To Assess the Prevalence of Dental Caries and Its Association with Body Mass Index, Socioeconomic Status, Dietary Habits, and Oral Hygiene among 6–12-year-old Children in Faridabad

Abstract

Aim

The aim of our study was to assess the prevalence of dental caries and the body mass index (BMI) in included school-going children. Moreover, to examine the relationship between the prevalence of dental caries, BMI, and socioeconomic (SES) status and to evaluate sugar consumption and other dietary habits as risk factors for dental caries.

Materials and methods

The present cross-sectional study was performed among 400 school-going children aged 6–12 years from Faridabad city, Haryana. Parents filled out questionnaires for their respective children. The clinical examination of dental caries was performed according to World Health Organization (WHO) 1997. The BMI calculation was done by measuring height and weight.

Statistical analysis

The collected data were analyzed statistically using parametric and nonparametric tests.

Results

The prevalence of dental caries in deciduous teeth was 95.5% and in permanent teeth was 47.3%, respectively.

Conclusion

This study displayed the positive correlation of dental caries to BMI, oral hygiene practices, beverages, aerated drinks, chips, candy, and tea/coffee. Whereas the SES status and dietary habits Jam group variable had no significance in relation to dental caries.

How to cite this article

Kapil D, Saraf BG, Sheoran N, et al. To Assess the Prevalence of Dental Caries and Its Association with Body Mass Index, Socioeconomic Status, Dietary Habits, and Oral Hygiene among 6–12-year-old Children in Faridabad. Int J Clin Pediatr Dent 2023;16(4):626–632.

Introduction

Dental caries, like childhood obesity, is a lifestyle-related condition that may harm a child's teeth and general health.¹ Many poor and middle-income nations, especially in metropolitan areas, are struggling with two types of problems: those related to hunger or nutritional inadequacy, and those related to food excess, caused by fast lifestyle changes.² Dietary sugar consumption, salivary flow, salivary fluoride level, and preventative behavior all have a role in a patient's risk for developing dental caries. Because of these variables and the passage of time, children whose diets are rich in sugar and children who eat carbonated soft drinks and sugary snacks are more likely to develop dental caries.³ Obesity is strongly linked to dietary habits. Weight gain and obesity have been linked to a diet heavy in energy-dense, low-nutrient meals that are often high in saturated fats and sweets and a diet low in fruits and vegetables. Poor nutrition may also have an effect on the immune system, as well as on physical growth and development, the aging process, and even the state of your teeth. The development of dental caries is a hallmark of poor oral health and is now the most prevalent chronic illness in children.

Studies all across the globe have looked at the correlation between childhood obesity and dental caries, with some finding that eating sugary snacks in between meals is to blame. High-fructose-containing beverages and high carbohydrate foods is related to a higher prevalence of dental caries and obesity.^1–4 However, some studies have found dental caries related to a low body mass index (BMI) in children with harmful eating habits, such as being a picky eater, leading to malnutrition and inability to consume food adequately.⁵ Some research has revealed no link between childhood dental caries and BMI.⁶

Multiple studies detailed the correlation between caries and obesity, finding that overweight children were more likely to suffer from caries than their normal-weight counterparts.⁷ While some studies found substantial variations in decayed, missing due to caries, and filled permanent teeth(DMFT)/decayed, missing, and filled primary teeth (dmft) scores amongst children of varying BMIs (3–8 years old), others came to the opposite conclusion.⁸ Therefore, the question of whether or not children who are overweight are at an increased risk of developing dental caries is still up for debate. School-going children in urban and rural locations were studied to determine the impact of age, gender, dental hygiene, socioeconomic (SES) status, physical activity, diet, and sugar consumption on BMI and dental caries.

Materials and Methods

Children in Faridabad between the ages of 6 and 12 who met the inclusion and exclusion criteria were tested for the presence of dental caries. Every child was examined under World Health Organization (WHO) examination; DMFT/deft was also noted. Children's height and weight measurements for calculating BMI were recorded. In addition, a questionnaire regarding SES status, dietary habits, and oral hygiene was given to parents.

The study's primary investigator received expert instruction and calibration in the field of pediatric and preventive dentistry from the head supervisor. This action was taken to eliminate examiner bias.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Children with the chronological age of 6–12-year-old and their parents residing in Faridabad.

• Children for whom parent consent is given.

Exclusion Criteria

• People with obvious obesity-induced or linked syndromes, such as those with chronic sickness, severe malnutrition, endocrine disorders, physical and mental impairments, and so on.

• Children for whom parental consent is not given.

• Undergoing orthodontic treatment.

• Those who refused to let their anthropometrics be taken were left out.

