective of this study was to evaluate the prevalence of obesity and dental caries among children and adolescents in Huizhou and explore the association between Body Mass Index (BMI) category and dental caries.

Methods

This cross-sectional study enrolled 105,181 students (55,500 males and 49,681 females) from 87 schools in Huizhou. Height and weight were measured, and BMI was calculated. Based on Chinese BMI standards, students were classified into underweight, normal weight, overweight, and obesity groups. Dental caries was diagnosed according to criteria recommended by World Health Organization (WHO). We used the Chi-square test to compare proportions of groups and performed Association Rules Mining to identify patterns and combinations of BMI categories and dental caries. Finally, a multilevel logistic regression model was applied to analyze the association between BMI category and dental caries when confounders were considered.

Results

The prevalence of underweight, overweight, and obesity among children and adolescents was 7.56%, 8.85%, and 2.95%, respectively. The overall prevalence of dental caries was 58.10%, with a lower prevalence among boys than girls. Students from primary schools and remote towns more easily suffer from dental caries. Caries prevalence of students belonged to underweight, normal, overweight, and obesity was 65.6%, 58.8%, 49.6%, and 46.1% individually. With increasing BMI levels, the prevalence of dental caries decreased. Further, this trend still exists in each subgroup of gender, educational stage, school type, and area. Association rules indicate underweight has a positive effect on the occurrence of dental caries, while overweight or obesity has a negative impact on the occurrence of dental caries. The three-level logistic regression model results show that BMI category is inversely associated with dental caries after adjusting confounders.

Conclusion

Obesity is negatively associated with dental caries among children and adolescents in Huizhou. Further research is required to investigate how dietary habits, oral hygiene habits, and parental socioeconomic status mediate the association between BMI and dental caries.

Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review

OBJECTIVES

We aimed to review how 'Risk of Bias In Non-randomized Studies-of Interventions' (ROBINS-I), a Cochrane risk of bias assessment tool, has been used in recent systematic reviews.

STUDY DESIGN AND SETTING

Database and citation searches were conducted in March 2020 to identify recently published reviews using ROBINS-I. Reported ROBINS-I assessments and data on how ROBINS-I was used were extracted from each review. Methodological quality of reviews was assessed using AMSTAR 2 ('A MeaSurement Tool to Assess systematic Reviews').

RESULTS

Of 181 hits, 124 reviews were included. Risk of bias was serious/critical in 54% of assessments on average, most commonly due to confounding. Quality of reviews was mostly low, and modifications and incorrect use of ROBINS-I were common, with 20% reviews modifying the rating scale, 20% understating overall risk of bias, and 19% including critical-risk of bias studies in evidence synthesis. Poorly conducted reviews were more likely to report low/moderate risk of bias (predicted probability 57% [95% CI: 47-67] in critically low-quality reviews, 31% [19-46] in high/moderate-quality reviews).

CONCLUSION

Low-quality reviews frequently apply ROBINS-I incorrectly, and may thus inappropriately include or give too much weight to uncertain evidence. Readers should be aware that such problems can lead to incorrect conclusions in reviews.

Common Determinants of Dental Caries and Obesity in Children: A Multi-Ethnic Nested Birth Cohort Study in the United Kingdom

The article examines the common determinants of childhood dental caries and obesity. Longitudinal data from the Born in Bradford cohort study (BiB1000) (n = 1735) and dental data (dental general anaesthetics (GA) and oral health survey 2014/15) (n = 171) were used to test a framework on the social determinants of childhood dental caries (decayed, missing, filled teeth (dmft) index) and obesity (body mass index (BMI)). The BiB1000 data were collected at pregnancy week 26–28 and after birth at 6, 12, 18, 24 and 36 months. The determinants were demographics, wellbeing, socio-economic status (SES), dietary behaviours and physical activity behaviour of the children. Missing data were accounted for through multiple imputation (MI). The framework was tested through structural equation modelling. Overall, the model fit was adequate. No alcohol consumption of the mother after giving birth, higher frequency of child drinking sugar-sweetened beverages, emotional and behavioural difficulties of the child and being male were directly associated with both BMI and dental caries. Caregivers uninvolved or indulgent feeding style were associated with higher BMI and less dental caries. Social deprivation was associated with lower BMI and higher dmft. Five determinants were directly associated with BMI only. Fifteen indirect paths were significant for both child dental caries and BMI. The findings suggest common determinants for both childhood obesity and dental caries. Common risk factor approach seems appropriate for planning future health promotion programmes.

