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ORIGINAL ARTICLE
Year : 2011  |  Volume : 29  |  Issue : 4  |  Page : 305-309
 

Underweight in low socioeconomic status preschool children with severe early childhood caries


Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India

Date of Web Publication21-Oct-2011

Correspondence Address:
S Gaur
Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka - 576 104
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.86375

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   Abstract 

Background: The prevalence of severe early childhood caries (sECC) is high in developing nations like India. It has local as well as systemic manifestations. Aims: This study evaluated the influence of sECC and its management on growth parameters and quality of life (QoL) of preschool children from low socioeconomic status families. Materials and Methods: 100 preschool children (50 with sECC and 50 with no dental caries; mean age 5.42 ± 0.74 years) from low socioeconomic status were studied. QoL; Decayed, extracted and filled teeth (def) index; Height (Ht); Weight (Wt); Head circumference (HC); Mid arm circumference (MAC); and, Body Mass Index (BMI) were recorded at baseline and compared after six months of dental rehabilitation. The test group included children with sECC having def > 6 and at least one pulpally involved tooth.The control group children did not have DC (def =0). Both the groups were age, gender and socioeconomic status matched. Statistical Analysis: Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) v.11.0 computer software. Chi-square test, Analysis of Variance (ANOVA), Fisher's exact and paired t tests were performed for comparing the groups at baseline and six month recall visit. Results: Baseline measurements showed that 46% of children with sECC had Wt below 3rd percentile (underweight; mean 15.49 ± 1.87Kg) which was less than the controls (mean Wt 16.34 ± 1.46kg). They also complained of pain (40%), avoidance of hard food (24%), noticed Wt loss (18%) and sleep disturbances (12%). After 6 months of dental rehabilitation, there was a significant improvement in their Wt (P= 0.002) and QoL. Conclusions: sECC negatively influenced the Wt and QoL of children. Awareness, education of parents and facilitation of oral health services may help in improving their Wt and QoL.


Keywords: Dental caries, growth, low socioeconomic status, severe early childhood caries


How to cite this article:
Gaur S, Nayak R. Underweight in low socioeconomic status preschool children with severe early childhood caries. J Indian Soc Pedod Prev Dent 2011;29:305-9

How to cite this URL:
Gaur S, Nayak R. Underweight in low socioeconomic status preschool children with severe early childhood caries. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2019 May 25];29:305-9. Available from: http://www.jisppd.com/text.asp?2011/29/4/305/86375



   Introduction Top


Early childhood caries (ECC) is a severe form of dental caries (DC), in which one or more decayed (cavitated or non cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth, are present in a child 71 months of age or younger. [1] In 2004, the American Academy of Pediatric Dentistry defined severe early childhood caries (sECC) as any sign of smooth-surface caries in children younger than three years of age. For children in the age group of three to five, one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or a decayed, missing, or filled score of > 4 (3 years old), > 5 (4 years old), or > 6 (5 years old) surfaces constitutes sECC. [1] Despite the advances in the field of medical science, dental caries continues to be a major health problem in the developing nations because of the lack of education, awareness and poor socio economic status. [2],[3] Socio economic status influences the nutrition and access for health care services. [4] In the developing nations children suffer from a dual risk of malnutrition, with obesity in those living in urban areas and under nutrition in children from rural and slum areas. [5] Recently, United Nations International Children's Emergency Fund (UNICEF) reported that about 146 million children below five years of age were underweight. [6] It was the target of the millennium's development goals to half the count of the world's population of underweight five year old children by 2015.

This cannot be accomplished with food deliveries alone. Factors like maternal educational levels, socio-economic status and family size have to be addressed, to reduce the number of children in the underweight category.

Prevalence of DC is more in younger children. A study by Goel P et al. showed a prevalence of DC at about 81.25% in the age group of five to six years. [7] Children with DC (with at least one pulpally involved tooth) can weigh less than those without it. [8],[9] It can also have a major impact on their physical, mental and overall systemic health. DC increases their susceptibility for iron deficiency anaemia, by lowering the serum ferritin levels. [10],[11] Some severe cases have even shown features of failure to thrive without any other obvious reasons. [12],[13]

Anthropometry is the single most universally applicable, inexpensive, and non-invasive method available to assess the size, proportions, and composition of the human body. Paediatricians have long used child growth as an important parameter in evaluating the health and general well-being of children. Low height and/or weight relative to reference data have been used as classic indicators of undernutrition for individuals and groups. World health Organization (WHO) has recommended the use of pediatric growth charts by the health professionals to monitor the physical growth of infants, children and adolescents. The measured values are plotted on the growth chart to determine the percentile relative to the child's age and gender. The anthropometric parameters below 3 rd percentile are indicative of insufficient growth and nutrition. [14]

With this background, the present study was conducted with the objectives of evaluating the affect of sECC and its comprehensive rehabilitation on the growth parameters and QoL of children from low socioeconomic strata of the society.


   Materials and Methods Top


Hundred preschool children (50 with sECC and 50 with no DC) from low socioeconomic status families were evaluated in this study. A written informed consent was obtained from the parents of the children participating in the study. Ethical approval was obtained from the institutional ethical committee before the commencement of the study.

