Chronic malnutrition and oral health status in children aged 1 to 5 years: An observational study

Micronutrients and the Periodontium: A Narrative Review

This is a comprehensive narrative assessment of micronutrient relevance for periodontal health. The periodontium is a crucial and intricate structure that supports the tooth within the alveolar bone. Composed of four tissues with distinct embryological origins- the alveolar bone, cementum, gingiva, and periodontal ligament - the periodontium plays a fundamental role in maintaining dento-alveolar function and homeostasis. Periodontitis is gaining attention due to its widespread occurrence worldwide. This inflammatory condition disrupts the balance between the host immune response and microbial virulence factors. Connective tissue production and host defenses require proteins for periodontal health. Vegetable proteins support periodontal health by promoting tissue repair and immune function, while excessive dietary fats can exacerbate inflammation and increase the risk of periodontal disease (PD). Inflammation is further compounded due to dietary animal fats, which contribute to the risk of PD. Omega-3 fatty acids are well-known for their anti-inflammatory effects, which help reduce periodontal inflammation. Adequate intake of essential minerals and vitamins is required for maintaining periodontal health. Vitamins K, D, and A are crucial in maintaining oral epithelial integrity, facilitating bone development, and supporting overall tissue maintenance. Inadequate calcium (Ca²⁺) and magnesium (Mg²⁺) levels have been associated with severe PD. Antioxidants such as vitamin C help alleviate inflammation in periodontal tissues. As recognized by dental professionals, nutritional status plays a considerable role in an individual's risk of developing PD.

The Updated Trend of Association between Dental Caries and Stunting in All Age Groups: A Systematic Review

Background

Stunting has a negative impact on the growth and development of children, which include their susceptibility to dental caries. Caries in primary teeth have been consistently related to malnutrition. Having a history of severe caries was connected with slower childhood growth. We aimed to explain the updated trend of association between stunting and dental caries among all age groups.

Methods

A review was done using PRISMA. PubMed and Science Direct was used as database from Jan 2022 to Jan 2023. Studies obtained using specific keywords was 1.748 then filtered. All of the studies that were obtained using specific keywords about stunting and DMFT and or PUFA index. There is no limited year in this systematic search. Endnote software was used to help with the inclusion process; data was extracted into a table that had been prepared.

Results

There were 10 included studies in this systematic review. Eight studies that reported higher dental caries in stunting children than the normal children. Two studies showed a connection between developing stunting malnutrition and severe dental caries. Early childhood caries may increase vulnerability to dental caries by causing odontogenesis to fail, delayed tooth eruption and changes in the salivary glands. Children's ability to eat and sleep may be negatively impacted by untreated caries pain. It might result in decreased nutrient intake and poor appetite, while sleep disturbances might prevent growth hormones from being secreted.

Conclusion

There was a correlation between dental caries and growth stunting because of a decrease in the composition of saliva and defects in tooth formation in children suffered stunting. Thus, there were oral functional limitations and a decrease in food intake since severe dental caries.

Relationship Between Body Mass Index (BMI) and Severity of Caries Among Primary School Children: A Scoping Review

The relationship between body mass index (BMI) and the severity of dental caries in children varies significantly across different age groups, with some studies showing favorable associations. At the same time, some found no or inverse links. This review examines the existing literature on the relationship between BMI and the severity of dental caries among primary school children specifically between the ages of six and 12. This review follows the preferred reporting items for scoping reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR)) guidelines. A comprehensive literature search was performed utilizing PubMed, Scopus, and Web of Science (WoS) to identify relevant studies published in English from January 2015 to June 2024. Studies on primary school children aged six to 12 years old, BMI, and severity of caries were included. Five hundred and seventy-seven articles were screened with 26 meeting the inclusion criteria. The majority of the studies were cross-sectional in design. The study identified a varied association between BMI and dental caries. Further understanding of this relationship can guide the development of preventive strategies and interventions that address childhood disproportionate BMI and dental caries, ultimately enhancing oral health and overall well-being in this population.

Study on the association between malnutrition, early childhood caries and caries activity among children aged 3-5 years

BACKGROUND

This study aims to investigate the association between malnutrition and early childhood caries (ECC) and caries activity among children aged 3-5 years, in order to provide a theoretical basis for preventing and blocking ECC and improving malnutrition.

METHODS

Children aged 3-5 years from six kindergartens in Zhao Xian, China were enrolled in this study. The decayed, missing, filled teeth (dmft) of all children were examined and recorded. The Cariostat method was used to detect dental caries activity, collect anthropometric data and measure haemoglobin concentration. Parents were asked to complete a questionnaire on the general characteristics and oral health behaviour of the participants. The "Growth Standards for Chinese Children Under 7 Years Old" was used to assess the nutritional status of all participating children. Wilcoxon rank sum test and multivariate logistic regression analysis were used to analyse and evaluate the relationship between ECC, caries activity and malnutrition.

