Association between overweight, obesity and incidence of advanced dental caries in South Korean adults: A 10-year nationwide population-based observational study

Correlation between tooth decay and insulin resistance in normal weight males prompts a role for myo-inositol as a regenerative factor in dentistry and oral surgery: a feasibility study

Background

In an era of precision and stratified medicine, homogeneity in population-based cohorts, stringent causative entry, and pattern analysis of datasets are key elements to investigate medical treatments. Adhering to these principles, we collected in vivo and in vitro data pointing to an insulin-sensitizing/insulin-mimetic effect of myo-inositol (MYO) relevant to cell regeneration in dentistry and oral surgery. Confirmation of this possibility was obtained by in silico analysis of the relation between in vivo and in vitro results (the so-called bed-to-benchside reverse translational approach).

Results

Fourteen subjects over the 266 screened were young adult, normal weight, euglycemic, sedentary males having normal appetite, free diet, with a regular three-times-a-day eating schedule, standard dental hygiene, and negligible malocclusion/enamel defects. Occlusal caries were detected by fluorescence videoscanning, whereas body composition and energy balance were estimated with plicometry, predictive equations, and handgrip. Statistically significant correlations (Pearson r coefficient) were found between the number of occlusal caries and anthropometric indexes predicting insulin resistance (IR) in relation to the abdominal/visceral fat mass, fat-free mass, muscular strength, and energy expenditure adjusted to the fat and muscle stores. This indicated a role for IR in affecting dentin reparative processes. Consistently, in vitro administration of MYO to HUVEC and Swiss NIH3T3 cells in concentrations corresponding to those administered in vivo to reduce IR resulted in statistically significant cell replication (ANOVA/Turkey tests), suggesting that MYO has the potential to counteract inhibitory effects of IR on dental vascular and stromal cells turnover. Finally, in in silico experiments, quantitative evaluation (WOE and information value) of a bioinformatic Clinical Outcome Pathway confirmed that in vitro trophic effects of MYO could be transferred in vivo with high predictability, providing robust credence of its efficacy for oral health.

Conclusion

Our reverse bed-to-benchside data indicate that MYO might antagonize the detrimental effects of IR on tooth decay. This provides feasibility for clinical studies on MYO as a regenerative factor in dentistry and oral surgery, including dysmetabolic/aging conditions, bone reconstruction in oral destructive/necrotic disorders, dental implants, and for empowering the efficacy of a number of tissue engineering methodologies in dentistry and oral surgery.

Oral Health Differences Between Middle-Aged and Older Adults in South Korea

INTRODUCTION AND AIMS

The oral health characteristics of middle-aged and older adults exhibit variations. This study identifies the various factors associated with oral health among middle-aged and older adults through a subgroup analysis by age group of data representative of the South Korean population.

METHODS

We examined influencing factors: demographic, socioeconomic, dental, physical attributes, psychological, and mental attributes. Oral health was assessed using the Geriatric Oral Health Assessment Index. The participants were divided into two groups: those under 65 years of age (middle-aged) and those over 65 years of age (older adults). We used multiple linear regression analysis and dominance analysis to determine the dominant factors associated with oral health.

RESULTS

A total of 6369 participants were aged 69.2 ± 9.8 years on average, and 57.5% were women. Dominance analysis revealed that lower educational levels and activity difficulty caused by diseases were significantly associated with both groups. Moreover, depressive symptoms were the foremost adverse factor linked to oral health in the middle-aged (P < .001, standardized beta [β] = -4.30, general dominance index [GDI] = 19.00) and older (P < .001, β = -0.30, GDI = 10.70) adults. The number of teeth exhibited the most positive association with oral health in both middle-aged (P < .001, β = 0.20, GDI = 5.30) and older (P < .001, β = 0.23, GDI = 7.40) adults. However, cognitive function, dental visits, body mass index, severe pain, functional limitations, and cognitive function exhibited distinct patterns between the age groups.

CONCLUSION

Depressive symptoms and the number of teeth significantly influence oral health in middle-aged and older adults, though the impact varies by age. These findings stress the importance of tailored strategies considering age-specific attributes for effective oral health improvement.

CLINICAL RELEVANCE

Enhancing oral health requires healthcare providers to prioritize monitoring age-specific risk factors. Further, educational plans should highlight the importance of preventive oral care and regular dental visits.

Public and dental teams' views about weight management interventions in dental health settings: Systematic review and meta-analysis

Collaborative approaches across healthcare to address obesity are needed but intervention in dental settings is not widely implemented. Here we systematically synthesized the views of both the public and dental teams about delivering weight management interventions in dental settings and identified potential barriers to implementation. A systematic review of five databases from inception to April 3, 2023 was completed. Proportional meta-analyses were performed with quantitative data and thematic analysis of qualitative data. A total of 7851 studies were screened and 33 included in the review. The prevalence of height and weight screening in dental settings varied (4%-87%) with an average of 29% undertaking screening (p = <0.01; 95% CI: 14%-46%). A significant proportion of the public were supportive of weight screening in dental settings (83%; p = <0.01; 95% CI:76%-88%). Significant barriers to providing weight screening and/or intervention included fear of offending patients (57%; 95% CI: 45%-68%) and a lack of time (48%; 95% CI: 30%-66%). Qualitative data revealed further barriers including stigmatizing views of dental teams toward people living with overweight/obesity. Enablers of weight discussion included associating weight with oral health. Overall, whilst some barriers were identified, there is potential for weight management interventions to be used more routinely in dental settings.