Interventions Targeting Bottle and Formula Feeding in the Prevention and Treatment of Early Childhood Caries, Overweight and Obesity: An Integrative Review

Overweight, obesity and early childhood caries (ECC) are preventable conditions affecting infants and young children, with increased prevalence in those formula-fed. Previous research has focused on distinct outcomes for oral health and healthy weight gain. However, the aetiology may be linked through overlapping obesogenic and cariogenic feeding behaviours, such as increased sugar exposure through bottle propping and overfeeding. Best-practice bottle feeding and transition to cup use may concurrently reduce overweight, obesity and ECC. This integrative review aimed to identify interventions supporting best-practice formula feeding or bottle cessation and examine the intervention effects on feeding, oral health and weight outcomes. The reviewers searched nine databases and found 27 studies that met the predetermined inclusion criteria. Eighteen studies focused on populations vulnerable to ECC or unhealthy weight gain. All studies focused on carer education; however, only 10 studies utilised behaviour change techniques or theories addressing antecedents to obesogenic or cariogenic behaviours. The outcomes varied: 16 studies reported mixed outcomes, and eight reported worsened post-intervention outcomes. While some studies reported improvements, these were not maintained long-term. Many study designs were at risk of bias. Effective intervention strategies for preventing ECC and child obesity require the holistic use of interdisciplinary approaches, consumer co-design and the use of behavioural change theory.

Obesity and oral health in Mexican children and adolescents: systematic review and meta-analysis

Context

A relationship between obesity and poor oral health has been reported.

Objective

To investigate the association between overweight/obesity and oral health in Mexican children and adolescents.

Data Sources

A literature search was conducted of 13 databases and 1 search engine for articles published from 1995 onward.

Data Analysis

A total of 18 publications were included. Evidence was inconclusive and varied according to sociodemographic factors or outcome measuring tools. The Decayed, Missing, and Filled Teeth and Filled Teeth Surfaces indices and the decayed extracted filled teeth index outcomes were included in a random effects model meta-analysis. Pooled estimates showed no statistically significant oral health differences (measured via the decayed extracted filled teeth or the Decayed, Missing, and Filled Teeth Surfaces indexes) among body mass index (BMI) categories. However, pooled estimates of 6 studies showed that children with higher BMI had worse oral health in permanent teeth (measured via the Decayed Missing Filled Teeth Index) than children with lower BMI (overall mean difference, –0.42; 95%CI, –0.74, –0.11).

Conclusion

Whether there is an association between poor oral health and high BMI is inconclusive; however, both co-exist among Mexican children. Therefore, health promotion and prevention efforts should address common risk factors and broader risk social determinants shared between noncommunicable diseases.

Exploring the Interplay Between Oral Diseases, Microbiome, and Chronic Diseases Driven by Metabolic Dysfunction in Childhood

Oral childhood diseases, such as caries and gingivitis, have much more than a local impact on the dentition and tooth surrounding tissues, which can affect systemic conditions. While the mouth is frequently exposed to microbial stressors that can contribute to an inflammatory state in the entire body, chronic disorders can also interfere with oral health. Sharing common risk factors, a dynamic interplay can be driven between 1. dental caries, gingivitis, and type I diabetes mellitus, 2. early childhood caries and obesity, and 3. caries and cardiovascular diseases. Considering that there are ~2.2 billion children worldwide and that childhood provides unique opportunities for intervention targeting future health promotion, this review is of prime importance and aimed to explore the relationship between the oral microbiome and oral chronic diseases driven by metabolic dysfunction in childhood.

