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Table of Contents   
ORIGINAL RESEARCH  
Year : 2013  |  Volume : 24  |  Issue : 1  |  Page : 66-70
Association between dental caries and age-specific body mass index in preschool children of an Iranian population


1 Department of Pediatric Dentistry, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2 Department of Restorative Dentistry, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

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Date of Submission23-Jan-2010
Date of Decision26-Apr-2010
Date of Acceptance15-Jul-2010
Date of Web Publication12-Jul-2013
 

   Abstract 

Background: The aim of this study was to determine the association of dental caries and BMI-for-age in preschool children and whether BMI-for-age is similar or different between Severe Early Childhood Caries (S-ECC) and caries free children.
Materials and Methods: Four hundred preschool children aged 30-70 months were entered into this study. The parameters examined in this study were weight, height, BMI-for-age and number of decayed, extracted and filled surfaces of deciduous teeth (defs). Based on dental caries, the subjects were also divided into S-ECC and caries-free groups. Then data was analyzed by t-test, one-way ANOVA, multiple regression and logistic regression tests.
Results: The mean and SD of defs index was 8.37 ± 11.2. In the underweight, normal-weight, at risk of overweight and overweight groups, these values were 4.89 ± 10.8, 8.84 ± 11.8, 8.68 ± 10.6, and 10.39 ± 10.2, respectively. Multiple regression analysis revealed a statistically a significant direct association between BMI-for-age and defs index (P = 0.001) after adjusting for gender and age. The percentage of subjects who were caries free and S-ECC was 44.8% and 51.2%, respectively. Logistic regression analysis showed that there was statistically a significant inverse association between BMI-for-age scores and the frequency of caries-free (P = 0.001) and a significant direct association with S-ECC children (P = 0.001).
Conclusions : The findings of this study demonstrated that there was an association between higher defs scores and severe early childhood caries with overweightness.

Keywords: Body mass index, dental caries, Iranian population, preschool children

How to cite this article:
Bagherian A, Sadeghi M. Association between dental caries and age-specific body mass index in preschool children of an Iranian population. Indian J Dent Res 2013;24:66-70

How to cite this URL:
Bagherian A, Sadeghi M. Association between dental caries and age-specific body mass index in preschool children of an Iranian population. Indian J Dent Res [serial online] 2013 [cited 2020 Oct 22];24:66-70. Available from: https://www.ijdr.in/text.asp?2013/24/1/66/114956
Childhood obesity is increasing rapidly worldwide [1] and is one of the most serious public health challenges of the 21 st century. The problem is steadily affecting many low-and middle-income countries, particularly in urban settings and its prevalence is increased at an alarming rate. In 2007, an estimated 22 million children under the age of 5 years were overweight throughout the world. More than 75% of overweight children live in low-and middle-income countries. [2]

Overweight children are likely to stay obese into adulthood. [3] Obesity in adulthood is not easy to treat and also increases the risk of some systemic diseases like type-2 diabetes, hypertension, coronary heart diseases, fatty liver, colon, breast and other types of cancers, and psychological stress that may lead to general poor health. [3],[4],[5],[6]

Oral health can play an important role in nutritional intake and general status of health. [7] Severe Early Childhood Caries (S-ECC) is a specific form of severe dental caries that affects young children. [8] Like other types of caries, fermentable carbohydrates such as sucrose, sweetened beverages and juices are among its main etiologic factors. [8],[9],[10],[11]

Age and gender specific BMI values for children are referred as "BMI-for-age". Categories describing amount of body fat for children and teenagers are also different from the categories describing amount of body fat in adults. BMI categories used for children and teenagers include underweight, normal-weight, at risk of overweight and overweight. There is no obese category for children and teenagers. [12]

Nowadays overweightness and underweightness are two main public health problems, [13] and their association with dental caries is still an unanswered question. A study in Scotland showed that among 165 children aged 3-11 years, children with more severe dental decay were more underweight [14] while Willershausen et al. have shown that high BMI was linked to a high number of caries lesions in primary school children. [15] Some researchers have supposed that frequent sugar intake can be a predisposing factor of both overweightness and dental caries. [7],[16],[17] Therefore, dental caries status of a child may have an effect on what he or she eats or drinks, and based on this information there can be a change in the child's dietary habits.

Although theoretically, dental caries status can be associated with both underweightness and overweightness, the documentation of such an association, especially in preschool children, is limited and controversial. Therefore, the aims of this current study was to determine if dental caries and overweightness or underweightness were associated in the preschool children population, or age and gender specific body mass index was similar or different between S-ECC and caries-free group children.


