Dental caries and childhood obesity: roles of diet and socioeconomic status

Association between obesity, flow rate of whole saliva, and dental caries in adolescents

In a cross-sectional study design, we test the hypothesis whether childhood obesity is associated with reduced flow rate of stimulated whole saliva and dental caries. Obese adolescents (n = 65) with a mean age of 14.5 years and normal weight subjects (n = 65) with a mean age of 14.2 years were clinically examined with respect to dental caries, visible plaque accumulation (visible plaque index (VPI%)), gingival inflammation in terms of bleeding on probing (BOP%) as well as answered a questionnaire concerning medical history, medication, oral hygiene habits, smoking habits, and sociodemographic background. The flow rate of stimulated whole saliva (ml/min) was determined. BMI was calculated and adjusted for age and gender (BMI-sds). The obese subjects exhibited higher number of decayed surfaces (DS), 0.7 vs. 0.1 (P = 0.008) and lower flow rate of stimulated whole saliva 1.2 vs. 2.0 ml/min (P < 0.001). Of obese patients, 17 subjects had VPI% >25 and 21 had BOP% >25, both compared to only 5 subjects of the normal weight with P values of 0.005 and <0.001, respectively. In a multivariate logistic regression model BMI-sds was significantly associated with the flow rate of stimulated whole saliva less than the median value 1.5 ml/min (P < 0.001; odds ratio (OR) 1.36) as well as with DS (DS >0) (P = 0.002; OR 1.31) and the associations were not found to be confounded by any of the studied variables. The results indicate that childhood obesity is associated with reduced flow rate of stimulated whole saliva and dental caries and further strengthens obesity's negative effect on children's oral health.

Association between obesity and dental caries in a group of preschool children in Mexico

OBJECTIVE

The aim of this study was to determine the association between obesity and caries by utilizing the data of a cohort of preschool children aged 4-5 years.

METHODS

Data were obtained from a cohort of 1,160 children. Dental caries detection was performed according to the World Health Organization criteria. The caries index was measured as the number of decayed (d), extracted (e), and filled (f) teeth (t) (deft), or surfaces (defs). The body mass index (BMI) in units of kg/m2 was determined, and children were categorized according to age- and gender-specific criteria as normal weight (5th-85th percentile), at-risk overweight (> or = 85th-<95th percentile), and overweight (> or = 95th percentile). Odds ratios were determined for at-risk overweight and overweight children using logistic regression.

RESULTS

The prevalence of dental caries was 17.9 percent. A slightly higher percentage of dental caries was found in boys (19.6 percent) than in girls (16.4 percent). From the total sample, the mean BMI was 17.10 +/- 3.83. Approximately 53.7 percent of children were classified as normal weight, 14.2 percent as at-risk overweight, and 32.1 percent as overweight. At-risk overweight children were higher among girls (17.1 percent) than among boys (11.3 percent). When adjusted for covariates, the logistic regression model showed that there was a significant association between at-risk overweight children (P < 0.001), overweight children (P < 0.001), and caries in the primary dentition. Mean (SD) deft value of the sample was 1.08 (2.34), while the corresponding defs value was 1.43 (3.29).

CONCLUSION

Obesity appears to be associated with dental caries in the primary dentition of preschool Mexican children.

Prevalência de sobrepeso e obesidade e fatores associados em adolescentes na região centro-oeste do estado de São Paulo (SP, Brasil)

Objetivou-se avaliar a relação entre o Índice de Massa Corporal (IMC) e o índice CPOD em 207 adolescentes de 12 anos, de 8 escolas públicas e particulares da região centro-oeste do estado de São Paulo. A amostra foi constituída por 380 adolescentes aos 12 anos, de ambos os gêneros, sendo examinados 207. Utilizou-se o índice CPOD, IMC para peso, medida de estatura, e aplicou-se questionário sobre hábitos alimentares, características antropométricas e atividade física. Quanto ao peso corpóreo, 55,93% apresentaram normal (G4), 35,59% de baixo peso (G3), 8,47% de pré-obesos (G2), nas escolas particulares. Nas públicas, 52,03% apresentaram normal, baixo peso 41,22%, pré-obesos 4,73% e obesos (G1) 2,03%; não houve diferença significativa (p=0,45). Verificou-se que o CPOD nas escolas públicas foi 2,16 e nas particulares, 0,23 (p<0,05), sendo que 39,2% das crianças estavam livres de cárie nas municipais e nas particulares, 88,1%. Não houve correlação do maior IMC com o incremento de CPOD. Houve correlação negativa entre condições socioeconômicas e índice de cárie dentária. Concluiu-se que os grupos pré-obesos e obesos, embora houvesse maior frequência de ingestão de alimentos, não apresentaram correlação com o incremento de cárie dentária, mas as condições socioeconômicas foram determinantes para essa ocorrência.