RESULTS

A total of 635 children who met the criteria were included in this study. After adjusting for confounding factors, logistic regression showed that the risk of ECC was significantly increased in underweight children compared with normal children (OR = 5.43, P < 0. 05); compared with normal children, the risk of ECC decreased in overweight and obese children (OR = 0.31, P < 0.001); underweight children had higher caries severity than normal weight children, and the difference was statistically significant (OR = 2.69, P < 0. 05); stunted children had higher caries severity than normal weight children and the difference was statistically significant (OR = 2.28, P < 0.05); underweight was positively associated with caries activity and the association was statistically significant (OR = 2.33, P < 0. 05); stunting was positively associated with caries activity and the association was statistically significant (OR = 2.1, P < 0.05); overweight and obesity were negatively associated with caries activity and the association was statistically significant (OR = 0.61, P < 0.05).

CONCLUSIONS

The risk of ECC among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition. The severity of ECC among children aged 3-5 years was positively associated with undernutrition. The caries activity among children aged 3-5 years was positively associated with undernutrition and negatively associated with overnutrition.

Assessment of Chronic Malnutrition and Its Correlation With Oral Health Status in Children Aged Three to Six Years in Jabalpur District, India: An Epidemiological Study

OBJECTIVE

This study aims to examine the correlation of chronic malnutrition with the oral health status of children aged three to six years.

METHODS

A total of 400 children were selected and divided into four groups based on z-scores. For evaluation of oral health status, teeth were examined for dental caries using the decayed, missing, and filled permanent teeth (DMFT) scores. Salivary samples were collected to measure salivary flow rate (SFR), pH, and salivary buffering capacity (SBC). Teeth were also visualized to detect the presence or absence of enamel hypoplasia. The data obtained was statistically analyzed (p<0.05).

RESULTS

A total of 400 children participated and were also categorized into mild, moderate, and severe obesity according to the z-scores. The mean DMFT scores among adequately nourished children were 2.4086; with severely malnourished and severely obese children, the mean values were found to be 1.0652 and 1.4286, respectively. The mean SFR among children with adequate nutrition was 1.0366, and the mean flow rate among children with severe malnutrition and obesity was 0.5348 and 0.4036, respectively. The mean salivary pH among children with adequate nutrition was 7.1295, and the mean values for participants with severe malnutrition and severe obesity were found to be 6.4772 and 7.6521, respectively. The mean SBC among children with adequate nutrition was found to be 4.4861; for severely malnourished children and those with severe obesity, the values were 3.2472 and 2.8332, respectively. There was an absence of enamel hypoplasia in children with adequate nutrition, whereas a total of five participants with severe malnutrition and three children with severe obesity were found to have hypoplastic lesions, respectively.

CONCLUSION

Malnutrition exerts a negative impact on the overall oral health of children. It is critical to diagnose the effects of malnutrition on children's oral environments in order to provide appropriate treatment and enhance their quality of life.

A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health

Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.

Exploring the association between early childhood caries, malnutrition, and anemia by machine learning algorithm

OBJECTIVE

The objective of this study was to determine the prevalence of early childhood caries in children with severe acute malnutrition (SAM) and also the hierarchy of association if any with malnutrition, anemia, and other risk factors with ECC using machine learning algorithms.

METHODS

A hospital-based preventive and interventional study was conducted on SAM children (age = 2 to <6 years) who were admitted to the malnutrition treatment unit (MTU). An oral examination for early childhood caries status was done using the deft index. The anthropometric measurements and blood examination reports were recorded. Oral health education and preventive dental treatments were given to the admitted children. Three machine learning algorithms (Random Tree, CART, and Neural Network) were applied to assess the relationship between early childhood caries, malnutrition, anemia, and the risk factors.

RESULTS

The Random Tree model showed that age was the most significant factor in predicting ECC with predictor importance of 98.75%, followed by maternal education (29.20%), hemoglobin level (16.67%), frequency of snack intake (9.17%), deft score (8.75%), consumption of snacks (7.1%), breastfeeding (6.25%), severe acute malnutrition (5.42%), frequency of sugar intake (3.75%), and religion at the minimum predictor importance of 2.08%.

CONCLUSION

Anemia and malnutrition play a significant role in the prediction, hence in the causation of ECC. Pediatricians should also keep in mind that anemia and malnutrition have a negative impact on children's dental health. Hence, Pediatricians and Pediatric dentist should work together in treating this health problem.

The bi-directional relationship between growth stunting and early childhood caries: a rapid review

Objective

This review aims to determine the two-way relationship between stunting and ECC in developing countries worldwide.

Methods

The procedure in this study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Rapid Review protocol. Article searches were carried out using databases Cochrane and PubMed. In addition, searches were also carried out using backward and forward snowballing techniques to identify articles that were not detected through database searches.

Results

Nine observational epidemiological articles were found in children aged six months to six years, published in 2015-2020. Five articles discussed the features of ECC in stunted children, and the other five discussed stunting in children with caries in their primary teeth.

Conclusion

Several studies found associations between severe ECC and stunting, with ECC and stunting as both independent and dependent variables, suggesting a bi-directional relationship, also supported by literature on the physiological relationship between oral health and nutrition.