   Materials and Methods Top


This cross-sectional study was conducted using the cluster random sampling procedure. Four hundred preschool children (211 boys and 189 girls) were selected from 12 private and state-funded preschools with different social backgrounds in Rafsanjan, Iran in 2009. Only children fulfilling the following conditions were included in this study: Age between 30 to 70 months, no history of congenital and genetic problems and parental permission. The protocol was reviewed and approved by the Medical Research Ethics Committee of Rafsanjan University of Medical Sciences.

Examination for dental caries was carried out using the dental explorer (Medisporex Ltd. Sailkot, Pakistan) and disposable plane mouth mirror ( Atlas More Details Teb Co, Tehran, Iran) for an indirect look at lingual areas of the teeth in natural light after cleaning the teeth with cotton rolls, when necessary. This was done by an examiner (Bagherian A) according to the World Health Organization criteria and methods. [18]

The defs scores for primary teeth were recorded by an assistant on data collection forms. Teeth extracted for trauma reasons were not included in defs score. Restored teeth with recurrent caries and teeth filled with temporary materials were considered as decayed. White spots were not considered as decayed; radiographs were not taken.

Based on dental caries, the subjects were divided into two groups: The caries free group, whose defs was zero; and the S-ECC group which defines any sign of smooth surface caries in children younger than three years, defs greater than four at age three, defs greater than five at age four, or greater than six at age five. [8]

Body weight of children was recorded to the nearest 0.1 kg using a standard beam balance scale (Hopeway Industrial Ltd., Guangdong, China) with the children wearing lightweight clothing and no shoes. Body height of children was recorded to the nearest centimeter according to the following protocol: No shoes, heels together and head touching the ruler. All the measurements were done by the mentioned examiner. Forty subjects were re-examined after two weeks by the examiner. Intra-examiner reproducibility was assessed using Cohen's Kappa statistics for dental caries scores, weight and height, and was found to be satisfactory (Kappa value > 0.89).

Body mass index (weight/height 2 in kg/m 2 ) was calculated and compared with the international gender-and-age specific charts [19] for BMI-for-age determination. Among children, BMI-for-age categories include underweight, normal-weight, at risk of overweight and overweight. Underweight is defined as BMI-for-age <5 th percentile, normal-weight 5 th percentile < BMI-for-age < 85 th percentile, at risk of overweight 85 th percentile < BMI-for-age < 95 th percentile, and overweight BMI-for-age > 95 th percentile. [20]

All data were statistically analyzed by SPSS-16 (SPSS Inc., Chicago, IL, USA) software. Multiple and logistic regression analysis were used to test relationship between independent variables (BMI-for-age, sex and age) and dependent variables (defs index, caries free and S-ECC). For detecting the differences between defs index with BMI-for-age scores, one-way ANOVA was used. Chi-square was used to assess the differences between BMI-for-age with gender and frequencies of caries free and S-ECC; a P value less than 0.05 was considered as statistically significant.


   Results Top


In this study, 400 preschool children were examined. The demographic characteristics of the samples are summarized in [Table 1]. The mean age was 55.2 ± 9.3 months. The overall prevalence of underweight, normal-weight, at risk of overweight and overweight were 21%, 41%, 13.2%, and 24.8%, respectively. The Chi-square test showed that the frequency of overweight subjects was higher among boys (P = 0.013) [Table 2].
Table 1: Mean±SD of age, weight (kg), height (cm) and defs index; and percentage of caries free and S-ECC among 400 preschool children according to gender in an Iranian population

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Table 2: Distribution of BMI-for-age according to gender among 400 preschool children of an Iranian population

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[Table 3] shows the mean and SD of defs index, and percentage of d (decayed), e (extracted), and f (filled) compartments according to BMI-for-age. A one-way ANOVA test showed there was significant differences between defs and BMI-for-age scores (P = 0.008). The Tukey Post Hoc test revealed that there were statistically significant differences between underweight with overweight (P = 0.005) and normal-weight (P = 0.04) groups. The mean ± SD of defs index was 8.37 ± 11.2. [Figure 1] demonstrates the mean and SD of defs index in underweight, normal-weight, at risk of overweight and overweight children. Decayed surface (ds) contributed the greatest proportion (79.4%) of the defs and the filled surface (fs) contributed the least (9.7%).
Figure 1: Distribution of defs index among 400 preschool children according to BMI-for-age of an Iranian population

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Table 3: Mean±SD of defs index, and percentage of d (decayed), e (extracted), and f (filled) compartments among 400 preschool children according to BMI-for-age of an Iranian population

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Multiple regression analysis revealed that there was statistically a significant relationship between BMI-for-age and defs index after adjusting for gender and age [Table 4].
Table 4: Multiple regression analysis of BMI-for-age (independent variable) with defs (dependent variable) after adjusting for gender and age among 400 preschool children of an Iranian population