Oral health and frailty in the medieval English cemetery of St Mary Graces

The analysis of oral pathologies is routinely a part of bioarcheological and paleopathological investigations. Oral health, while certainly interesting by itself, is also potentially informative about general or systemic health. Numerous studies within modern populations have shown associations between oral pathologies and other diseases, such as cardiovascular disease, certain types of cancer, and pulmonary infections. This article addresses the question of how oral health was associated with general health in past populations by examining the relationship between two oral pathologies (periodontal disease and dental caries) and the risk of mortality in a cemetery sample from medieval England. The effects of periodontitis and dental caries on risk of death were assessed using a sample of 190 individuals from the St Mary Graces cemetery, London, dating to approximately AD 1350-1538. The results suggest that the oral pathologies are associated with elevated risks of mortality in the St Mary Graces cemetery such that individuals with periodontitis and dental caries were more likely to die than their peers without such pathologies. The results shown here suggest that these oral pathologies can be used as informative indicators of general health in past populations.

Dental caries experience in young Australian Army recruits 2008

BACKGROUND

Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002-2003, and in Australian adults between 1987-1988 and 2004-2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008.

METHODS

A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water.

RESULTS

Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17-20, 21-25, 26-30 and 31-35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87.

CONCLUSIONS

Caries experience in Australian Army recruits aged 17-25 years increased between 2002-2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

Association of cardiometabolic risk factors and dental caries in a population-based sample of youths

BACKGROUND

Cardiovascular disease (CVD) risk factors begin from early life and track onto adulthood. Oral and dental diseases share some risk factors with CVD, therefore by finding a clear relation between dental diseases and cardiometabolic risk factors; we can then predict the potential risk of one based on the presence of the other. This study aimed to compare the prevalence of dental caries between two groups of age-matched adolescents with and without CVD risk factors.

METHODS

In this case-control study, the decayed, missing and filled surfaces (DMFS), based on the criteria of the World Health Organization, were compared in two groups of equal number (n = 61 in each group) of population-based sample of adolescents with and without CVD risk factors who were matched for sex and age group.

RESULTS

The study participants had a median age 13 y 5 mo, age range 11 y 7 mo to 16 y 1 mo, with male-to-female proportion of 49/51. We found significant difference between the mean values of DMFS, body mass index, waist and hip circumferences, as well as serum lipid profile in the case and control groups. Significant correlations were documented for DMFS with TC (r = 0.54, p = 0.02), LDL-C (r = 0.55, p = 0.01) and TG (r = 0.52, p = 0.04) in the case group; with LDL-C (r = 0.47, p = 0.03) in the whole study participants and with TC in control s(r = 0.45, p = 0.04).

CONCLUSIONS

Given the significant associations between dental caries and CVD risk factors among adolescents, more attention should be paid to oral health, as one of the topics to be taken into account in primordial/primary prevention of cardiometabolic disorders.

Pediatric obesity: a review for the child psychiatrist

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.

Dental caries, tooth eruption timing and obesity: a longitudinal study in a group of Mexican schoolchildren

OBJECTIVES

To identify the possible association between dental caries and body mass index (BMI) and to explore the effect of BMI on tooth eruption in a cohort of elementary schoolchildren.

MATERIAL AND METHODS

A 4-year longitudinal study was completed. A total of 110 children from a public elementary school, located in a middle-income area of Mexico City, entered the study; of these, 88 completed the 4-year follow-up period. Dental caries assessments were carried out using the WHO criteria for decayed, missing and filled primary and permanent teeth indices (dmft and DMFT, respectively) and surface indices (dmfs and DMFS, respectively). BMI was used to classify the children's obesity status, according to the Centers for Disease Control 2000 reference charts.

RESULTS

At 7 years of age, 29.6% of the children were in the overweight or at risk of being overweight categories and, by 11 years of age, this proportion had risen to 45.5%. The mean dmft for children aged 7 years was 2.70 and, for children aged 11 years, the DMFT was 0.54. Children in the higher BMI categories had more erupted teeth than the other children (p < 0.001). A lower dmfs index was detected in the overweight children, compared with children with a lower BMI (p < 0.001).

CONCLUSIONS

The overweight children had more erupted teeth and a lower caries index. The complex relationships between body composition and oral health should be considered in pediatric patients.

Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos

Background

In recent decades low-income countries experienced an increasing trend in dental caries among children, particularly recorded in 12-year olds, which is the principal WHO indicator age group for children. This increases the risks of negative affects on children's life. Some data exist on the oral health status of children in low-income countries of Southeast Asia. However, information on how oral health is associated with socio-behavioural factors is almost not available. The aims of this study were to: assess the level of oral health of Lao 12-year-olds in urban and semi-urban settings; study the impact of poor oral health on quality of life; analyse the association between oral health and socio-behavioural factors; investigate the relation between obesity and oral health.

Methods

A cross sectional study of 12-year old schoolchildren chosen by multistage random sampling in Vientiane, Lao P.D.R (hereafter Laos). The final study population comprised 621 children. The study consisted of: clinical registration of caries and periodontal status, and scores for dental trauma according to WHO; structured questionnaire; measurement of anthropometric data. Frequency distributions for bi-variate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables.

Results

Mean DMFT was 1.8 (SEM = 0.09) while caries prevalence was 56% (CI95 = 52-60). Prevalence of gingival bleeding was 99% (CI95 = 98-100) with 47% (CI95 = 45-49) of present teeth affected. Trauma was observed in 7% (CI95 = 5-9) of the children. High decay was seen in children with dental visits and frequent consumption of sweet drinks. Missed school classes, tooth ache and several impairments of daily life activities were associated with a high dD-component. No associations were found between Body Mass Index (BMI) and oral health or common risk factors. The multivariate analyses revealed high risk for caries for children with low or moderate attitude towards health, a history of dental visits and a preference for drinking sugary drinks during school hours. Low risk was found for children with good or average perception of own oral health. High risk for gingival bleeding was seen in semi-urban children and boys.

Conclusion

Although the caries level is low it causes considerable negative impact on daily life. School based health promotion should be implemented focussing on skills based learning and attitudes towards health.

The contribution of dietary factors to dental caries and disparities in caries

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars, is significantly associated with increased dental caries risk. Malnutrition (undernutrition or overnutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods, substituting instead high-energy, low-cost, nutrient-poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation, including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for early childhood caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in Oral Health in America: A Report of the Surgeon General. Dental and other care providers can educate and counsel pregnant women, parents, and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods, to effect positive changes in children's diets and advance the oral components of general health.

A holistic food labelling strategy for preventing obesity and dental caries

Obesity and dental caries in childhood are among the major public health concerns described as a global pandemic because of their global distribution and severe consequences. A consensus has developed as to a recently emerging and alarming common risk factor that leads to the double burden of dental caries and obesity; energy-dense foods (sugar-coated cereals, high-sugar yogurt, soft drinks) are becoming very popular among children because of their dense marketing, cheaper price, increased supply and variety. Implementation of health-promoting and -supporting marketing strategies for healthy food can be one initial cornerstone for successful application of the common risk factor approach in prevention of obesity and dental caries, as also suggested by World Health Organization. Labelling healthy food with a 'health-friendly' logo, illustrating that the teeth and the heart are both parts of the whole body (standing side by side supporting each other as close friends), both happy and protected because of consumption of healthy food for the whole body, can promote the foods that are friendly to health of the whole body, implementing the common risk factor approach under a single theme. Labelling healthy food as 'health-friendly' based on an international consensus will provide a clear and uniform picture of what is healthy to eat and result in an international integrated programme for prevention of obesity and caries.

Obesity and dental caries in children aged 2-6 years in the United States: National Health and Nutrition Examination Survey 1999-2002

OBJECTIVE

This study assessed the associations between obesity and dental caries in young children participating in a national survey.

METHODS

Participants included 1507 children aged 2-6 years who received dental examinations and had at least 10 primary teeth in the National Health and Nutrition Examination Survey 1999-2002. Decayed/filled teeth (dft) counts of primary dentition were obtained, and weight and height were measured. Body mass index (BMI; kg/m2) was calculated, and participants were categorized using age- and gender-specific criteria as underweight (<5th percent), normal (5th-85th percent), at risk for overweight (>85th and <95th percent), and overweight (> or =95th percent). With appropriate sample weighting, relationships between dft and BMI were assessed using the Kruskal-Wallis test and multivariable logistic regression.

RESULTS

Seventy-four percent of children were classified as normal weight, 11 percent as at risk for overweight, and 11 percent as overweight; 58 percent did not have caries; 30 percent had 1-5 dft and 12 percent had >5 dft. When caries experience was compared across BMI categories stratified by age and race characteristics, statistically significant association between caries and obesity was found only for 60- <72-month age group. In the comparison between children with normal and at-risk BMI only, significant associations were also found in the Hispanic and non-Hispanic Black strata. In multivariable logistic regression models to predict caries experience, family income and age were statistically significant predictors for severe early childhood caries only.

