Body mass index and dental caries in young people: a systematic review

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.

Evaluating the harmonization potential of oral health-related questionnaires in national longitudinal birth and child cohort surveys

BACKGROUND/OBJECTIVES

Effective use of longitudinal study data is challenging because of divergences in the construct definitions and measurement approaches over time, between studies and across disciplines. One approach to overcome these challenges is data harmonization. Data harmonization is a practice used to improve variable comparability and reduce heterogeneity across studies. This study describes the process used to evaluate the harmonization potential of oral health-related variables across each survey wave.

METHODS

National child cohort surveys with similar themes/objectives conducted in the last two decades were selected. The Maelstrom Research Guidelines were followed for harmonization potential evaluation.

RESULTS

Seven nationally representative child cohort surveys were included and questionnaires examined from 50 survey waves. Questionnaires were classified into three domains and fifteen constructs and summarized by age groups. A DataSchema (a list of core variables representing the suitable version of the oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonization status assessments, 543 (26%) were complete. Approximately 50% of the DataSchema variables can be generated across at least four cohort surveys while only 10% (n = 4) variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%.

CONCLUSION

Data harmonization can improve the comparability of variables both within and across surveys. For future cohort surveys, the authors advocate more consistency and standardization in survey questionnaires within and between surveys.

Dental decay in children and the link to weight status: A cross-sectional analysis of national school health data

Recent national reports have indicated an increasing trend of dental decay among school-aged children. National school-based data are required to guide decision-making to ensure effective public health efforts to manage dental decay. This study aimed to assess the prevalence of dental decay among school-age children in Saudi Arabia and explore the possible link between dental decay and weight status. This was a cross-sectional analysis of a national sample including 1,134,317 Saudi children in the 1st, 4th, 7th, and 10th grades who participated in a national school screening program. Data for weight, height, body mass index (BMI), dental decay prevalence, and decayed, missing, and filled teeth (DMFT) index were analysed. An independent t-test, one-way analysis of variance, and chi-square test were used to compare the means, while Pearson's r correlation and multiple linear regression were used to examine the relationships between the study variables. The prevalence of dental decay was 24.20%, and dental decay was the highest among female students (26.5%), students in primary school (25.9%), students living in the eastern region (35.2%), in the administrative capital (27.6%), and in rural areas (23.4%). Dental decay was the highest among students who were underweight. Female sex and living in rural areas significantly predicted higher DMFT while being overweight/obese significantly predicted lower DMFT. Dental decay is highly prevalent among underweight students, female students, and students living in rural areas and the eastern regions of Saudi Arabia. To reduce the prevalence of dental decay and related health disparities, dental health screening programs should be designed to detect dental decay early among children at high risk due to abnormal BMIs and sociodemographic factors. In addition, dental health screening and management programs should utilize standardized dental decay assessment methods and ethnically representative growth charts.

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.

Caries Experience before and after COVID-19 Restrictions: An Observational Study

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the suspension of several clinical practices globally, including dentistry. This study investigates the impact of these restrictions on dental caries experience. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University's dental hospital in the Lisbon Metropolitan Area from June 2019 to June 2021. The study involved 3380 participants who were divided into two cohorts: after and before COVID-19 restrictions. Data collection included a questionnaire, full-mouth clinical examinations, and radiographs (panoramic X-rays, bitewings). Results: Before the COVID-19 restrictions, the prevalence of dental caries was 91.8%, with an average DMFT (decayed, missing, and filled teeth) index of 12.13. Post-restrictions, the prevalence decreased to 84.5%, with a DMFT index of 10.99. There was an increase in missing teeth and a decrease in decayed and filled teeth. Additionally, the frequency of toothbrushing declined among participants. Conclusions: The COVID-19 pandemic restrictions have significantly impacted dental caries experiences and oral health, highlighting a decrease in dental caries, but also a concerning reduction in oral hygiene practices. These results emphasize the importance of customized dental healthcare during public health emergencies to reduce impacts and maintain oral health.

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 pattern of association between early childhood caries and body mass index in pre-school children within Aotearoa | New Zealand: a national cross-sectional study

OBJECTIVES

The relationship between childhood anthropometric measurements and dental caries has an inconsistent evidence-base. This study investigated dental caries experience and body mass index (BMI) measurements of children aged 4 years in a national cohort, after accounting for key confounding variables.

METHODS

A near whole-population cross-sectional study of children who had a health and developmental assessment, as part of the nationwide B4 School Check screening program, conducted in Aotearoa | New Zealand (ANZ) between 1 July 2010 and 30 June 2021 was studied. The extracted database included 582 820 children, of whom 572 523 (98.2%) had valid BMI and oral health records. Dental caries experience was derived from the 'lift the lip' oral health screening, and measured height and weight were used to calculate sex-specific BMI-for-age z-scores (BMIz). Analyses were adjusted for age, sex, ethnicity and area-level deprivation. Modified Poisson regression models using 2-degree fractional polynomial curves for BMIz were employed.

RESULTS

In the extracted sample, the median age was 4.3 years (interquartile range: 4.1-4.5 years), 283 565 (48.7%) were female, 135 734 (23.4%) and 74 237 (12.8%) were identified as Māori and Pacific, respectively, and 140 931 (24.4%) lived in the most deprived areas of ANZ. Overall, 81 926 (14.2%) had dental caries identified. In unadjusted analyses, a significant J-shaped association was observed between dental caries experience and BMIz. However, in the adjusted analysis, a significant flattened S-shaped association was found; those with lower BMIz had lower predicted probabilities of dental caries experience. Large differences in predicted probabilities were observed between different sex, ethnicity and area-level deprivation groups.

CONCLUSIONS

This study found significant non-linear associations between dental caries experience and BMI in 4-year-old children. However, the inclusion of confounders importantly changed the shape of this non-linear association. Sex, ethnicity and area-level deprivation inequalities had a greater impact on dental caries experience than BMI.

