Relationship between Body Mass Index and Tooth Decay in a Population of 3-6-Year-Old Children in Iran

Iranian early childhood dental caries: a comprehensive systematic review and meta-analysis of prevalence and associated risk factors

OBJECTIVES

Early childhood dental caries (ECC) is a prevalent dental condition affecting infants and young children, characterized by one or more carious lesions in primary teeth. ECC risk factors include malnutrition, genetic predisposition, specific dietary habits, lack of fluoride, and prolonged bottle feeding. A comprehensive prevalence estimate is crucial for understanding the extent of dental caries in the population. So, this study aimed to determine the prevalence of ECC and its associated risk factors in Iranian children.

METHODS

A comprehensive literature search was conducted in Scopus, Web of Science, PubMed, Google Scholar, ACECR Scientific Information Database ( www.ACECRScientific Information Database.ir ), and Magiran research databases. Eligible English and Persian studies published between 2006 and 2024 were reviewed and analyzed. The studies on ECC prevalence were identified and included in the meta-analysis. Random effect models were utilized to calculate the pooled prevalence, and meta-regression and sensitivity analyses were conducted to assess sources of heterogeneity in the systematic review of risk factors.

RESULTS

The meta-analysis encompassed thirty eligible studies, providing the prevalence of ECC in Iran, with an estimated prevalence of 61.7%. Meta-regression analysis indicated a non-statistically significant increase in ECC prevalence with age and a substantial slight decrease over time. Additionally, 68 Studies evaluated categories such as age, gender, sociodemographic factors, microbial flora, oral hygiene, breast/bottle feeding, and dietary. Significant ECC-related factors identified included parents' education and occupation, breastfeeding, and oral hygiene.

CONCLUSION

The overall prevalence of ECC in Iran was estimated at 61.7%, with notable heterogeneity. Most of the studies extensively evaluated sociodemographic factors as risk factors.

The Role of Oxidative Stress-Related Gene Polymorphisms (SOD2, GPX1) in Severe Early Childhood Caries (S-ECC)

Background and Objectives: Severe early childhood caries (S-ECC) is a chronic infectious disease with a multifactorial etiology which has not been completely elucidated. Research on the role of oxidative stress in the etiopathogenesis of oral diseases suggests that the level of local antioxidants plays an important role in determining susceptibility to caries. This study aimed to demonstrate that the host's redox imbalance, modified by genetic polymorphisms, may influence the onset and severity of S-ECC. Materials and Methods: A total of 110 patients were included in the study (59 diagnosed with S-ECC and 51 healthy controls). Upon initial appraisal, the DMFT (decayed-missing-filled teeth) index was determined, and epithelial cells were collected using oral swabs for genomic DNA extraction. Genotyping of SOD2 (rs4880) and GPX1 (rs1050450) was performed using TaqMan SNP genotyping assays and real-time polymerase chain reaction (PCR). Results: According to the results of the present study, there was a significant difference between the frequency of the reference genotype and variants for rs4880 (p = 0.0303). Subjects carrying the AG and GG variant genotype of rs4880 were significantly associated with a high DMFT value (p = 0.0005). However, no significant difference was found between the genotypes for rs1050450, nor was there an association with the severity of S-ECC. Conclusions: The AG and GG variant genotypes of the SOD2 polymorphism (rs4880) increase the severity of caries in preschoolers and predispose patients to develop carious lesions, especially when associated with certain feeding practices and infrequent toothbrushing. This observation emphasizes that host sensitivity to caries is a crucial factor in the onset and development of carious lesions in primary dentition, despite the main contributing factors to this pathology. The rs1050450 polymorphism was not associated with the severity of S-ECC.

Prevalence of Obesity and Dental Caries in Kindergarten Children During the First Decade of Saudi Vision 2030: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Obesity and dental caries are significant health issues affecting children worldwide. This study aims to investigate the prevalence of obesity and dental caries among kindergarten children in Saudi Arabia during the early implementation years of the Vision 2030 initiative. Specifically, it examines the obesity rates between public and private kindergartens and assesses the correlation between obesity and caries risk.

