Correlation of dental caries status with BMI in school children of age 3-16 years- An institutional study

ABSTRACT

Aim:

The study investigates the correlation of dental caries status with body mass index (BMI) in school children of age 3 to 16 years.

Background:

Obesity is a rising global health epidemic. Dental caries has been the predominant disorder in modern society. Obesity and dental caries are major health problems with multifactorial characteristics and similar risk factors, such as diet, lack of physical activity, unhealthy eating pattern, not enough sleep, and high amount of stress etc. Various studies have documented diverse outcomes linked to BMI and dental caries.

Material and Methods:

A cross-sectional study was implemented on 756 participants. Among the study participants, 475 (62.8%) were boys and 281 (37.2%) were girls. The decayed, missing and filled teeth (DMFT) index has been used to assess the prevalence of dental caries. Information of the study participant’s height and weight was reported using a standardized measuring scale and weighing machine; after that, the BMI was measured. SPSS version 22 was used to analyze the data.

Results:

The mean DMFT of the study participants in normal-weight children was 2.3. There was a positive correlation between the dental caries status and BMI, with a significant value of 0.27.

Conclusion:

Diet counselling and regular dental check-ups should be prescribed to prevent dental caries from occurring and monitor children’s healthy weight. Balanced nutrition needs to be provided to children by school authorities and parents.

Introduction

Dental caries has been the most chronic, terrifying disease affecting individuals in every corner of the world for decades. It is seven times more prevalent than seasonal allergies. It is a complex illness caused by modifiable risk variables such as dietary factors, water fluoride levels, teeth brushing frequency, and nonmodifiable risk factors such as socioeconomic status and past caries experience.[1] In the prevention of dental caries, the emphasis is now shifting to modifiable factors, especially nutritional.[2] Excessive childhood body weight is a global phenomenon. Obesity has reached epidemic proportions in India, impacting 5% of the population, as per the National Family Health Survey.[3] The body mass index (BMI) is calculated by dividing a person’s weight in kilograms by their height in meters square. A high BMI could suggest an increase in body fat.[4] The world is seeing an increase in the number of overweight people as a result of fast food and soft drink consumption and a lack of fitness and exercise. Excess carbohydrate consumption is implicated with obesity.[5] As per the Scientific Advisory Committee on Nutrition, a higher free sugar intake was linked to tooth caries. Consumption of sugar-sweetened beverages is related to increased weight gain and BMI.

Obesity, as per the World Health Organization, is defined as irregular or excessive fat build up that might harm one’s health. In teenagers or children, there is no cut-off point for excess fats caused by overweight or obesity.[6] The core notion that regulates weight increase or reduction is energy balance. The body can retain fat if it consumes more energy than is required for physical activity and basal metabolism, and the opposite is true if it consumes less energy than is required for physical activity and basal metabolism.[6] India is caught in a nutrition paradox where stunting and underweight coexist with overweight and obesity in children. National family health survey4 (2015-2016)[7] reported the prevalence of stunting, wasting, and underweight in children aged < 5 years to be 38%, 21%, and 36%, respectively. In this survey, overweight was defined as weight for height being more than 2SD, above the median of the reference population 2% of Indian children under the age of 5 years were overweight.[8]

The prevalence of overweight/obesity among adolescent Indian children rose from 9.8% in 2006 to 11.7% in 2009. Lobstein and Jackson Leach computed that there will be 17 million obese children by 2025.[9] This trend is reported from all over India, both in urban and rural areas. Prevalence of overweight/obesity in children in Delhi increased from 16% in 2002 to 24% in 2006.[10]

As per a recent study, the prevalence of childhood obesity in Riyadh was 19.5% for males and 20.8% for females.[11] Unfortunately, being overweight or obese between the ages of 14 and 19 years has been linked to an increase in chronic disease mortality. As per several studies, there is a link between BMI and DC.[7,8] However, there are no additional research in the Guntur District, so the purpose of this study is to examine the relationship between BMI and dental caries status in children aged 3 to 16 years. Novelty of the study was so far this kind of studies were not done in the Guntur district and it was an institutional-based study, with the study participants were taken from the Out-patient Department (OPD) Department of Pedodontics. For the present scenario, the study was useful because India is caught in a nutrition paradox where stunting and underweight coexist with overweight and obesity in children. National family health survey-4 reported the prevalence of stunting, wasting, and underweight in children aged less than 5 years to be 38%, 21%, and 36%, respectively.[3] Increased eating of junk foods may lead to obesity and subsequently high caries incidence among these children.

Materials and Methods

The cross-sectional study was conducted on 756 participants who attended the OPD Department of Pedodontics and Preventive Dentistry at the SIBAR Institute of Dental Sciences aged 3-16 years during the period from March 2019 to December 2019.

Ethical approval and consent of participants

The acquiescence was obtained from the Institutional Ethics Committee and an informed written consent was derived from the participants’ parents. The institutional review board approved the study on 20/01/2019 and has given the no 46/IRB/SIBAR/2019.