Adiposity is not associated with caries among youth in the United States

BACKGROUND

Body mass index has been traditionally used to determine the nutritional status of children in studies on obesity and caries. Imaging methods provide a superior assessment of body fat. This study investigated the relationship between measures of adiposity and caries in permanent teeth in children and adolescents.

METHODS

The analysis included 5,694 participants in the National Health and Nutrition Examination Survey from 2011 through 2018, aged 8 through 19 years. The body fat percentage (BF%) and fat mass index (FMI) were determined from whole-body dual-energy x-ray absorptiometry scans. Excess adiposity was defined as a sex- and age-specific value at or above the 75th percentile according to the US reference standards for BF% or FMI. Caries was measured with the decayed teeth and decayed, missing, and filled teeth indexes; prevalence of untreated dentin caries; and lifetime caries prevalence. The associations between adiposity and caries were tested in confounding variables-adjusted regression models.

RESULTS

The FMI score was associated with the decayed, missing, and filled teeth score (rate ratio, 1.03; 95% CI, 1.01 to 1.05) and lifetime caries prevalence (odds ratio, 1.06; 95% CI, 1.03 to 1.08), but the associations attenuated after adjustment for confounding variables. Neither the BF% score nor the presence of excess adiposity, defined according to the BF% or FMI reference standards, were associated with caries.

CONCLUSION

The authors found no association between measures of adiposity and caries among US children and adolescents.

PRACTICAL IMPLICATIONS

Caries is a multifactorial disease, and any observed association between obesity and caries is most likely due to the shared determinants and risk factors of both conditions.

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 gastroesophageal reflux disease and dental caries among adults in the Azar cohort population: A cross-sectional study

BACKGROUND

Considering the high prevalence of dental caries in adults, it is necessary to study its risk factors to prevent the disease. Gastroesophageal reflux disease (GERD) is a common chronic disease with an increasing incidence that may affect the quality and quantity of saliva.

OBJECTIVES

This study aimed to determine the association of gastroesophageal reflux disease (GERD) with dental caries according to the DMFT index in the Azar cohort population.

MATERIALS AND METHODS

This cross-sectional study was performed on data obtained from the enrollment phase of the Azar Cohort Study (ACS), conducted on 15,000 adults aged 35 to 70. Data of 905 subjects with gastroesophageal reflux disease in the ACS-without full denture-together with a control group of 1894 subjects, who were matched in terms of gender and age, were included in this study. Dental caries data and data on GERD, demographic and socioeconomic characteristics, individual and nutritional habits, BMI, and toothbrushing frequency were elicited from the databank of the ACS center. A Generalized Linear Models assuming negative binomial distribution with a log-link function was used for analytical statistics to examine the effect of possible confounding variables.

RESULTS

The DMFT index in the group with GERD was 15.09±6.18, and for the control group was 15.00±6.07. No statistical association was seen between GERD and dental caries. Among the variables included in the regression analysis, being younger and toothbrushing one or more times per day were associated with a lower DMFT index score.

CONCLUSION

According to the results, having GERD did not increase the risk of dental caries. However, due to the cross-sectional design of the study, the results should be interpreted cautiously. The results showed that oral hygiene is one of the most influential factors in reducing dental caries prevalence.

Exposure to household dysfunction at childhood and later number of teeth among older Japanese adults: A life course study from the Japan Gerontological Evaluation Study

OBJECTIVES

The aim of this retrospective cohort study was to investigate the life course association between exposure to two household dysfunctions (father violence against mother and parental divorce) at childhood (≤18 years) with later number of remaining teeth (≥65 years) in functionally independent older Japanese population. This was the first study to investigate this research question in the Asian context.

METHODS

The Japan Gerontological Evaluation study (JAGES) self-reported retrospective data gathered in 2013 was used (n = 21,604). Each household dysfunction was binary variable (Yes/No), while the five categories of the number of remaining teeth were ≥20, 10-19, 5-9, 1-4, and no teeth. Sex-stratified ordered logistic regression models were used to calculate the odds ratios (OR) of having fewer teeth. The models were adjusted for age, economic adversity in childhood, educational attainment, comorbidities, and smoking status.

RESULTS

Overall, 46.4% were men and a total of 1149 participants (5.3%) experienced household dysfunction at childhood [men = 642 (6.4%), women = 507 (4.4%)]. The regression models showed higher OR of having fewer teeth among men who experienced a household dysfunction [OR = 1.16; 95% Confidence interval (CI) = 1.00-1.36] than men who did not. This association was not observed among women [OR = 0.94; 95% CI = 0.79-1.13]. Similar magnitude and direction of the association was observed among men but not among women when the two components of household dysfunction were used separately and aggregately as exposure variables.

CONCLUSION

An exposure to a household dysfunction at childhood was associated with having fewer teeth in later life among men but not among women.

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.

Caries Experience and Risk Indicators in a Portuguese Population: A Cross-Sectional Study

Oral health surveys are essential for assessing the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analyze dental caries experience for which dental treatment was sought in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, and sociodemographic, behavior, and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9349 participants (5592 females/3757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR = 1.01, 95% CI [1.00-1.02], occupation (OR = 2.94, 95% CI [2.37-3.65], OR = 3.35, 95% CI [2.40-4.67], OR = 2.55, 95% CI [1.66-3.91], for employed, unemployed, and retired, respectively), overweight (OR = 1.52, 95% CI [1.18-1.96]), reporting to have never visited a dentist (OR = 0.38, 95% CI [0.23-0.64], and self-reported week teeth status (OR = 2.14, 95% CI [1.40-3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal.

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.

Association between dental caries and obesity among Libyan schoolchildren during the armed conflict in Benghazi

BACKGROUND

Dental caries and Obesity in children are issues of public health concern. Even though researching the relationship between these two noncommunicable diseases has been conducted for many years, the results remain equivocal. This paper aimed to examine the association between dental caries and obesity among 12-year-old schoolchildren living in war-affected environment in Benghazi.