METHODS

We conducted a cross-sectional study involving a stratified sample of 347 kindergarten children in Jeddah, Saudi Arabia, from September 2022 to March 2023, as part of a larger project assessing the obesity and dental caries prevalence in school-aged children. Their body mass index (BMI) was computed after their weight and height were measured. Following an oral examination, the decayed, missing, and filled teeth (dmft) scores were noted. The relationships between dmft and BMI, sex, and school type were studied using non-parametric tests, and its predictors were assessed as well.

RESULTS

Our findings indicate that 15.3% of the children were classified as obese based on the BMI measurements, while 9.8% were categorized as overweight. The prevalence of obesity did not show significant differences by school type when classified by BMI. The mean dmft score was 2.8 ± 3.6, with those children in public kindergartens demonstrating significantly higher dmft scores compared to their private counterparts (p < 0.001). Notably, there was no observed relationship between obesity and caries activity.

CONCLUSIONS

Despite the implementation of Saudi Vision 2030, the high prevalence of obesity and dental caries among kindergarten children suggests that the current health initiatives may be insufficient. The lack of a relationship between obesity and caries activity highlights the complexity of these health issues and the need for targeted interventions. To improve the health outcomes, it is recommended to enhance the awareness campaigns regarding oral health and nutrition, increase access to preventive dental care, and integrate nutrition education into kindergarten curricula.

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.

Obesity and oral health in Mexican children and adolescents: systematic review and meta-analysis

CONTEXT

A relationship between obesity and poor oral health has been reported.

OBJECTIVE

To investigate the association between overweight/obesity and oral health in Mexican children and adolescents.

DATA SOURCES

A literature search was conducted of 13 databases and 1 search engine for articles published from 1995 onward.

DATA ANALYSIS

A total of 18 publications were included. Evidence was inconclusive and varied according to sociodemographic factors or outcome measuring tools. The Decayed, Missing, and Filled Teeth and Filled Teeth Surfaces indices and the decayed extracted filled teeth index outcomes were included in a random effects model meta-analysis. Pooled estimates showed no statistically significant oral health differences (measured via the decayed extracted filled teeth or the Decayed, Missing, and Filled Teeth Surfaces indexes) among body mass index (BMI) categories. However, pooled estimates of 6 studies showed that children with higher BMI had worse oral health in permanent teeth (measured via the Decayed Missing Filled Teeth Index) than children with lower BMI (overall mean difference, -0.42; 95%CI, -0.74, -0.11).

CONCLUSION

Whether there is an association between poor oral health and high BMI is inconclusive; however, both co-exist among Mexican children. Therefore, health promotion and prevention efforts should address common risk factors and broader risk social determinants shared between noncommunicable diseases.

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.

The effects of socioeconomic status, oral and dental health practices, and nutritional status on dental health in 12-year-old school children

Background

This study aims to examine the effects of socioeconomic status, oral, and dental health practices, dietary habits and anthropometric measurements on dental health in 12-year-old schoolchildren.

Methods

The sample of the study consisted of a total of 254 children (44.1% boys and 55.9% girls) in three schools which were identified as low, moderate and high socioeconomic status. The data were collected by face-to-face interviews via a questionnaire form. Dentist determined DMFT and dmft indices of the children. SPSS (Statistical Package for the Social Sciences) package program was used to analyze the data.

Results

It was found that 70.9% of the children have dental caries on their permanent teeth. The number of girls with caries in permanent teeth and boys with caries in milk teeth was higher (p < 0.05). The frequency of seeing a dentist and changing toothbrush vary according to the socioeconomic status (p < 0.05). Oral and dental health indicators were determined to be affected by the frequency and duration of tooth brushing (p < 0.05). It was found that dmft values of the children consuming molasses and table sugar are lower (p < 0.05). There is a negative correlation between oral and dental health indicators and anthropometric measurements.

Conclusion

Dietary habits, anthropometric measurements, oral and dental health practices, gender, and socioeconomic status were shown to be effective on caries. Caries risk assessment and determining leading risk factors enable effective prevention programs to be implemented at different levels.