Dietary Habits and Oral Hygiene as Determinants of the Incidence and Intensity of Dental Caries-A Pilot Study

OBJECTIVES

The aim of this study was to assess the influence of dietary and hygiene habits on the prevalence and intensity of dental caries. A group of 148 adults participated in the study.

METHODS

A self-administered nutrition and oral hygiene questionnaire was used to assess dietary habits and oral hygiene routine. A preventive diet index (PDI), a cariogenic diet index (CDI), and an oral health hygiene and prevention index (OHHPI) were created based on part of the questions. The intensity of dental caries among the respondents was investigated by the decayed, missing, and filled teeth index (DMFT), which was estimated on the basis of data obtained during the dental examination.

RESULTS

The study showed that 97% of the respondents had filled carious cavities, while untreated carious cavities were observed in up to 78% of the study participants. The respondents had an average consumption of preventive products and a low consumption of caries-stimulating foods. The preventive dietary index (PDI) value was higher in the female group than in the male group. A more frequent consumption of caries-inhibiting products was demonstrated by those declaring that they took various types of dietary supplements. The use of health-promoting sugar substitutes by the respondents was associated with a lower intensity of dental caries and a more frequent consumption of preventive products.

CONCLUSIONS

The analysis of the survey results indicates the need to implement educational activities aimed at increasing public awareness of the prevalence of dental caries among adults.

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.

Emotional distress and risk of dental caries: Evaluating effect modification by chronic conditions among low-income African American caregivers in Detroit, Michigan

Background/aim

Limited research has been conducted regarding the association between mental illness and dental caries. We studied the impact of emotional distress on current and new dental caries among low-income African-American caregivers in Detroit, Michigan and if this association was mediated by poor oral hygiene and sugar consumption and modified by a chronic health condition.

Methods

Data came from Detroit Dental Health Project, a prospective cohort study of low-income African American caregivers and their children. We focused on baseline (n = 1,021) and 4-year follow-up participants (n = 614). Dental caries were assessed using the International Caries Detection and Assessment System. The study outcomes included two baseline caries outcomes (counts of non-cavitated lesions, baseline counts of cavitated lesions) and two outcomes of new caries over 4 years (new cavitated lesions and new non-cavitated lesions). The exposure was emotional distress. We performed multivariable quasi-Poisson regression analysis to test the association between emotional distress and caries. We tested effect modification by stratifying data by chronic health conditions and performed causal mediation analysis to test an indirect effect of oral hygiene and sugar consumption.

Results

Ninety six percent of the caregivers were female, and their average age was 28 years old. Thirteen percent reported emotional distress at baseline. After accounting for potential confounding, emotional distress was positively associated with cavitated lesions at baseline (IRR = 1.36, 95% CI = 1.08, 1.70). Among those with a chronic health condition, stronger association was observed (IRR = 1.73, 95% CI = 1.27, 2.35). After 4 years, those with emotional distress and chronic health conditions had an increased risk of developing non-cavitated carious lesions (IRR = 1.41, 95% CI = 1.06, 1.88). Poor oral hygiene explained 51% of the association between emotional distress and baseline cavitated lesions (natural indirect effect = 1.16, 95% CI = 1.02, 1.33), but there was no evidence for an indirect effect of sugar consumption.

Conclusion

In this group of young, African-American caregivers with low socioeconomic status, dental caries was associated with emotional distress. This association was explained by poor oral hygiene and strengthened among those who reported a chronic health condition.

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.

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.

Metaproteomics associated with severe early childhood caries highlights the differences in salivary proteins

OBJECTIVE

To investigate the salivary metaproteomic characteristics of the children with and without severe early childhood caries (S-ECC).

DESIGN

In this study, we collected unstimulated saliva samples from 34 children (age 3-4 years) with caries free (NC, dmfs (= index of decayed, missing due to caries, or filled tooth surfaces) = 0, n = 23) and with S-ECC (dmfs≥10, n = 11). Salivary proteins were extracted and reduced, and then a Liquid Chromatography/Mass Spectrometry system was used to identify proteins.

RESULTS

Nearly 3000 proteins were identified in this study, and about 3.5 % of the proteins originated from human while 86 % were derived from microbes. The salivary protein types in the NC group were statistically greater than those in the S-ECC group (P <0.05). Specifically, the salivary protein types derived from microbes in the NC group were significantly greater than those in the S-ECC group. Three proteins, human lactoferrin, penicillin-binding protein 1C [Burkholderia ubonensis], human alpha-defensin 1 (F28a mutant), were decreased statistically in the NC group compared to the S-ECC group (P < 0.05). Only one protein, 50S ribosomal protein L17 secreted by Haemophilus haemolyticus, was significantly increased in the NC group compared to the S-ECC group. Salivary IgA was the top highest protein in the NC group whereas human lysozyme was the top highest protein in the S-ECC group.

CONCLUSIONS

The differential proteins recognized in this study may be conducive for finding a caries biomarker. Understanding the metaproteomic characteristics can help us to control the caries from human origin and microbial origin.