METHODS

A secondary analysis of a cross-sectional study was conducted to determine the prevalence of caries among 12-year-old school children in Benghazi in 2017 during the armed conflict that affected the city. The data extracted for the analysis included sociodemographic of the participants (gender, maternal education and school type), caries experience (DMFT index), and anthropometric measures (height in cm, weight in kg, BMI and Z score for BMI). Comparisons of anthropometric measures were conducted according to caries experience. Linear regression models were developed to determine the association between Body Mass Index and Z score as outcome variables, caries as an explanatory variable, and covariates (gender, maternal education and school type). Beta coefficient (β) and 95% confidence intervals were calculated. All statistical tests were conducted at p ≤ 0.05.

RESULTS

There were 782 children with a mean (SD) BMI of 20.7 SD5.09 and an average z (SD) score of 0.56 SD1.51. Also, 159 (20%) children had obesity. No significant association was observed between caries and anthropometric measures. However, higher BMI was observed in children from a private school (p ≤ 0.001***), females (p ≤ 0.001***) and self-reported regular sugary drinks consumers (p ≤ 0.001***).

CONCLUSION

The present study shows no significant association between dental caries and anthropometric measures. However, the study findings support the notion of tackling sugar intake as a common risk factor for caries and obesity, which should be encouraged in the Libyan culture.

Body Mass Index and Caries: Machine Learning and Statistical Analytics of the Dental, Oral, Medical Epidemiological (DOME) Nationwide Big Data Study

The objectives of the research were to analyze the association between Body Mass Index (BMI) and dental caries using novel approaches of both statistical and machine learning (ML) models while adjusting for cardiovascular risk factors and metabolic syndrome (MetS) components, consequences, and related conditions. This research is a data-driven analysis of the Dental, Oral, Medical Epidemiological (DOME) big data repository, that integrates comprehensive socio-demographic, medical, and dental databases of a nationwide sample of dental attendees to military dental clinics for 1 year aged 18−50 years. Obesity categories were defined according to the World Health Organization (WHO): under-weight: BMI < 18.5 kg/m2, normal weight: BMI 18.5 to 24.9 kg/m2, overweight: BMI 25 to 29.9 kg/m2, and obesity: BMI ≥ 30 kg/m2. General linear models were used with the mean number of decayed teeth as the dependent variable across BMI categories, adjusted for (1) socio-demographics, (2) health-related habits, and (3) each of the diseases comprising the MetS definition MetS and long-term sequelae as well as associated illnesses, such as hypertension, diabetes, hyperlipidemia, cardiovascular disease, obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD). After the statistical analysis, we run the XGBoost machine learning algorithm on the same set of clinical features to explore the features’ importance according to the dichotomous target variable of decayed teeth as well as the obesity category. The study included 66,790 subjects with a mean age of 22.8 ± 7.1. The mean BMI score was 24.2 ± 4.3 kg/m2. The distribution of BMI categories: underweight (3113 subjects, 4.7%), normal weight (38,924 subjects, 59.2%), overweight (16,966, 25.8%), and obesity (6736, 10.2%). Compared to normal weight (2.02 ± 2.79), the number of decayed teeth was statistically significantly higher in subjects with obesity [2.40 ± 3.00; OR = 1.46 (1.35−1.57)], underweight [2.36 ± 3.04; OR = 1.40 (1.26−1.56)] and overweight [2.08 ± 2.76, OR = 1.05 (1.01−1.11)]. Following adjustment, the associations persisted for obesity [OR = 1.56 (1.39−1.76)] and underweight [OR = 1.29 (1.16−1.45)], but not for overweight [OR = 1.11 (1.05−1.17)]. Features important according to the XGBoost model were socioeconomic status, teeth brushing, birth country, and sweetened beverage consumption, which are well-known risk factors of caries. Among those variables was also our main theory independent variable: BMI categories. We also performed clinical features importance based on XGBoost with obesity set as the target variable and received an AUC of 0.702, and accuracy of 0.896, which are considered excellent discrimination, and the major features that are increasing the risk of obesity there were: hypertension, NAFLD, SES, smoking, teeth brushing, age as well as our main theory dependent variable: caries as a dichotomized variable (Yes/no). The study demonstrates a positive association between underweight and obesity BMI categories and caries, independent of the socio-demographic, health-related practices, and other systemic conditions related to MetS that were studied. Better allocation of resources is recommended, focusing on populations underweight and obese in need of dental care.

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.

The role of oral health-related quality of life in the association between dental caries and height, weight and BMI among children in Bangladesh

OBJECTIVES

To examine whether oral health-related quality of life (OHRQoL) explained the negative associations between dental caries and anthropometric measures of child growth among a sample of 5- to 9-year-old children in Dhaka, Bangladesh, while taking potential confounding factors (maternal education, family income, study setting, child's birth weight and childhood diseases) into account. In addition, to test whether specific oral impacts had a role in explaining these associations.

METHODS

Data collection was conducted via a cross-sectional survey among children and their parents from both hospital and school settings in Dhaka. Dental caries and severe consequences of dental caries (defined here as dental sepsis) were the exposure variables, and age- and sex-adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ) were the outcome variables. OHRQoL was measured using the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). First, associations between oral impacts (prevalence of overall impacts and specific items of the SOHO-5) and outcome measures were assessed. Multiple linear regression was used to assess associations between caries and anthropometric measures, adjusted for potential confounders. Oral impacts were then added to test whether their inclusion attenuated the associations between exposures and outcomes. To further investigate potential mediating role of oral impacts, structural equation modelling (SEM) was used to test the hypothesis that dental caries and sepsis were associated with the outcomes directly and also indirectly via oral impacts in general. A similar approach was used to investigate mediation by specific SOHO-5 items.