Body Mass Index and Early Childhood Caries in High Caries Risk Children: A Nested Case-Control Methodological Investigation

Purpose: To evaluate body mass index (BMI) - early childhood caries (ECC) relationships with various BMI expressions.
Methods: Healthy eight- to 18-month children with unerupted molar(s) were conveniently sampled from Uniontown, Ala., USA, a high caries risk community (i. e., rural, poor, racial minority). Staff measured height/weight, dentists conducted oral exams, and parents completed questionnaires annually (from 2008 to 2014) for BMI, ECC (decayed, missing due to caries, filled primary tooth surfaces [dmfs] score), and sociodemographic values, respectively. Nationally recognized standard (underweight-normal-overweight-obese), crude (overweight/obese-not), and continuous BMI variables were evaluated. Logistic regressions (with restricted cubic splines) assessed BMI-ECC relationships, producing odds ratios (ORs) and 95 percent confidence intervals (95% CIs).
Results: Male and female ECC ORs supported positive and negative parabolic functions, respectively, for increasing standard BMI categories; underweight males were associated with ECC (OR=4.59; 95% CI=1.06 to 19.85). Crudely expressed, overweight/obese males and females had lower and slightly increased odds of ECC, respectively. A continuous BMI produced a similar OR across sexes, while spline models suggested nonlinearity for each.
Conclusion: BMI-ECC associations might be nonlinear; being underweight could be a male ECC risk factor. Studies should include extreme BMI values without collapsing BMI categories.

Observational Study Regarding the Relationship between Nutritional Status, Dental Caries, Mutans Streptococci, and Lactobacillus Bacterial Colonies

The prevalence of dental caries and obesity is high as both raise significant health problems. The objective of this study was to evaluate the relationship between dental caries, the number of salivary colonies forming units of Mutans Streptococci (MS) and Lactobacillus (LB), and the nutritional status in a group of children from Transylvania. This observational study used a sample of 154 school children, aged 9 to 12 years. The prevalence of caries was measured using the decayed, missing, and filled teeth index for deciduous teeth (dmft index) and for permanent teeth (DMFT index). Height and weight were assessed for each subject, and their body mass index (BMI) percentile was calculated. Salivary levels of Mutans Streptococci (MS) and Lactobacillus (LB) were determined using the CRT Bacteria Test from Ivoclar Vivadent. In our study, we found a positive association between the BMI percentile, MS count, LB count, tooth brushing frequency, and the incidence of dental caries in children aged 9 to 12 years old. Future preventive programs should include nutrition control in order to prevent both the apparition of dental caries and obesity in children.

Dental Caries Severity and Nutritional Status of Nigerian Preschool Children

INTRODUCTION

Malnutrition in children is one of the most prevalent global health challenges, and malnourished children have a higher risk of death from childhood diseases. Early childhood caries (ECC) is the most common chronic disease of childhood. Complications from ECC such as pain, loss of tooth/teeth, and infection can undermine a child's nutrition and growth.

AIM

This study aims to evaluate the severity of decay, missing, and filled tooth (dmft) by nutritional status using the z scores of the anthropometric measurements: height for age (HFA), weight for age (WFA), weight for height (WFH), and body mass index for age (BMIA) among children with ECC in Nigeria.

STUDY DESIGN

This is a cross-sectional study conducted in 5 local government areas (LGAs) in Lagos State, Nigeria. A multistage sampling technique was used.

RESULTS

A total of 273 cases of ECC were included in the analyses (mean age 4.19 ± 0.96 y). Overall, the mean dmft was 3.04 ± 2.28, and most (96%) were accounted for by untreated decay. The distribution of dmft within the different z score categories of BMIA (<-3 = severely wasted, -2 to -3 = wasted, -2 to +2 = normal, +2 to +3 = overweight and >+3 = obese) showed the highest dmft scores among the combined severely wasted and wasted groups, lowest among children with normal z scores, and intermediate in the overweight and obese groups. There was a significant negative correlation between BMIA z score, WFH z score, and dmft (r = -0.181, P < 0.05 and r = -0.143, P < 0.05, respectively). However, the correlations between HFA z score, WFA z score, and dmft were positive but not significant (r = 0.048, P = 0.44 and r = 0.022, P = 0.77, respectively).