Preschoolers' and Mothers Dietary Practices and Compliance with the 24-h Movement Guidelines: Results of Oman's National Nutrition Survey

Introduction: Little is known on the nutritional and lifestyle variables of preschool children in Oman. This study analyzed data of the 2017 Oman National Nutrition Survey to assess the prevalence and interrelationships between dietary and movement variables among preschool children, aged 2–5 years. Methods: Household visits of a nationally representative sample evaluated mothers and children’s dietary, sleep and physical activity practices; media exposure; and anthropometric and sociodemographic variables. Results: Dyads of mothers and pre-school children aged 2–5 years (n = 1771) were assessed. Childhood overweight/obesity was prevalent in 2% of the sample. Over 54% of children consumed sweetened items and/or French fries or chips at least once daily. Over 65% of children had fruits and/or vegetables once daily or less. Mothers had healthier dietary and movement habits compared to their offspring. Compliance with media exposure was the lowest among mothers and children. Multivariate regression revealed children’s increased sweet intake was the only significant predictor of excess weight in children. Conclusion: This study revealed a low prevalence of overweight/obesity among preschool children in Oman. Children had an acceptable compliance with sleeping recommendations, yet limited adherence to media exposure, activity, added sugar and fruits and vegetables guidelines.

Differences between Obese and Non-Obese Children and Adolescents Regarding Their Oral Status and Blood Markers of Kidney Diseases

(1) Background: A rarely discussed effect of obesity-related glomerulopathy (ORG) may slowly lead to irreversible glomerular damage and the development of chronic kidney disease. These patients need to undertake medical care, but whether they should be included in intensive oral care is still not mandatory. The study aimed to assess a relationship between renal, metabolic, and oral health indicators among pediatric patients affected by simple obesity. (2) Methods: 45 children and adolescents with simple obesity hospitalized (BMI 34.1 ± 4.8 kg/m², age 15.4 ± 2.3) and compared with 41 aged-matched healthy controls (BMI 16.4 ± 2.4 kg/m², age 15.4 ± 2.7). Echocardiography, 24-h ambulatory blood pressure monitoring, ultrasound exam with Doppler, and laboratory tests including kidney and metabolic markers were performed. Oral status was examined regarding the occurrence of carious lesions using decay missing filling teeth (DMFT), gingivitis as bleeding on probing (BOP), and bacterial colonization as plaque control record (PCR). (3) Results: The strongest correlation was revealed between BMI and concentration of uric acid, cystatin C, GFR estimated by the Filler formula (r = 0.74; r = 0.48; r = -0.52), and between oral variables such as PCR and BOP (r = 0.54; r = 0.58). Children and adolescents with obesity demonstrated untreated dental caries, less efficient in plaque control and gingivitis. (4) Conclusions: No specific relation to markers of kidney disease were found; however, more frequent gingivitis/bacterial colonization and significant differences in oral status between obese and non-obese patients were revealed. Susceptibility to inflammation may be conducive to developing metabolic syndrome and kidney damage in the form of obesity-related glomerulopathy and contribute to future dental caries. Uric acid seems to indicate metabolic syndrome and cardiovascular complications (LVMI > 95 percentiles). Cystatin C and uric acid might aspire to be early markers of kidney damage leading to obesity-related glomerulopathy.

Selecting Risk of Bias Tools for Observational Studies for a Systematic Review of Anthropometric Measurements and Dental Caries among Children

In conducting a systematic review, assessing the risk of bias of the included studies is a vital step; thus, choosing the most pertinent risk of bias (ROB) tools is crucial. This paper determined the most appropriate ROB tools for assessing observational studies in a systematic review assessing the association between anthropometric measurements and dental caries among children. First, we determined the ROB tools used in previous reviews on a similar topic. Subsequently, we reviewed articles on ROB tools to identify the most recommended ROB tools for observational studies. Of the twelve ROB tools identified from the previous steps, three ROB tools that best fit the eight criteria of a good ROB tool were the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, and Agency for Healthcare Research and Quality (AHRQ) and the Effective Public Health Practice Project (EPHPP) for a cross-sectional study. We further assessed the inter-rater reliability for all three tools by analysing the percentage agreement, inter-class correlation coefficient (ICC) and kappa score. The overall percentage agreements and reliability scores of these tools ranged from good to excellent. Two ROB tools for the cross-sectional study were further evaluated qualitatively against nine of a tool's advantages and disadvantages. Finally, the AHRQ and NOS were selected as the most appropriate ROB tool to assess cross-sectional and cohort studies in the present review.