RESULTS

The sample consisted of 715 children, 73.1% of whom had dental caries, 37.5% presented with sepsis, and 57.3% reported at least one oral impact (SOHO-5 score ≥1). Prevalence of overall oral impacts and also the impact on 'eating difficulty' (a specific item of SOHO-5) were negatively associated with all three outcomes. Dental caries and sepsis was associated with lower HAZ, WAZ and BAZ, and adjustment for overall oral impacts considerably attenuated the associations between 'severe dental caries' and outcomes, and dental sepsis and outcomes. Using SEM, we found significant indirect associations between caries and sepsis and anthropometric measures via oral impacts (except for dental caries and HAZ). Considering specific oral impacts, eating difficulties explained about 44% and 65% of the associations between caries and anthropometric outcomes, and dental sepsis and anthropometric outcomes, respectively.

CONCLUSIONS

Oral impacts, in particular eating difficulties, appear to mediate associations between caries and markers of child growth among this population.

Excess Weight and Dental Caries throughout Childhood and Adolescence: Systematic Review of Longitudinal Studies

Objective

The aim of the present study was to analyze existing scientific evidence on the longitudinal association between overweight/obesity and dental caries in children and adolescents and indicate possible gaps in the literature to guide future studies.

Study design

A systematic search of the literature was performed for the identification of longitudinal studies on this issue. The search strategy included words related to the outcome (dental caries), exposure (overweight/obesity), population (children and adolescents), and study design (longitudinal) of interest. Searches were performed in the PubMed, Web of Science, and Latin American and Caribbean Health Sciences Literature (LILACS) databases. The risk of bias in the studies was appraised using the tool for the critical analysis of cohort studies proposed by the Joanna Briggs Institute.

Results

Among the 400 studies retrieved from the databases, only seven met the inclusion criteria and were selected to compose the present review. Five of the studies had a low risk of bias, but all had methodological flaws. As the studies reported different findings, the association between obesity and dental caries continues to be undefined. Moreover, there is a lack of well-designed studies on this issue with standardized methods to enable comparisons.

Conclusion

Future studies should consider longitudinal designs, more precise diagnostic methods for obesity and dental caries, as well as the rigorous control of confounding factors and effect modifiers.

How to cite this article

Silveira MG, Schneider BC, Tillmann TF, et al. Excess Weight and Dental Caries throughout Childhood and Adolescence: Systematic Review of Longitudinal Studies. Int J Clin Pediatr Dent 2022;15(6):691-698.

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.

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.

Association between Body Mass Index (BMI) and Dental Caries among 6-12-Year-Old School Children

This study aimed to identify the association between BMI and dental caries in 6−12-year-old children. This cross-sectional study was carried out among 6−12-year-old school children and their parents. The data on Body Mass Index (BMI) and dental caries for study participants were included in the study. The association between BMI and dental caries was evaluated using SPSS software. The study comprises 400 school children (157 boys and 243 girls) aged an average of 8.9 years. The overall prevalence of dental caries was 84% in primary dentition and 75% in permanent dentition, with a mean DMFT and dmft (decayed, missing and filled teeth) of 2.85 and 5.48, respectively. There was a significant association witnessed between mothers’ education and BMI status. A significant association was also evident between decayed (d), missing (m) and filled (f) teeth and overall dmft with different BMI categories (p < 0.05). There was no significant association evident between DMFT and each category of BMI (p > 0.05). The dmft and DMFT within the four BMI categories by one-way ANOVA were highly significant (p < 0.001). Post hoc analysis helped us identify the relationship among the various categories of BMI with dental caries. There was a positive association evident between the BMI of the children and dental caries.

Relationship between Salivary Alpha-Amylase Enzyme Activity, Anthropometric Indices, Dietary Habits, and Early Childhood Dental Caries

Objectives

Although early childhood dental caries (ECC) have the same general etiology as other types of caries, predisposing factors are not well elucidated. This study aimed to investigate the effect of salivary alpha-amylase (sAA) activity, body mass index (BMI), dietary habits, and oral hygiene on ECC.

Methods

This cross-sectional study was performed on 38 ECC-affected and 41 caries-free children, aged 36 to 72 months. Upon the parents' consent, 3 mL of non-stimulated saliva was collected from the participants to measure the level of sAA activity through spectrophotometry. Additionally, parents/caretakers completed a structured questionnaire about demographic factors, oral hygiene, and consumption of sugar-containing foods. BMI, BMI z-scores, and percentile data were calculated by using an online calculator. The independent variables were dichotomized and tested through chi-square test, followed by a stepwise logistic regression, by using SPSS software (α = 0.05).

Results

The sAA activity was significantly higher in caries-free children (P ≤ 0.001). However, the mean BMI was not significantly different between the two groups (P=0.49). Brushing and other measured dietary habits were significantly associated with the development of ECC (P ≤ 0.001). According to the results of the logistic regression, sAA activity was shown to be a predictor for ECC development (Odds ratio (95% confidence interval): 0.9 (0.95–0.98)).

Conclusion

Children with inherently lower levels of sAA activity were more susceptible to dental caries. Improper nutritional habits and poor oral health care could exacerbate the risk of ECC.

Childhood malnutrition and hypo mineralized molar defects ;a cross sectional study, Egypt

Background:  Malnutrition is well-known to yield high morbidities and it has pre-eruptive and post-eruptive consequences. The objective of the study was to evaluate the prevalence of Hypomineralized Second Primary Molars (HSPM), Molar Incisor Hypomineralization (MIH) and dental caries in malnourished children, as well as addressing the relation between types of malnutrition and the dental morbidities.

Methods: This is a cross sectional analytical study. A consecutive sample of 54 malnourished cases aged 5-10 years and presented to the Outpatient Clinic of Pediatric Dentistry Department, Faculty of Dentistry, Cairo University across 6 months period were examined for HSPM, MIH – using the  European Academy of Pediatric Dentistry criteria - and dental Caries using def/ DMF indices. Outcomes were the presence or absence of MIH and HSPM and their levels measured as percentage as well as Caries Indices. Exposures were types of malnutrition and the socioeconomic status.