Methodology

Prior to the study method, written agreement was sought from the parents of the participating children. The participants were polled on their sociodemographics (such as age, gender, and ethnicity) and physical well-being. Before administering the surveys, instructions were given on answering the survey questions. One of the two parents filled out the oral hygiene, diet chart, and sugar consumption questionnaire. Institutional Ethical clearance has been obtained from the review board committee.

The population was examined using WHO (2013) criteria of oral health examination. The data was collected by combining “Interviewer administered structured questionnaire” and “Clinical Examination” of children. The last section of the questionnaire included the information of parents concerned about their occupation, education, and their income, and according to that, the SES status of that family was calculated through” Modified Kuppuswamy's SES Scale 2019,”⁹ that is, most popular tool for assessing a household's economic standing in metropolitan settings.¹⁰

Proposed Statistical Analysis

The obtained information was imported into an Excel spreadsheet and analyzed using Statistical Package for the Social Sciences version 21. For inferential statistics, we utilized the parametric tests of significance (independent t-test, paired t-test), and for nonparametric statistics, we used the Wilcoxon test and the Mann–Whitney U test. The significance threshold was determined to be 0.05.

Results

Demographics

The children aged 6–12 years from Faridabad (Haryana) were included, 268 were males, and 132 were females (n = 400). The mean age for males was 8.571 ± 2.15 years, and for females was 8.348 ± 1.34 years, respectively, with no statistically significant difference (p-value = 0.279 according to Chi-squared test of significance) (Tables 1 and 2).

Table 1.

Correlation of sugar score with DMFT and dmft score

	Spearman's correlation coefficient	p-value
Sugar score and DMFT score	0.190	<0.001. S
Sugar score and dmft score	0.313	<0.001. S

Table 2.

Independent factors predicting the DMFT index according to linear regression

Independent variables	Unstandardized Coefficients		Standardized coefficients	t	p-value
	B	Standard error	β
(Constant)	0.573	0.778		0.736	0.462
Age	0.340	0.025	0.463	13.650	<0.001
Sex	−0.824	0.117	−0.273	−7.012	<0.001
School Type	0.692	0.106	0.239	6.540	<0.001
SES	0.017	0.065	0.010	0.262	0.793
Frequency of oral cleaning	−0.761	0.266	−0.092	−2.855	0.005
Beverages	−0.476	0.185	−0.078	−2.571	0.011
Aerated	1.326	0.119	0.467	11.187	<0.001
Jam	0.038	0.122	0.013	0.312	0.756
Chips	−0.654	0.162	−0.176	−4.035	<0.001
Candy	−0.336	0.121	−0.105	−2.769	0.006
Tea/coffee	−0.352	0.173	−0.062	−2.034	0.043
BMI	−0.082	0.012	−0.211	−6.782	<0.001

Caries Prevalence

The overall prevalence of Dental caries in ages 6−12 years in deciduous teeth was 95.5%. In permanent teeth was 47.3% which was statistically significant (p-value of <0.001). The prevalence of dental caries associated with BMI in deciduous teeth was 100% in underweight, 96.1% in average weight, 95.8% in obese, and 88.9% in overweight, which was statistically not significant (p-value 0.111). On the other hand, the prevalence of dental caries associated with BMI in permanent teeth was 73.3% in overweight, 45.9% in average weight, 40% in underweight, and 27% in obese, respectively, which was statistically significant (p-value of 0.001) (Fig. 1). According to SES, the prevalence of dental caries in deciduous teeth was highest at 100% in upper-lower and lower-middle-class followed by 91.1% in upper-middle-class, respectively (Fig. 2). In contrast, in permanent teeth, it was 54.5% in the upper-middle-class, 53.8% in the upper-lower, and 19.8% in the lower-middle-class, which was statistically significant (p-value of <0.001). The highest mean dmft score in deciduous teeth was 5.36 ± 2.09 in underweight, and in permanent teeth was 2.62 ± 1.74 in overweight.

Fig. 1.

Body mass index (BMI) category wise comparison of mean DMFT and mean dmft

Fig. 2.

Socioeconomic (SES) class wise comparison of prevalence of dental caries in deciduous and permanent teeth

Dental Hygiene Behavior

According to oral hygiene practices, the mean dmft score was found to be highest at 9.00 ± 0.0 in children who brush once a week, and the mean DMFT score was found to be highest at 2.24 ± 1.76 in children who brush several times a week (Fig. 3). Also, the highest mean dmft score of 5.47 ± 2.34 was recorded in children who visited thrice in the past 12 months and 5.37 ± 2.81 who never received any visits in the past 12 months. The highest mean DMFT score of 2.91 ± 1.41 was recorded in children who visited once in the past 12 months and 1.41 ± 1.04 who visited more than four times in the past 12 months (Fig. 4).

Fig. 3.