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The percentage of subjects who were caries free and S-ECC were 44.8% and 51.2%, respectively. The percentage of underweight, normal-weight, at risk of overweight and overweight children in the caries-free group were 30.2%, 37.4%, 13.4%, and 19%, respectively, but these values in S-ECC groups were 11.7%, 44.4%, 13.7%, and 30.2%, respectively [Figure 2]. The Chi-square test indicated that there was a significant difference of BMI-for-age scores between caries free and S-ECC (P = 0.001) [Figure 2].
Figure 2: Percentage of BMI-for-age scores in S-ECC and caries-free groups

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When adjusted for gender and age, logistic regression analysis showed that there was statistically a significant inverse association between BMI-for-age scores and the frequency of caries-free and a significant direct association with S-ECC children [Table 5]. Also, the results of this study showed that the effect of age on S-ECC was significant (P = 0.001) but the effect of gender was not (P = 0.35).
Table 5: Logistic regression analysis of BMI-for-age (independent variable) with caries free and S-ECC (dependent variables) after adjusting for gender and age among 400 preschool children of an Iranian population

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   Discussion Top


Childhood obesity is the most prevalent nutritional disease in many countries around the world including European and North American countries, and it is a growing phenomenon in Iran. [21],[22],[23],[24],[25] Changes in lifestyles, like increased consumption of more energy-dense, nutrient-poor foods with high levels of sugar combined with reduced physical activity are key causes to both nutritional and dental caries diseases. [2],[26]

The present study indicated that overweight children had higher defs score. So these children with more dental caries were more prone to be overweight. In agreement with our findings, Willershausen et al. have shown that in 2071 primary school pupils aged 6-10 years, high BMI was linked to a high number of caries lesions in primary school children. [15] Larsson et al. have also shown that adolescents with higher DMFT values tended to be more obese. [27] But Hong et al. found no association between BMI-for-age and dental caries in 2-6-year-old children. [28] In a study among US children aged 2 to 17 years; Macek also concluded that there is no statistically significant association between BMI-for-age and dental caries prevalence for children in either dentition. [12] Other studies on children or adolescents had different results from this study. [29],[30] In a study done in Iran, Sadeghi, and Alizadeh concluded that there was no association between BMI-for-age and DFT/dft indices among 6-11-year-old children. [31]

Oral health plays a significant role in nutritional intake and general status of health. [32] Its seems that, with the increase in dental decay and extracted teeth in children, there will also be greater changes in their dietary habits as it has been indicated that elderly people with early tooth loss, showed a deviation from preferred foods. [32],[33]

These changes happen slowly and unwantedly over time. If they preferred to eat meat, chicken, or any similar textured foods, it will bother them when the food particles enter the teeth cavities; so, they will prefer to eat sugary snacks and sweetened beverages that are less annoying for them to chew, in order to satisfy their body needs. Since these foods contain high sugar, they are more cariogenic, and increase calorie intake, they might lead to overweightness.

These changes in dietary habits that occur unwantedly can also lead to malnutrition in children with severe early childhood caries. A study has indicated that malnutrition can cause salivary gland hypofunction, [34] which may affect the cariogenic potential of food particles in the oral cavity. This hypothesis may also be a reason for increasing dental caries in overweight groups.

Some other researchers have stated that since overweight children have high sugar intake and the cariogenicity of sucrose has also been well proven, it may contribute to the general excess of food energy consumption and be reasonable for development of both overweightness and dental caries. [7],[16],[17],[29] Considering the fact that no significant association between dental caries and overweightness has been seen in some of the studies, [12],[28] this may be explained by better dental care preventive programs, such as water fluoridation, routine use of fluoride tablets and dental care education in those countries, compared to our country.

In this study more than half of the children were S-ECC and there was an association between higher defs scores and S-ECC with overweightness. The greatest portion of the total defs score was decayed, while the least was the filling, which means we need an improvement in our preventive dental care policies. So it is suggested that dental professionals (pediatric dentists, general dentists, and oral hygienists) have more important roles in weight counseling, eating habits and food choices for their patients. Public health measures should also be improved in dental care and dietary education in order to reduce the prevalence of both diseases.


   Acknowledgment Top


This study was supported by a grant provided to Vice Chancellor of Research of Rafsanjan University of Medical Sciences.

 
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Correspondence Address:
Mostafa Sadeghi
Department of Restorative Dentistry, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan
Iran
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Source of Support: Vice Chancellor of Research of Rafsanjan University of Medical Sciences, Conflict of Interest: None


DOI: 10.4103/0970-9290.114956

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