  Results :  The mean age of study participants was 7.10 ± 1.34 years. HSPM and MIH were found in 47.2% and 45.2% of the study participants respectively, while dental caries was observed in 83% and 64.3% for primary and permanent teeth respectively. There was co-occurrence between HSPM and MIH in 39% of the cases.

HSPM level was significantly different in various types of malnutrition. It showed significant difference between the stunted group (median HSPM of 14.2%) and the overweight or obese group (median HSPM of 0.0%) (P value 0.01). MIH level showed significant differences between the stunted group (median MIH of 19.4%) and overweight or obese group (median MIH of 0.0%) (p value 0.001), as well as between the stunted group (median MIH of 19.4%) and wasted group (median MIH of 0.0%) (p value 0.025).

Conclusions : Malnourished children have high prevalence of dental abnormalities. HSPM could expect the presence of MIH.

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.

Eating Disorders in the Adolescent Patient

Eating disorders such as anorexia nervosa, female athlete triad, bulimia nervosa, obesity, and binge eating initially emerge during adolescence. These disorders are present primarily in females, but males may also present with these conditions. Dentistry has a pivotal role in the management of patients with such diet-related disorders. Because dentists examine their patients at frequent intervals and may be the health care professionals with whom patients feel more comfortable discussing eating disorders, dentists must have knowledge of the etiology, diagnostic criteria, systemic effects, and intraoral manifestations of eating disorders. In addition, the dental professional may be the first health care provider to identify the condition and refer the patient appropriately to medical colleagues for subsequent treatment. This chapter provides dentists with current and relevant information to recognize, diagnose, and integrate dental treatment for their adolescent patients who may exhibit manifestations of an eating disorder.

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.

Body Mass Index and Dental Caries, a Five-Year Follow-Up Study in Mexican Children

There are conflicting reports on a possible association between body mass index (BMI) and caries. Given the ongoing worldwide increase in obesity, we undertook a 5-year follow-up study on 201 Mexican schoolchildren to analyse their BMI and dental caries experience. The children's weight and height were recorded, and their BMI was calculated using the WHO tables. Decayed, missing, and filled surfaces in both dentitions (dmf/DMFS) were assessed annually according to WHO criteria by two calibrated researchers (Kappa value 0.92 p < 0.001). The means, standard deviation, an ANOVA, and Student's t-test were calculated to analyse the relationship between the variables. At baseline, the children had an average of 6.5 ± 0.5 years, a BMI of 17.2 ± 3.1 (CI_95% 16.8-17.6). Their weight's classifications were 61% normal, 19% obese, 17% overweight, and 3% showed thinness. At the end of the study, their BMI were 20.6 ± 4.4 (CI_95% 19.8-21.5), 53% normal, 15% obese, 30% overweight, and 2% thin. The children's dmfs decreased from 5.8 ± 9.2 to 1.8 ± 3.4 and the DMFS increased from 0.07 ± 05 to 1.4 ± 2.3. In this population based on a 5-year follow-up, caries prevalence and incidence were not significantly associated with the BMI. However, schoolchildren with malnutrition had the highest caries indexes.

Anthropometric Status, Diet, and Dental Caries among Schoolchildren

Childhood dental caries and obesity are prevalent health problems. Results from previous studies of the caries–obesity relationship are conflicting. This study aimed to assess the association between anthropometric status and dental caries among schoolchildren, taking into account dietary habits, oral hygiene, and sociodemographic factors. This cross-sectional study recruited 569 children aged 6–12 years from five elementary schools in central Taiwan. Each child underwent an oral health examination and anthropometric measurements. The DMFT (decayed, missing due to caries, and filled permanent teeth) and deft (decayed, extracted, and filled primary teeth) indexes were calculated to record caries experience. A structured questionnaire was used to collect information on food intake frequency and other related factors. The World Health Organization’s reference data was applied to define weight status: obese, overweight, and normal/underweight. The results showed that the mean (±standard deviation) deft and DMFT scores were 2.3 ± 2.6 and 0.7 ± 1.2, respectively, among participating children. The prevalence of obesity and overweight was 18.1% and 18.5%, respectively. After comprehensive evaluation of potential confounders, weight status was not an independent predictor of DMFT or deft scores in the negative binomial regression models. In conclusion, weight status was not associated with caries scores in primary or permanent teeth among 6–12 year-old schoolchildren.

Databases Selection in a Systematic Review of the Association between Anthropometric Measurements and Dental Caries among Children in Asia

A comprehensive search for primary studies using a sufficient number and relevant databases is critical to minimise bias and increase the validity of a systematic review. We examined the frequency and choices of databases commonly used to provide an efficient search of primary studies for a systematic review of anthropometric measurements and dental caries among children in Asia. Twelve previous systematic reviews on a similar topic were retrieved from six databases. The frequency and choice of databases used by reviewers were determined from the methods sections. We also identified the lists of other databases usually searched in other reviews. Eligibility criteria for final databases selection were the database's scope, the topic of interest, design of the study, type of article, and the accessibility of the databases. Of the 77 databases identified, previous reviews on this topic used 21 databases, ranging from 2 to 12 databases in each review. Medline, Cochrane Library, Web of Science, and PubMed were employed most frequently. Twenty-six databases were eligible and selected for the present review. Twelve were regional databases to provide comprehensive coverage of primary studies. A systematic approach in selecting appropriate databases for searching primary studies is paramount to reduce errors, ensure coverage, and increase the validity of systematic reviews' conclusions.

Oral health of overweight and obese children and adolescents: a comparative study with a multivariate analysis of risk indicators

PURPOSE

The aim of this study was to investigate the oral health status of overweight and obese children compared to normal weight children and to explore the effect of risk indicators, including stress, on the oral health of the children.