Sampling method: Convenience sampling was carried out by including children from the out-patient department.

Study size of the population: A total of 756 participants were taken into this study, which ever comes to the OPD Department of Pedodontics and Preventive Dentistry. The sample population’s age group is 3-16 years. Overall, 756 children were recruited into the present study. Of these, 318 children were between 3 and 8 years and 438 children were between 10 and 15 years. Among the study participants, 475 (62.8%) were boys and 281 (37.2%) were girls. Study Questionnaire: Structured questions about specific daily eating circumstances, oral hygiene habits, and routine dental check-ups were created, and they proved to be important for a higher caries risk, were administered for conducting study. Questionnaire content validity was checked by conducting pilot study. As per the World Health Organization (WHO), the usual method for documenting the anthropometric measurement of BMI is to use a digital scale of 150 kg and 200 cm of tape to compute the height (WHO). The body weight was measured using a typical beam balancing scale while the individuals wore light clothes and walked barefoot. The height of the body is measured with subjects wearing no shoes and their heads contacting the ruler with their line of sight horizontally aligned. Weight (kg)/height (m²) is the BMI formula. As per WHO, the scores are as follows: underweight (18.5), average weight (18.5-24.99), overweight (>25), and obese (>30). The evaluation of dental caries was done by the Dunning type III examination method. By using mouth mirror and probe, the DMFT/deft were recorded, as decayed, missing, filled teeth.

Intra examiner reproducibility was checked among examiners and Kappa value was 0.85; it shows strong agreement.

Inclusion and exclusion criteria

• All healthy children with regular physical activity of both gender were included.

• Children of age group 3-16 years.

• Who are cooperative.

Exclusion criteria

• Children suspected of having some disease with chronic medical conditions (continuous use of sugar-containing medications is a compulsion), who were not physically involved and had enamel/dental abnormalities other than dental caries were excluded.

Procedure for recording dental caries

Diagnosis of dental caries was developed using a noninvasive technique based on the WHO approach and criteria. The children were positioned in chairs and visually inspected using optimum illumination, a CPI probe, and disposable mouth mirrors. The deft index was recorded for the primary teeth. Dental caries in permanent dentition were measured using the DMFT index.

Statistical methods

Data were collected and tables and graphs were created to represent it. The BMI and dental caries groups were evaluated with Chi-squared test, t-test, and linear regression model using the version 22 of SPSS computer software. The significance level was set top <0.05%.

Results

The majority of the children (79.3%) had a BMI falling within the underweight category. Around 1.4% of the children were either overweight or obese. The rest of the children were normal weight (17.9%). The majority of the children (66%) had a fair OHI-S index, 32% had good, and remaining 2% had a poor OHI-S [shown in Table 1].

Table 1.

Distribution of study subjects by age, gender, categories of body mass index, and OHI-S

Variables	Frequency	Percent
Age group
3-8 years	318	42.1
10-15 years	438	57.1
Gender
Female	281	37.2
Male	475	62.8
BMI Index
Under weight	599	79.3
Normal weight	135	17.9
Over weight	11	1.4
Obese	11	1.4
OHI-S Index
Good	242	32.0
Fair	499	66.0
Poor	15	2.0

Table 2 shows a statistically significant relationship between BMI categories and subjects’ OHI-S (Chi-squared test, P =0.001).

Table 2.

Statistical comparison of dental variables and BMI categories by age and gender

	no (%)	OHI-S			Total	R	P
		Good	Fair	Poor
Age group
3-8 years	n	126	192	0	318	0.165	0.095
	%	39.6%	60.4%	0.0%	100.0%
10-15 years	n	115	307	16	438
	%	26.3%	70.1%	3.6%	100.0%
Gender
Female	n	85	196	0	281	0.006	0.360
	%	30.2%	69.8%	0.0%	100.0%
Male	n	156	303	16	475
	%	32.8%	63.8%	3.4%	100.0%
BMI Index
Under weight	n	222	377	0	599	0.274	0.001*
	%	37.1%	62.9%	0.0%	100.0%
Normal weight	n	20	105	10	135
	%	14.8%	77.8%	7.4%	100.0%
Over weight	n	0	6	5	11
	%	0.0%	54.6%	45.4%	100.0%
Obese	n	0	11	0	11
	%	0.0%	100.0%	0.0%	100.0%

P=Chi-square test, R=Pearson’s correlation, *Statistically significant.

The mean DMFT of male and female subjects was 2.71 and 1.5, respectively, which was statistically significant. There was no significant relationship found between age groups [Figure 1].

Figure 1.

Bar chart showing association between age, gender, BMI, and the dependent variable DMFT

However, after taking the age and gender into consideration, the relationship between the dental variables and BMI categories showed that the mean value of DMFT was significantly greater among overweight (8.5) compared with other age groups (P <.018) [Figure 1].