Frequency of oral cleaning with mean DMFT and mean dmft

Fig. 4.

Frequency of visits to dentist during past 12 months

Dietary Habits

The correlation of sugar score with dmft was 0.313 in deciduous teeth, and DMFT in permanent teeth was 0.19 (Table 1).

The multivariate linear regression model estimates the prevalence of dental caries depending on SES status, oral hygiene practices, eating behavior, and demographic variables (Table 2). The demographics variables had significant values (p-value 0.001) according to the population selected. (The SES status and dietary habits Jam group variable had no significance about dental caries. At the same time, oral hygiene practices, beverages, aerated drinks, chips, candy, and tea/coffee and BMI had a significant correlation to the prevalence of dental caries (p-value 0.005, 0.011, <0.001, <0.001, 0.006, 0.043, and <0.001).

Discussion

Prevalence of Dental Caries According to Age

We found that the incidence of dental caries was greater in the baby teeth than in the adult teeth. In 2016, Jain et al.,¹¹ deciduous teeth had a lower calcium content, and structural changes make them more prone to dental caries, you said. Moreover, children during early childhood could be associated with a nutrition deficiency. Caries prevalence was higher in the 11–12-year-old age range for permanent dentition than in the 6–8-year-old range. There are fewer adult teeth present in children aged 6–7 than in those aged 11–12. Oral health among school-aged children was also investigated in research conducted in Chennai, with findings correlating similarly.^12,13 According to Psoter et al.,¹⁰ the clinical composition, micro and macro morphology, and eruption patterns may respond to a wide range of minerals, including vitamins A and D, calcium, and phosphorus.

Prevalence of Dental Caries According to Gender

Jose found no significant gender gap in his research of the population of children and adolescents in Kerala, India.¹³ But Moses et al.,¹⁴ demonstrated the shift in the prevalence of dental caries from male to female with the increasing age. In the 5-year-old age group, the prevalence of dental in males was about 47.4%, and in females was 1.1% which switched to the female population in the 12-year-old age group, which was found to be more in females versus the male population. Ferraro and Vieira,¹⁵explained why girls had greater caries rates than guys on average. The risk of dental caries in pregnant women should take into account the woman's social environment, which includes her saliva flow, saliva composition, food, hormonal changes, and specific AMELX gene variations. Females in the current research had a higher rate of dental caries than men, perhaps because their teeth erupted earlier than males’ teeth. This suggests that females’ teeth were first exposed to the oral cavity.

Association between BMI and Dental Caries

Swaminathan et al.,¹⁶ in India and Abbass et al., in Egypt¹⁷ discovered no statistically significant association between BMI and dental caries in the developing permanent teeth. Similarly, the current investigation demonstrated no association between BMI and dental caries in deciduous dentition. However, underweight children had the greatest mean dmft in deciduous dentition. Research by Oliveria et al., provides similar evidence.^4,18 in Brazil, showing that underweight kids had a higher prevalence of caries lesions.

In permanent dentition, the overweight children concluded the highest DMFT, which linked excessive body fat to cavities in teeth. This was supported by the research done in German primary schools,¹⁸ which found a correlation between BMI and DMFT. One research, however, found a nonstatistical association between DMFT and BMI among teenagers in public and private schools in Sao Paulo state over a period of 1 year.¹⁹

Oral Hygiene/DMFT

According to our present study, the questionnaire responded to by parents revealed that children who brush once a week had higher dmft/DMFT scores. Prada,²⁰ found tooth brushing habits to be statistically significantly associated with dental caries. Jessri et al.,²¹ did a study in Tehran on primary schools which revealed that children who brushed their teeth once a week have almost four times the chance of having dental caries compared to those who brushed their teeth less than ≥ 2 times a day. Likewise, children who were not aware of dental floss were more prone to experiencing gingivitis. Similar studies reported in Hong Kong²² dental caries were shown to be positively correlated with the number of times per day that people brushed their teeth. Additionally, our research demonstrated that the majority of children only went to the dentist when they were experiencing discomfort, swelling, or trauma. Many studies supported this evidence and provided a similar pattern, that is, patients visit dentist visit only in emergencies.^23,24

Prevalence of Dental Caries According to SES

Elger et al.,²⁵ showed a correlation between dmft in deciduous dentition and SES status and poor oral hygiene. Our research similarly found that dental caries in deciduous teeth were more common in those of lower SES status due to inadequate diet and lack of access to dental care. Mathur et al.,²⁶ investigated area-wise prevalence of dental caries, which showed that adolescents from highly deprived areas, such as urban slums, had high caries. Also, in a systematic review, 272 articles revealed the prevalence of dental caries to be higher in children with low SES families.²⁷ In addition to this, a study by Piovesan et al.,²⁸ revealed that highly educated parents are probably more interested and responsible for health issues in maintaining oral hygiene and a balanced diet because their children have healthier teeth. They know preventive dental services and the harmful effects of sugar-containing food and drinks. Also, It was also suggested that this is because persons with higher incomes and levels of education tend to have better access to dental care. Cross-section research in German published by Pieper et al., found that these parents took care of their children's dental health and taught them how to wash their teeth before the age of two.²⁹ which could be related to low dental caries in high SES status.