METHODS

For this cross-sectional study, 7-15-year-old children were enrolled: divided into a group of overweight and obese and a group of normal weight children. Parent-reported questionnaires were used to for data collection demographic data, children's medical and developmental history, brushing frequency and dietary habits. Participants' state and trait anxiety levels were evaluated using STAIC questionnaires while saliva cortisol was measured as a biomarker of stress. Dental Caries (DMFT/dmft), periodontal health (plaque index-PI and gingival index-GI), saliva flow rate and buffer capacity were recorded at the dental clinic by two calibrated examiners. Student's t-test, Pearson's r and Fisher's exact test were used for bivariate associations and backward stepwise multivariate regression analysis for each oral health outcome was performed (P ≤ 0.05).

RESULTS

Overweight and obese children had significantly higher DMFT (3.92 ± 4.69 vs. 1.30 ± 2.49, P < 0.001), PI (0.9 ± 0.5 vs. 0.45 ± 0.52, P < 0,001) and GI (0.38 ± 0.39 vs. 0.18 ± 0.47, P < 0,001), salivary cortisol AUC (128.3 ± 55.5 vs. 99.4 ± 35.7, P = 0.004), lower saliva flow rate and decreased "high" saliva buffer capacity. There were no differences for the STAIC measures between the groups. Child's weight affected periodontal parameters but not dental caries, when controlling for other risk indicators.

CONCLUSION

Oral status of overweight and obese children was worse compared to normal weight children and this did not correlate to stress variables.

Age at first childbirth in relation to oral health later in life

OBJECTIVE

This study aimed to examine the relationship between age at first childbirth and oral health. The mediation effect of body mass index (BMI) on this relationship was also determined.

METHODS

This study analyzed data of 2,506 parous postmenopausal women aged 50 or older from the Korea National Health and Nutrition Examination Survey 2013-2015. Chewing inconvenience was investigated by an oral interview. Periodontitis and dental caries were determined through dental examinations. Multivariable logistic regression analysis was performed to examine the relationship between age at first childbirth and oral health, and mediation analysis was performed to examine the contribution of BMI on the relationship between age at first childbirth and oral health.

RESULTS

Women who underwent their first delivery between the age of 26 and 46 years had significantly decreased odds of chewing inconvenience (odds ratio [OR] = 0.72, 95% confidence interval [95% CI] = 0.56-0.93, P = 0.010) compared with the odds of those women whose first delivery was between at the age of 15 and 22 years. We also found a significant linear relationships between age at first childbirth and odds of chewing inconvenience (OR = 0.83, 95% CI = 0.74-0.95, P = 0.017) and dental caries (OR = 0.84, 95% CI = 0.74-0.96, P = 0.025). BMI accounted for 12.9% of the relationship between age at first childbirth and dental caries. Age at first childbirth was only indirectly associated with periodontitis through BMI (OR = 0.98, 95% CI = 0.96-0.99, P = 0.003).

CONCLUSIONS

Women whose first delivery occurred at a young age had significantly increased odds of chewing inconvenience and dental caries. BMI mediated the relationships between age at first childbirth and periodontitis and dental caries.

Association of Dental Caries and Anthropometric Measures among Primary School Children

Aim: This study aimed to investigate an association between dental caries status and anthropometric measures in primary school children. Methods and Materials: An analytical cross-sectional study (n = 376) was conducted among primary school children (age range = 6–9 years) registered in private schools. Non-clinical data was gathered from parents of participating children through a self-administered structured questionnaire as well as from the children through an interviewer-administered questionnaire. Clinical data included the examination of dental caries using dmft/DMFT index and anthropometric measures including calculated z-scores of height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age (BAZ), and physical examination. Inferential statistics included Kruskal Wallis and linear regression for univariate and multivariate analysis respectively. Results: The proportion of dental caries in primary and secondary dentition was 67.6% and 8.2% respectively. A significant association was observed between dental caries status and HAZ, WAZ, and BAZ (p < 0.001). An inverse relation was found between low, medium, and high dental caries categories and anthropometric measures. Conclusions: In the primary dentition, dental caries were significantly and inversely related to weight-for-age, height-for-age, and BMI-for-age. Hence, it can be concluded that among the low-income population dental caries is associated with lower anthropometric outcomes in children and therefore caries management should be considered an approach impacting overall health and quality of life.

Assessing the Association Between Nutritional Status, Caries, and Gingivitis in Schoolchildren: A Cross-Sectional Study

Objective. To evaluate if nutritional status is associated with caries and gingivitis in Brazilian schoolchildren. Material and methods. Children of both genders, age ranging from 8 to 11 years old, were included in this study. Caries was diagnosed using ICDAS (International System for Detection and Assessment of Carious Lesions) and gingivitis was diagnosed using the Community Periodontal Index. The nutritional status of each child was defined by BMI Z-score calculation. Data on oral health behavior and dietary habit were collected through parent's questionnaires. Parametric analyzes were performed to compare the groups. The established alpha was 5%. Results. The sample consisted of 353 schoolchildren: 16 underweight children, 247 eutrophic children, 64 overweight children, and 26 were obese children. Overweight, Obese and Overweight + Obese children presented less cavitated caries lesion than Eutrophic children (P < .05). Gingivitis was not associated with nutritional status (P > .05). Conclusion. Caries was associated with overweight and obesity in Brazilian schoolchildren.

Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers

Background: The persistently high prevalence of undernutrition in Cambodia, in particular stunting or chronic malnutrition, calls for innovative investigation into the risk factors that affect children’s growth during critical phases of development. Methods: Secondary data analysis was performed on a subgroup of children who were present at two time points within the Cambodian Health and Nutrition Monitoring Study (CAHENMS) and who were less than 24 months of age at the nominated baseline. Data consisted of parent interviews on sociodemographic characteristics and feeding practices, and clinical measures for anthropometric measures and dental status. Logistic regression modelling was used to examine the associations between severe dental caries (tooth decay)—as indicated by the Significant Caries Index—and the presence of new cases of stunting malnutrition at follow-up. Results: There were 1595 children who met the inclusion criteria and 1307 (81.9%) were followed after one year. At baseline, 14.4% of the children had severe dental caries, 25.6% presented with stunted growth. 17.6% of the children transitioned from healthy status to a low height-for-age over the observation period. Children with severe dental caries had nearly double the risk (OR = 1.8; CI 1.0–3.0) of making that transition. Conclusion: Severe caries experience was associated with poorer childhood growth and, as such, could be an underinvestigated contributor to stunting.