Caries Experience among Children with History of Neonatal Stunting

OBJECTIVE

 Children with neonatal growth retardation (defined as birth length <48cm) are at risk for chronic malnutrition that begins before birth and continues into infancy. Stunting can adversely affect a child's growth and development, including oral health itself, and especially the experience of dental caries. This study analyzed the dental caries experience in children with neonatal growth retardation.

MATERIALS

AND METHODS:  This was a baseline and 1-year follow-up analysis of a cohort of stunted children in a potential stunting site in Bandung City. Annual data collection included interviews with mothers and dental and anthropometric examinations of children. Descriptive analysis was performed in SPSS.

STATISTICAL ANALYSIS

 Data were recorded on paper forms and manually entered into a Microsoft Excel spreadsheet for later analysis using IBM SPSS (version 23.0). After assessment, descriptive statistics was generated prior to bivariate analysis.

RESULTS

 Fifty-five children met the inclusion criteria and participated in the 1-year study. Decay, missing, filling teeth (Dmft) was in the intermediate category (4.13) at baseline and fell into the high category (5.16) at 1-year follow-up, although the increase in caries remained in the low category.

CONCLUSION

 Dysplastic children with a history of neonatal developmental delay experience dental caries beginning in the first year of life and may become more severe later in life.

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.

Does Growth Stunting Correlate with Oral Health in Children?: A Systematic Review

Growth stunting is when children tend to be shorter than their peers through the World Health Organization child growth standard measurement. The condition may affect the development of the brain and other parts of the body, including the oral cavity, which manifests in oral hygiene and overall oral health. This systematic approach literature study aimed to evaluate the correlation between growth stunting and oral health in children. This study was conducted by using a literature review method with a systematic approach by searching for articles related to research topics on PubMed and Google Scholar. The search was adjusted to the inclusion category, which is research that discusses malnutrition and oral health published between 2010 and 2020—research conducted on boys and girls—from birth to 18 years. The exclusion categories used were articles that did not discuss growth stunting and oral health, and grey literature was excluded. The selection of articles was carried out by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach and resulted in 10 selected articles with details as follows: the correlation between growth stunting and oral health in three articles. A high plaque index in growth stunting children was found in two articles, and a decrease in saliva composition in growth stunting children was also found in two articles. Four articles showed a relationship between growth stunting and salivary flow rate. Lastly, one article showed the relationship between growth stunting and the incidence of dental caries. Despite the limitation of the review, the correlation between growth stunting and overall oral health in children can be seen through the oral hygiene index as moderate to low, high plaque index, decreased salivary flow rate, salivary composition, and dental caries in children with growth stunting.

Using Oral Microbiota Data to Design a Short Sucrose Intake Index

Excessive sucrose consumption is associated with numerous health problems, including dental caries, and is considered to play a critical role in shaping the human microbiota. Here, we aimed to confirm the association between sucrose exposure and oral microbiota profile, develop a short food-based index capturing variation among sucrose consumers and validate it against oral microbiota and dental caries in a derivation cohort with 16- to 79-year-old participants (n = 427). Intake and food preferences were recorded by questionnaires and saliva microbiota by 16S rDNA sequencing. Taxonomic similarities clustered participants into five clusters, where one stood out with highest sucrose intake and predicted sugar related metabolic pathways but lowest species diversity in the microbiota. Multivariate modelling of food intake and preferences revealed foods suitable for a sucrose index. This, similarly to sucrose intake, was related to bacterial pattern and caries status. The validity of the sucrose index was replicated in the population-based Gene-Lifestyle Interactions in Dental Endpoints (GLIDE, n = 105,520 Swedish adults) cohort. This suggested that the index captured clinically relevant variation in sucrose intake and that FFQ derived information may be suitable for screening of sucrose intake in the clinic and epidemiological studies, although adjustments to local consumption habits are needed.

Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador

As communities worldwide shift from consuming traditional diets to more processed snacks and sugar-sweetened beverages (SSBs), increases in child obesity and tooth decay and persistence of undernutrition are particularly apparent in Latin American countries. Further evidence of shared risk factors between child undernutrition and poor oral health outcomes is needed to structure more effective health interventions for children’s nutrition. This study aims to identify dietary, oral health, and sociodemographic risk factors for child undernutrition and severe early childhood caries (sECC) among a convenience sample of 797 caregiver–child pairs from rural Salvadoran communities. Caregiver interviews on child dietary and oral health practices were conducted, and their children’s height, weight, and dental exam data were collected. Multivariable regression analyses were performed using RStudio (version 1.0.143). Caregiver use of SSBs in the baby bottle was identified as a common significant risk factor for child undernutrition (p = 0.011) and sECC (p = 0.047). Early childhood caries (p = 0.023) was also a risk factor for developing undernutrition. Future maternal–child health and nutrition programs should coordinate with oral health interventions to discourage feeding children SSBs in the baby bottle and to advocate for policies limiting SSB marketing to young children and their families.