Is obesity associated to dental caries in Brazilian schoolchildren?

Socioecological determinants of child oral health-A scoping review

OBJECTIVES

Child oral health is a result of interactions between multilevel influences within a complex system. Understanding those interactions informs conceptualizing a socioecological framework of important influences on oral health. This paper aimed to present a scoping review on the determinants of dental caries and their interactions in childhood and adolescence.

METHODS

The two review questions were as follows: Which factors are determinants of child dental caries? and, How do determinants interact within and across socioecological levels? The three main electronic databases for biomedical records, PubMed, Web of Science and Scopus were searched, followed by reference check. The search and screening/selection procedures followed an a priori strategy and inclusion/exclusion criteria were specified in advance. The main components of the strategy were participants, concept and context. Following the final selection, eligible studies were assessed with quality appraisal tools for the risk of methodologic biases. Determinants reported in the included studies were then assigned to the micro-, meso-, exo- or macro-systems levels in a socioecological framework. Interactions between determinants were also identified and reported.

RESULTS

A total of 100 studies were included after removal of duplicates, screening on the title/abstracts and full-text assessment among 3313 records initially identified. A higher number of studies included were cross-sectional studies published in recent years. The majority of determinants found to influence child dental health were assigned to microsystem level within the framework. However, determinants were found at all levels and interactions were reported within and between socioecological levels. Determinants identified in the scoping review represent factors at different socioecological levels that influence child oral health.

CONCLUSION

Application of a socioecological model through a complex systems approach should lead to valid and robust progress towards practical solutions for better child oral health globally.

Potential Renal Acid Load, Salivary Buffer Capacity and Healthy Eating Index as Predictors of Children's Dental Caries: A Cross-Sectional Study

INTRODUCTION

Dental caries is one of the most common childhood diseases. This study purposed to investigate the prediction capability of potential renal acid load (PRAL), salivary buffer capacity (SBC), and Healthy Eating Index (HEI) on children's dental caries.

METHODS

The decay, missing, filing, and teeth for primary teeth (dmft)/Decay, Missing, Filling, and Teeth for permanent teeth (DMFT) indexes of the children aged 7-12 years who applied to our faculty were recorded. Approximately 1 mL of unstimulated saliva samples were collected, and SBC was evaluated. PRAL and HEI scores were calculated by entering the data in the form of a daily nutrition record of the children into the BeBiS software (Ebispro for Windows, Stuttgart, Germany). The association of dental caries indices with PRAL, SBC, and HEI was analyzed using an independent sample t-test. A binomial logistic regression analysis was performed to predict the dental caries burden. The statistical significance level was adjusted to a=0.05.

RESULTS

A total of 150 children, 88 (58.6%) females and 62 (41.4%) males, were included in the study. Significant differences were found between the low and high dental caries groups for dmft regarding PRAL and SBC (p<0.001). A significant difference was found between the low and high dental caries groups for DMFT in terms of SBC (p<0.05).

CONCLUSION

In our study, established regression models significantly predicted dental caries in primary teeth. SBC was the most influential factor in predicting dental caries compared to PRAL and HEI. There was a significant relationship between SBC, PRAL, and caries in primary teeth. In the model we created, the strongest predictor was SBC.

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.

Evaluating a linkage between obesity and the occurrence of dental caries among school going children in Sakaka, Al Jouf, Kingdom of Saudi Arabia

Background

Obesity and dental caries are global public health problems. There are conflicting reports about the relationship between caries and obesity. The aim of this study was to analyze the type of relationship between the dental caries and obesity among school children in Al-Jouf region of Saudi Arabia.

Methods

This cross-sectional study was conducted among 400 participants aged 6 to 14 years. The study involved measuring caries (dmft/DMFT), assessing body mass index (BMI), and administering a self-completion questionnaire. An independent t-test, one-way ANOVA, and multivariate logistic regression analyses were performed.

Results

Out of 400 participants, 380 agreed to participate in the study. Overall caries prevalence among the participants was 76.1% and mean DMFT and dmft values were 2.8 ± 1.0 and 3.7 ± 1.6. Among the factors associated with mean caries scores, relation between DMFT scores and frequency of consumption of sugar was statistically significant (F = 3.82,0.01). Regression models has identified children with increased BMI values has 3.2 times more risk of getting dental caries in permanent teeth (P = 0.001).

Conclusion

There was a positive association between obesity and dental caries in school going Saudi Arabian children. Comprehensive multidisciplinary approach by health professionals is recommended for preventive public health issues related to caries and obesity in teenagers.

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.

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies.

SOURCES

We searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I²) and publication bias were investigated by meta-regression and Egger's test, respectively.