CONCLUSION

Our study showed an increased severity of dental caries among severely wasted or wasted children with ECC compared to those of normal or overweight.

KNOWLEDGE TRANSFER STATEMENT

The results from this study will raise awareness among clinicians and policy makers on the need for a primary prevention program for early childhood caries in countries with high burden of malnutrition and limited resources. Also, it will help draw the attention of clinicians to the caries status of malnourished children that can be managed to improve the nutritional outcomes.

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.

Dental caries and anthropometric measures in a sample of 5- to 9-year-old children in Dhaka, Bangladesh

AIM

This study aimed to assess associations between dental caries and anthropometric measures among a sample of children aged 5-9 years in Dhaka, Bangladesh.

METHODS

A cross-sectional observational study was conducted among 5- to 9-year-old children in Dhaka, Bangladesh. Data were collected from children and their parents attending the Dhaka Dental College Hospital and from three nearby primary schools. The outcome measures were as follows: age and sex adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ). Multiple linear regressions were used to assess the associations between caries and anthropometric measures, adjusted for maternal education, family income, study setting, birth weight and childhood diseases as potential confounders.

RESULTS

The final sample comprised 788 children, and the overall response rate was 96.7%. The majority (73.2%) had experience of dental caries. The mean dmft + DMFT score was 2.84 (95% CI 2.64, 3.03) and 35.8% experienced dental sepsis. Dental caries and sepsis were negatively associated with HAZ, WAZ and BAZ scores. After adjustment for potential confounders, children with severe levels of caries had lower HAZ scores (coefficient: -0.40; 95% CI -0.69, -0.10), lower WAZ scores (coefficient: -0.59; 95% CI -0.94, -0.24) and lower BAZ scores (coefficient: -0.50; 95% CI -0.87, -0.13) than those who were caries free. Children with moderate levels of caries also had lower WAZ scores (coefficient: -0.43; 95% CI -0.72, -0.15) and lower BAZ scores (coefficient: -0.43; 95% CI -0.72, -0.13) than caries-free children. Children with dental sepsis had lower HAZ (coefficient: -0.23; 95% CI -0.42, -0.03), WAZ (coefficient: -0.33; 95% CI -0.56, -0.10) and BAZ scores (coefficient: -0.29; 95% CI -0.53, -0.05) than dental sepsis-free children.

CONCLUSIONS

Dental caries was associated with lower height, weight and BMI among this sample of Bangladeshi children, even after adjusting for age and sex and a number of potential confounders.

Body mass index and dental caries in children aged 5 to 8 years attending a dental paediatric referral practice in the Netherlands

Background

Obesity and dental caries are widely-recognised problems that affect general health. The prevention of both dental caries and obesity have proven very difficult: children and their parents may need professional support to achieve behaviour change. To find out whether both dental caries and overweight in childhood can be targeted using a common risk factor approach, it is necessary to establish whether the two diseases are indeed linked. The aim of the present study was therefore to use anthropometric data obtained professionally to investigate the association between Body Mass Index and dental caries experience in children aged 5–8 years receiving treatment in a referral centre for paediatric dental care in the Netherlands.

Methods

Children’s dmft and dmfs scores were calculated using dental records and sociodemographic data were also extracted from these records. Dentists were trained to measure standing height and weight in a standardised way. Body Mass Index was calculated by dividing kilograms by height squared (kg/m²). Extended International (International Obesity Task Force) body mass index cut-offs were used to define ‘no overweight’ and ‘overweight’ (with the latter category including obesity).

Results

No statistically significant differences were found between the mean dmft or dmfs scores of the two groups (overweight and non-overweight), even after correction for the effect of the potential confounders sex, socio-economic status and ethnicity. The percentage of caries-active children in the non-overweight group was almost the same as in the overweight group. No statistically significant differences were found.

Conclusions

We hypothesised to find a positive association between body mass index and dental caries experience in children aged 5–8 years attending our practice. However, this study did not find a relationship of this kind. A common risk factor approach for the prevention of caries and overweight is therefore not supported by our study.