CONCLUSIONS

There appears to be no significant association between childhood obesity and caries experience after controlling forage, race, and poverty/income ratio. However, further studies are needed to better understand this relationship.

Caries prevalence and background factors in Swedish 4-year-old children - a 40-year perspective

BACKGROUND

Periodic and well-controlled studies of caries and background factors are important for organizing dental care and how prevention should be addressed.

AIMS

The aims of this study were to compare data on caries prevalence and background factors in 4-year-old children from 2007 with data collected periodically between 1967 and 2002 with the same methods and criteria, and to compare immigrant and non-immigrant children concerning caries prevalence and background factors.

DESIGN

A cross-sectional study in 4-year-old children living in Umeå, northern Sweden (n = 218), was performed. Caries recordings included both cavitated and non-cavitated caries lesion, and bite-wing radiographs were used on indications. Data on oral hygiene, use of fluorides, general health, and medication and sugar consumption were collected using the same questions and questionnaire as in the previous studies.

RESULTS

In 2007, 38% of the children displayed caries compared to 46% in 2002. The distribution of decayed, missing, or filled surfaces-primary teeth values was statistically significantly different in 2007 compared to 2002 (P < 0.05). The intake frequency of sugary between-meal products was generally lower, and toothbrushing frequency was higher in 2007 compared with data from the 2002 study. In children with immigrant background, the frequency of toothbrushing was statistically significantly lower, and snacking was more common (P < 0.05). Sixteen per cent had immigrant background and 59% had caries compared to 32% in the rest of the cohort (P < 0.01).

CONCLUSION

Important changes in caries prevalence of 4-year-old children have taken place since 2002 concurrently with a decreased intake of sugary between-meal products and increased toothbrushing frequency. Immigrant background had a significant association with caries prevalence in 2007.

Body adiposity status in teenagers and snacking habits in early childhood in relation to approximal caries at 15 years of age

BACKGROUND

The prevalence of overweight and obesity in children is steadily increasing in many countries. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits.

OBJECTIVE

The purpose of this study was to investigate the relationship between body weight status in adolescents and snacking habits in early childhood to approximal caries prevalence at 15 years of age.

METHODS

This study is part of a series of surveys of oral health in children followed from the ages of 1 year to 15 years. Body adiposity status was estimated at 13.5-16.4 years using the International Obesity Task Force cut-off values [age-specific body mass index (isoBMI)]. Information about snacking habits in early childhood was collected from interviews conducted at 1 year and 3 years. Approximal caries information was obtained from bitewing radiographs at 15 years. Data related to isoBMI and approximal caries were available in 402 teenagers.

RESULT

Adolescents with isoBMI > or = 25 (n = 64) had an approximal caries prevalence that was a mean of 1.6 times higher than those with isoBMI < 25 (n = 338) (4.64 vs. 2.94; P = 0.014). Furthermore, children's snacking habits at an early age were associated with approximal caries at 15 years.

CONCLUSION

Overweight and obese adolescents had more approximal caries than normal-weight individuals. Moreover, the frequent consumption of snacking products during early childhood appears to be a risk indicator for caries at 15 years. Future preventive programmes should therefore include, on a multidisciplinary level, strategies to prevent and reduce both obesity and dental caries at an early age.

Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children

The main objective of this study was to assess whether dental caries status was related to nutritional status in preschool urban Brazilian children aged 12-59 months. Dental and anthropometric examinations were conducted on 1,018 12-59-month-old children during the National Day of Children Vaccination. Dental caries prevalence and severity were measured using the decayed, missing or filled surfaces (dmfs) index. The World Health Organization (WHO) Child Growth Standards Reference was used to evaluate nutritional status. Results on nutritional status were presented as Z-scores. The data collected included socio-economic conditions. Multilevel linear regression was applied to investigate the effect of nutritional, socio-economic, and demographic factors on the status of children's dental caries. Caries was present in 23.4% of children. The final hierarchical logistic model showed a significant association between nutritional status and caries experience. Children with low Z-scores in some indexes had an increased risk of having caries. In addition, children whose mothers had < 8 yr of education and were from lower-income families had an increased risk of high levels of dental caries. There was an association between nutritional and socio-economic factors, and dental caries. In conclusion, underweight children and those with adverse socio-economic conditions were more likely to have caries experience.