SUMMARY OF THE FINDINGS

53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the three-decade period was of 8.2% ([95% CI]: 8.1-8.4%, I² = 98.5%). Higher prevalence was observed in boys (9.7% [9.4-9.9%], I² = 97.4%) than girls (7.3% [7.1-7.5%], I² = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0-7.0 %], I² = 96.8%; 2000: 7.9% [7.7-8.0 %], I² = 98.8%; 2010: 12.0% [11.5-12.6 %], I² = 95.8%), and Brazilian region (Northeast: 6.4% [6.2-6.7%], I² = 98.1%; North: 6.7% [6.3-7.2%], I² = 98.8%; Southeast:10.6% [10.2-11.0%], I² = 98.2%; South: 10.1 [9.7-10.4%], I² = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746).

CONCLUSION

For every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.

Associated factors to caries experience of children undergoing general anaesthesia and treatment needs characteristics over a 10 year period

BACKGROUND

Aim of this study was to describe the characteristics of 1- to 6-year-old children who underwent general anesthesia (GA) in a German specialized pediatric dental institution between 2002 and 2011, and to evaluate the risk factors (age, migration background, nutritional status) for caries experience (dmf-s) in these children.

METHODS

A cross-sectional study with retrospective data collection was designed. Children who underwent comprehensive dental treatment under GA were enrolled in the study. The data were collected from patient records and included personal background: age, sex, dmf-s, nutritional status, reasons for GA and treatments provided. Mann-Whitney-U test, Chi-square tests, and linear regression modelling were applied for statistical analyses.

RESULTS

652 children (median age: 3 years [IQR: 2-4], 41.6% female) were treated under GA between 2002 and 2011. Of these, 30.8% had migration background, 17.3% were underweight and 14.8% overweight. The median dmf-s was 28 (IQR: 19-43.5). Univariate, only age and migration showed a significant association with dmf-s (p < 0.01) up to the age of 5 years. In the linear regression analysis, this association of dmf-s with age (OR: 4.04/CI: 2.81-5.27; p < 0.01) and migration (OR: 4.26/CI: 0.89-7.62; p = 0.013) was confirmed. At the patient level, tooth extraction was the most chosen option in both time periods, however, more restorative approaches were taken between 2007 and 2011 including pulp therapy and the use of strip and stainless steel crowns compared to 2002-2006.

CONCLUSIONS

Children aged 1-6 years treated under GA showed a high caries experience (dmf-s), whereby age as well as migration, but not BMI, were relevant risk factors. Although tooth extraction is the first choice in most cases in the first time period, more conservative procedures were performed in the second half of the follow-up period.

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.

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Obesity and dental caries among South Brazilian schoolchildren: a 2.5-year longitudinal study

The aim of this study was to assess the association between weight status and ΔDMFS among 12-year-old schoolchildren from South Brazil. A total of 801 12-year-old schoolchildren were followed-up for 2.5 ± 0.3 years. Data collection included questionnaire, recording of anthropometric measures (height and weight), and caries examination. The outcome was the difference between DMFS (number of decayed, missing or filled surfaces) at follow-up and baseline (ΔDMFS). Weight status, based on body mass index-for-age Z-scores, was considered the main predictor variable. Negative binomial regression models were used to model the association, and rate ratios and their 95% confidence intervals were estimated. A multivariable fractional polynomial model was used to further explore the relationship between obesity and dental caries. DMFS increased by 0.86 (95%CI = 0.65-1.07), 0.91 (95%CI = 0.59-1.23), and 0.42 (95%CI = 0.03-0.80) for normal weight, overweight, and obese schoolchildren, respectively. Obese adolescents had significantly lower ΔDMFS than normal weight ones (p < 0.05). No significant association between categories of weight status and ΔDMFS was found (overweight, IRR=0.92, 95%CI = 0.69-1.21, p = 0.54; obese IRR = 0.75, 95%CI = 0.51-1.12, p = 0.16). However, the multivariable fractional polynomial model showed an inverted U shaped relationship with a decreasing ΔDMFS with increasing BMI (p < 0.05). This population-based longitudinal study showed an inverse association between obesity and ΔDMFS over a 2.5-year period among South Brazilian adolescents.

Association between Dental Caries and Obesity in Children and Young People: A Narrative Review

OBJECTIVES

To explore the association between obesity and dental caries in children and adolescents. Furthermore, to consider the possible reasons behind this relationship.

METHODS

A database search for papers published between January 2015 and May 2018, inclusive, addressing the association between obesity and dental caries was conducted. A review and critical appraisal of all included studies was performed.

RESULTS

Twenty-six studies were included in this review from different populations worldwide. Eight studies assessed the primary dentition, nine studies were conducted on permanent dentition, and remaining nine studies on both dentitions. The results regarding the association between obesity and dental caries were conflicting and inconsistent. Nine studies concluded that there was no relationship between obesity and dental caries. A positive association was reported in five studies, while the inverse association was reported in eleven studies. Studies included in this review had significant variations in methodology and the investigated cofactors. Possible explanations of the controversial association between obesity and dental caries are discussed in this review.

CONCLUSION

Both obesity and dental caries are multifactorial diseases, and their association is far more complex that can be explained by a single common risk factor, presenting evidence for the complexity of this association.