Association of BMI, Diet, Physical Activity, and Oral Hygiene Practices with DMFT Index of Male Dental Students at King Faisal University, Al-Ahsa

Despite sufficient knowledge of good oral hygiene habits, dental students still suffer from oral health problems owing to dietary habits, obesity, and a sedentary lifestyle. This cross-sectional study was conducted to evaluate an association of BMI (body mass index), diet, physical activity, and oral hygiene practices with DMFT (decayed, missing, and filled teeth) of male dental students and interns at King Faisal University, Saudi Arabia, from August to September 2020. One hundred and eighty-five male participants completed the study questionnaire. The questionnaire consisted of sociodemographic information and nineteen close-ended questions about current diet, physical activity, and oral hygiene practices. Students’ height (cm) and weight (kg) were measured to calculate BMI. The principal investigator performed the oral clinical examinations for the DMFT status in the dental clinic. The chi-square test was used for the dichotomous variables and a t-test was used for the continuous variables. Linear and multinomial logistic regression were performed to detect the significant predictors of the DMFT score. The mean age of participants was 22.29 ± 2.13 years, and the BMI was 24.94 ± 3.36 (Kg/m²). Parents’ higher education and income levels were significantly (p < 0.001) associated with a higher BMI. Most dietary variables, especially sugar products, and low physical activity, were significantly (<0.047) associated with higher BMI. All oral hygiene practices, except miswak and mouthwash, were significantly (<0.003) associated with higher BMI. Decayed and missing teeth were significantly (<0.001) higher in the overweight and obese. A simple linear regression analysis demonstrated association between BMI and decayed teeth, with an R = 0.35 (<0.001); BMI and missing teeth had an R = 0.12 (p = 0.867); BMI and filled teeth had an R = 0.15 (p = 0.033), and BMI with DMFT had an R = 0.33 ((<0.001). This study demonstrated a strong significant association of the decayed and missing teeth with higher BMI levels. In addition, BMI was significantly associated with diet and physical activity, despite acceptable oral hygiene practices.

Relationship between Obesity and Dental Caries in Saudi Male Adolescents

Introduction

Obesity and dental caries are global public health problems. There are conflicting reports about the relationship between caries and obesity. Therefore, the study aimed to investigate the association between obesity and dental caries among male adolescents.

Materials and Methods

This cross-sectional study included a sample of 258 male students' aged 12 to 15 years from schools in Dammam/Al-Khobar, Saudi Arabia. The study involved measuring caries prevalence and DMFT estimates, assessing body mass index (BMI), and administering a self-completion questionnaire. Independent samples Student's t-test, one-way ANOVA test, Pearson's correlation test, and bivariate and multivariate logistic regression analyses were performed.

Results

Caries prevalence of the sample was 79.8%, and the mean score of DMFT was 3.55 ± 2.94. The mean BMI of participants was 23.42 ± 6.82 and 18% were obese (BMI > 30). The obese participants had a higher mean DMFT score (4.46 ± 3.54) than nonobese participants (3.35 ± 2.77) (P=0.021). Similarly, the mean untreated caries was higher in obese (4.17 ± 3.22) than in nonobese participants (3.01 ± 2.66) (P=0.010). In the logistic regression analysis, after controlling for father's education, family history of obesity, meals per day, fast food per week, and physical activity in the final model, the participants with high caries experience (DMFT = 5-15) were 2.21 times more likely to have obesity than those with low caries experience (DMFT = 0-4) (P=0.04). No/school education of father (odds ratio 3.54, P=0.011), family history of obesity (odds ratio 3.27, P=0.002), and not performing physical activity (odds ratio 4.37, P=0.002) were significantly associated with an increased likelihood of obesity.

Conclusion

The prevalence of caries and obesity was high in male adolescents in Saudi Arabia. Obesity was significantly associated with untreated caries and caries experience. Children with high caries experience were more likely to have obesity than children with low caries experience. Preventive programs and policies should address public health issues related to caries and obesity in male teenagers.

Is there an association between body weight and early childhood caries experience?

Data sources PubMed, Cochrane Library, and Google Scholar. Study selection Papers reporting a primary study in non-syndromatic preschool children aged 0-6 years, reporting body weight and dental caries experience as outcomes.Data extraction and synthesis Two reviewers independently screened the titles and abstracts of the identified citations for relevance. The full text articles were subsequently assessed for eligibility for both qualitative and quantitative review. Body weight outcomes were standardised into four groups; 'underweight' (BMI-for-age percentile less than five), 'normal weight' (BMI-for-age percentile between five and 85), 'overweight' (BMI-for-age percentile between 85 and 95), and 'obese' (BMI-for-age percentile greater than 95). Dental caries outcomes were based on decayed, missing, and filled teeth/surfaces (dmft/dmfs) index. The risk of bias in individual studies were assessed based on the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The GRADE system was used to perform quality assessment for each outcome reported.Results Following screening of 293 articles, a total of 32 studies qualified for qualitative review and 12 of them reported data that was used to conduct a meta-analysis. All included studies were cross-sectional in nature and presented a high risk of bias. Findings from meta-analysis showed that children who are overweight have a significantly higher dmft index (95% CI -0.64 to -0.14, P = 0.002, I2 equals 62 percent). The quality of evidence was found to be moderate.Conclusions Overweight and obese preschool children are at a greater risk of developing caries. Public health prevention programmes must target both conditions together to reduce their burden and effectiveness of prevention strategies.