As per a linear regression model, there is a significant relationship between BMI and DMFT (P =0.04). The DMFT score increases 0.624 times for every unit increase in BMI [Table 3]. Dental caries in children is commonly untreated and represents a public health problem. At least 30% of obesity begins in children and 50%-80% obese children become obese adults. The rise in the prevalence of obesity has mirrored in the rise in DMFT.

Table 3.

Linear regression model with BMI as predictor and DMFT as outcome variable

	n		Mean	Std. deviation		95% confidence interval for mean
						Lower bound	Upper bound
Under weight	599		2.14	2.760		1.64	2.64
Normal weight	135		2.30	2.643		1.25	3.34
Over weight	11		8.50	6.364		-48.68	65.68
Obese	11		2.50	0.707		-3.85	8.85
Total	756		2.26	2.839		1.80	2.72
Coefficientsa
Model	Unstandardized Coefficients		Standardized Coefficients Beta	t	Sig.	95.0% confidence interval for B
	B	Std. error				Lower bound	Upper bound
1
(Constant)	1.482	0.580		2.554	0.012	0.335	2.629
BMI	0.624	0.427	0.119	1.462	0.046	-0.220	1.468

^aDependent Variable: DMFT

Discussion

For ages, both obesity and dental caries are alarmingly multidisciplinary aspects. There is a tremendous need to fix it until it takes its full form. In the Alghamdi and Almahdy study,[12] about 32% of the study population was either overweight or obese, which is about 1.4% in the prevailing study. The mean DMFT of the research participants was 2 ± 0.05, which is very similar to 1.8 of the Jürgensen and Petersen study.[13] There is a positive correlation between BMI and dental caries, with a P value of. 001. Similarly, it is significant for BMI and age groups, that is, overweight and obese children in the 3-9 years age group, which is 2.3% in the 10-16 years age group, which is quite similar to Tubert Jeannin et al.,[21] showing that there is an increasingly growing risk to the health of populations in an increasing number of countries. Diet has a significant impact on the individual’s caries status, as fiber-containing food decreases the accumulation of plaque, preventing tooth decay. Carbohydrate-rich diets, on the other hand, facilitate the destruction of teeth. A statistically significant positive association between dental caries and BMI was found in this study, which contradicts the study of Alghamdi and Almahdy.[12,13] As per a systematic review, 48% of the studies found no association between dental caries and BMI, 35% found a positive correlation, and 19% found a negative association. High BMI and DCs are closely linked to lifestyle, for example, low consumption of sugar, frequent brushing, and regular oral dental check-ups can help improve general health. Macek and Mitola[14] demonstrated in 2006 that normal-weight children had greater dental cavities in both primary and permanent dentition. Similarly, Narksawat et al.[15,16] discovered that overweight children were less likely than normal-weight children to have dental caries in primary (Odds Ratio = 0.6) and permanent dentition (Odds Ratio = 0.5). It was also discovered that underweight and normal-weight pupils were at least 1.94 times and 2.22 times more likely to develop dental caries, respectively, than overweight and obese children aged 12 to 14 years. Similar to the present study, Honne et al.[16] discovered a positive relationship between obesity/overweight status and dental caries. Bailleul-Forestier et al.[17] discovered that highly obese children (n = 16) had a significant caries incidence. In the obese group, there was a significant relationship between BMI and DMFT indices (P =0.01). In the study by Sede and Ehizele,[18] the mean DMFT of overweight people is 8.5 ± 0.5, which is 3.03 ± 4.25. We discovered that obese students have a higher chance of developing dental caries than normal-weight participants, which is consistent with the findings of Costacurta et al.[19] The study participant’s mean DMFT among normal-weight children was 2.3. There was a link between BMI and the presence of dental caries. In the study done by Swaminathan et al.,[20] there is no difference in caries experience between normal-weight and overweight children. In the present scenario, factors causing high BMI were biological factors, genetic factors, age, dietary factors, physical activity, TV watching, psychological factors, family factors, and socioeconomic factors; control over these factors were most beneficial in the control of DMFT among children.

Limitations

1. Underestimation of caries burden because no radiographs were taken.

2. Many of normal weight children will be included in overweight category, if the BMI values were given specific to Indian population.

3. Generalizability usually not possible in the hospital-based studies.

Conclusion

The investigation concludes that there are more underweight subjects than overweight and obese children. In the current research, the prevalence of caries in obese subjects is high relative to normal-weight subjects, which could be attributable to reduced physical activity in obese subjects compared to normal-weight children. Diet counselling and regular dental check-ups should be prescribed to prevent dental caries from occurring and monitor children’s healthy weight. Balanced nutrition needs to be provided to children by school authorities and parents. It is proposed that newer and more comprehensive longitudinal research be performed in the future to provide useful insights into this relationship. Children should most significantly be provided with adequate education and knowledge of obesity and caries. This reinforcement would shield them from adverse effects. It also encourages them to have a safe and balanced lifestyle. In the present study, higher BMI was associated with higher odds of caries. Measures should be taken for the control of obesity and overweight among children to prevent future oral and general health consequences.

Future obesity management programs and oral health interventions through determining common risk factors are recommended through this study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.