On the contrary to this study, high SES and obesity have a crucial role in the risk of dental caries, which was concluded in a study by Abbass et al.¹⁷ Also, the logic was explained by Nabipour et al.,³⁰ Dental caries are exacerbated by the fact that higher-income households can afford to purchase more sugary and snack foods than lower-income ones. According to the results of a research by Reddy et al.²² The number of permanent teeth is lower in the 11–12-year-old age group, which may explain why dental caries is more common in this age range than in the 6–7-year-old age range. We found comparable results, with a greater frequency of dental caries in the permanent dentition among those of higher SES status.

Dietary Habits and Dental Caries

Sugar Consumption

We observed that the more sugar one consumes, the higher their DMFT/dmft. Data from throughout the world compiled by Sreebny et al.,³¹ observed a statistically significant correlation between sugar intake and tooth decay. The availability of more than 50 gm of sugar per person per day was associated with lower dmft or DMFT scores, as shown by statistics from the WHO on the prevalence of caries in children aged 6 in 23 countries (or 12 in 47 countries).³³

While McDonald did not find a link between sugar intake and the occurrence of dental caries, he did find a strong link between sugar intake and SES status. We found a strong correlation between the consumption of biscuits, cakes, sweets, candies and the incidence of dental caries and chocolate consumption. A similar study previously reported a positive correlation to these items.³² In addition, similar to the findings of previous research, chocolate intake was the primary factor in the increase of caries indices.

Because sugar is easily digested by many bacteria, it contributes to the development of caries by causing the production of dental biofilm, which in turn produces acid byproducts and ultimately leads to demineralization of tooth structure.³³

Beverages and DMFT/dmft

Caries in baby teeth were shown to be associated with the use of aerated drinks. The explanation provided in multiple studies suggests that the acidic nature of drinks causes the pH to reach 5.5, which dissolves the hydroxyapatite crystals, and decalcification occurs in enamel. This factor is crucial in understanding the causes of tooth decay. Increased DMFT may be the long-term outcome of drinking more soft drinks than normal and practicing poor dental care.³⁴

In our study, tea, and coffee showed a positive correlation with DMFT as the sugar added into tea and coffee makes them a risk factor. However, on the contrary, it was found that caffeinated drinks consumption did not correlate with DMFT. It was reported that in coffee and tea, polyphenols are present, which reduces the cariogenic potential of foods, but the added sugar, caramel, and syrup to milk, tea, and coffee might be the leading cause of tooth decay.³⁵

Correlation Between Eating Snacks While Watching Television and DMFT/dmft

Arya and Mishra,³⁶ showed that junk food and snack consumption while watching television was more which led to the intake of more calories for a more extended period thus, increasing the acid secretion amount displaying the positive association between increased dental caries and BMI. Our study also showed a significant increase in mean dmft/DMFT in deciduous and permanent dentition children who consume snacks while watching television. The study conducted by Docimo et al.,³⁷ evaluated the cariogenic risk related to sedentary and dietary habits during coronavirus disease 2019 (COVID-19). During the lockdown, the daily shopping for fresh fruits and vegetables was limited, which led to the consumption of exceedingly processed foods with high sugar and fat content, intensifying the risk of caries. This can be a significant factor for a drastic change in lifestyle and sports activity influencing the sleeping pattern and routines. This present study was also performed during COVID-19. Hence, it provides us with more relevant results showing correlation.

Conclusion

Children's baby teeth, known as deciduous dentition, had a higher prevalence of dental caries than their permanent teeth.

Dental caries was shown to have a favorable link with obesity, poor dental hygiene, and a poor diet (including soda, potato chips, sweets, and tea/coffee).

The correlation between SES status and dental caries among residents of Faridabad city was not significant.

Summary of Methodology

• School-going children in Faridabad.

• All the children who fulfil the inclusion criteria and volunteered to participate were approached.

• Selected 400 children.

• Parents filled out questionnaires for their respective children.

• The weight and height of each child were recorded.

• Examination of Dental caries in each child (DMFT/deft) was performed.

• Data related to dental caries was tabulated.

• Calculation of BMI and its classification was performed.

• Tabulation of data related to BMI.

• Statistical analysis.

• Result analysis, comparison, and conclusion were drawn.

Orcid

Shivani Singh https://orcid.org/0000-0003-4083-6315