The relationship between obesity and dental caries according to life style factors in schoolchildren: a case-control study

Objectives: To evaluate the association between obesity and dental caries in terms of life-style habits and socio-economic status in Turkish school children.Materials and methods: This case-control study was undertaken with 178 children aged 6-11 years in a Turkish government children's hospital. The case group consisted of 86 obese children who were categorized in ≥95 percentile according to the BMI. The control group consisted of 90 non-obese children that would not raise any doubts about the teeth disease. Data of demographic features and life-style habits were obtained by a questionnaire at the dental examination. Caries experience was measured with DMFT and dmft indices.Results: No difference was found between obesity and caries prevalence in primary dentition (p = .957); however, there was a statistically significant association in the permanent dentition (p = .002). Also, no differences were found in children with healthy natural teeth between the study groups according to education level, family income and food consumption during TV viewing in primary dentition (p = .297; p = .652; p = .023).Conclusions: It can be concluded that obesity appears to be not a possible risk factor for dental caries in primary dentition, but would be a probable endangerment in the permanent dentition.

Correlation between Caries, Body Mass Index and Occlusion in an Italian Pediatric Patients Sample: A Transverse Observational Study

BACKGROUND

The aim of this study was to evaluate the correlation between caries, body mass index (BMI) and occlusion in a sample of pediatric patients.

METHODS

The study group included 127 patients (72 female, 55 male) aged between 6 and 16 years (mean age 10.2) and selected between January and June 2019 at the Department of Pediatric Dentistry, University of Messina. Caries incidence was evaluated using the decayed, missing and filled teeth (DMFT) index. On the basis of BMI values, using a table adjusted for age and gender, patients were grouped into four categories (underweight, normal weight, risk of overweight, overweight).

RESULTS

There was no significant correlation between BMI and DMFT in the whole sample. The study of the correlation between BMI and DMFT in patients with different types of malocclusion showed a significant inverse correlation for patients affected by II class and deepbite malocclusion.

CONCLUSIONS

The incidence of caries does not seem to be significantly related to BMI and occlusal patterns, but it decreases with increasing age.

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

Obesity and dental caries in children are significant health problems. The aims of this review are to identify whether children aged 6 years and younger with overweight and/or obesity have higher dental caries experience compared with children with normal weight and, secondly, to identify the common risk factors associated with both conditions. Medline, Embase, and seven other databases were systematically searched followed by lateral searches from reference lists, grey literature, theses, conference proceedings, and contacting field experts. Longitudinal observational studies addressing overweight and/or obesity and dental caries in children aged 6 years and younger were included. A random effects model meta-analyses were applied. Nine studies were included in this review. Children with overweight and obesity had a significantly higher dental caries experience compared with children with normal weight (n = 6). The pooled estimates showed that difference in caries experience between the two groups was statistically significant. Low levels of parental income and education were identified to be associated with both conditions in the sample population. Children with overweight and obesity are more vulnerable to dental caries. Low levels of parental income and education influence the relationship between the two conditions. However, the quality of evidence varied considerably; therefore, findings should be interpreted cautiously.

Is there an association between children's screen use and cariogenic diet?

Data sources Databases searched included the International Database for Medical Research MEDLINE/Pubmed, ISI Web of Science, Scopus, Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Health Sciences (LILACS).Study selection Studies of observational design that examined the association between any screen-time behaviour and dietary intake in preschool and school-aged children (younger than 12 years) were selected by two independent reviewers. If a consensus could not be reached, a third reviewer was consulted.Data extraction and synthesis Data were extracted independently by two reviewers using a pre-tested data extraction form. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale for cross-sectional studies. A PRISMA flow chart was used to present the study selection results. The GRADE system was used to evaluate the strength of evidence. A qualitative synthesis was used to report the results. A meta-analysis was not conducted.Results Nineteen studies were included in the review, all of which were of cross sectional design or conducted cross-sectional analysis. Fourteen studies were assessed as high quality, three as moderate quality and two as low quality. All studies found a significant positive association between television and/or total screen-time viewing and poor quality diet including lower intake of fruit and vegetables and higher intake of unhealthy foods. Screen-based sedentary behaviour was positively associated with cariogenic foods consumption in 15 studies. Based on the GRADE rating, there was moderate evidence of an association between TV viewing and intake of potentially cariogenic diet.Conclusions Although there could be an association between TV viewing and poor quality cariogenic diet in preschool and school-aged children, the authors conclude that the strength of evidence is limited.Commentary.

Association between body mass index and dental caries in the Kingdom of Saudi Arabia: Systematic review

Objective

The Kingdom of Saudi Arabia (KSA) has one of the highest prevalence of both obesity and dental caries. To date, there has not been any documented evidence linking these two factors. Therefore, the objective was to conduct a systematic review of published studies that have analysed the association between body mass index and dental caries in the KSA for both children and adults.

Methods

A systematic database search [PubMed, EMBASE, Web of Science, CINAHL and Cochrane Library] was conducted following the PRISMA guidelines. The inclusion criteria were observational studies, with no limit on the publication date. Search terms included: dental caries, obesity, overweight, body mass index, BMI 'AND' Saudi Arabia. The independent variable was body mass index (BMI), and the primary outcome measure was dental caries prevalence and severity.

Results

From 951 search results, 935 citations were identified and excluded. Of the 16 potentially eligible studies, two citations were excluded, because the studies did not meet the inclusion criteria. This left fourteen studies meeting the criteria to be included in this systematic review. Ten studies outlined children, and four studies assessed adults. For children, two studies resulted in a positive association between high BMI and caries, six studies resulted in a negative association, and two studies had a non-significant association. For adults, two studies resulted in a positive association between high BMI and dental caries, and two studies had a non-significant association. These were rated as having low to moderate risk of bias.

Conclusion

As a result of this equivocal outcome within the systematic review, body mass index and dental caries present as a complex association. Further long-term studies are required to translate the findings into clinical practice.