The inclusion criteria were

  • Age range from three to six years;
  • Low socioeconomic status;
  • Systemically healthy and no intake of medications in last three months.
The test group included children with sECC having def > 6 and at least one pulpally involved tooth. [12] The control group children did not have DC (def =0). Both the groups were age, gender and socioeconomic status matched. The age of the subjects was obtained from their date of birth records. Their socioeconomic status was determined by using a standardized scale. [15] The parents were questioned about their education, occupation and family income. Children of families having scores between 5 and 15 were selected. All the children received midday meals in the preschool.

Assessment of QoL was done through a modified Early Childhood Oral Health Impact Scale (ECOHIS) which was filled by the parent. [16] It consisted of five parts with closed ended questions concerning pain due to DC, avoidance of hard food, noticed weight loss, disturbance of sleep, problem in attending the school, playing patterns and noticed behavioural change of the child. Baseline data included recording of decayed; extracted and filled teeth (def index) followed by the anthropometric measurements height (Ht), weight (Wt), head circumference (HC), mid arm circumference (MAC) and body mass index (BMI). All the measurements were made by a paediatrician using the standardized methodology recommended by WHO (1995). [17] The Ht was measured using a standiometer; and, Wt by electronic weighing machine (Essae Terraoka Ltd, model DS - 415 series, India) with standard minimum clothing and without shoes. HC and MAC were measured with a non stretchable nylon tape.

The BMI was calculated by using the formula:

BMI= weight (Kg)/ Height 2 (meters).

Values thus obtained were plotted on age and gender specific growth charts recommended by WHO. [17] The Ht, HC, MAC and BMI below the 3 rd percentile were considered as indicators of insufficient growth and Wt below 3 rd percentile was considered as underweight. [14] After recording the preliminary data, complete dental rehabilitation of the sECC group children was done according to the individual needs. The anthropometric measurements were repeated at the 6 month recall visit following the completed dental treatment.

Statistical analysis of the baseline and six month recall visit measurements was done using SPSS v.11.0 computer software (SPSS Inc, Chicago III), Chi-square test, ANOVA, Fisher's exact test and paired t tests. Associations and differences were considered significant when the P value was < 0.05.


   Results Top


Fifty preschool children (mean age 5.42 ± 0.74 years) with sECC were randomly selected and compared with children without DC. There were 25 males and 25 females in each group. At baseline, the mean def score in sECC group was 8.92 ± 3.21. [Table 1] shows that the mean values of anthropometric measurements were less in sECC group as compared to the controls. A comparison of baseline mean values of sECC group with the control group using ANOVA showed a statistically significant decrease in the Wt (P = 0.011) of sECC group. They also had higher complains of pain, avoidance of hard food, noticed Wt loss and disturbed sleep [Table 2]. Chi square test showed that 46% of the children with sECC and 10% of the children without DC weighed below 3 rd percentile (P=0.001) [Table 3].
Table 1: Values (Mean ± Standard Deviation) of baseline growth parameters in both the groups

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Table 2: Intergroup comparison of the quality of Life between the controls and severe early childhood caries group at baseline

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Table 3: Intergroup comparison of number of children with growth parameters below 3rd percentile (at baseline)

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At the follow up examination, 6 months after the complete dental rehabilitation, Fisher exact test showed a significant reduction in the number of children complaining of pain, noticed Wt loss and disturbed sleep in the sECC group [Table 4].Their QoL had significantly improved 6 months after dental rehabilitation. [Table 5] shows the mean values of anthropometric measurements in sECC group and control group at the 6 month follow up after complete dental rehabilitation of children in sECC group. Paired t test was done to compare mean anthropometric values below 3 rd percentile between sECC group with control group. It showed a significant increase in the Wt of sECC group children (P= 0.002). There was no significant change in the Ht, HC, MAC and BMI of these children (P > 0.05). There was also a significant reduction in the number of children with Wt below 3 rd percentile within the sECC group [Table 6].
Table 4: Comparison of quality of life after 6 months of complete dental rehabilitation in children with severe early childhood caries

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Table 5: Values (Mean ± Standard deviation) of growth parameters in both the groups after 6 months of dental rehabilitation of children in sECC group

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Table 6: Decrease in number of children with growth parameter below 3rd percentile within the severe early childhood caries group after 6 months after completion of the dental rehabilitation of children in sECC group

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   Discussion Top


In the present study, 100 preschool children from low socioeconomic sections of the society were evaluated. The results suggested that DC had a negative impact on QoL of children, and if left untreated may affect the weight of children. All untreated DC may not be detrimental to the general health; however, it significantly influences the QoL and dietary intake of children, especially when it is associated with pain and discomfort. [8],[9] Disturbed sleep as a result of pain can affect glucosteroid production in the body and thereby the growth. Another possible mechanism of impact of sECC on growth could relate to chronic inflammation from pulpitis and dental abscesses. Both of these conditions alter the metabolic pathways resulting in increased cytokine production. Cytokines like interleukin- 1 (IL-1) inhibit the process of erythropoiesis in bone marrow. The resultant reduced levels of haemoglobin may lead to anaemia of chronic disease. [8],[10],[11]

According to WHO, affected eating pattern can rapidly manifest in younger children of 3 to 6 years of age. [14],[18] Hence, this age group was selected for the study. The children were from similar socioeconomic background and were provided with daytime meal from the preschool, this minimized the bias between the controls and sECC group for any change in weight related to different eating patterns.

Low QoL was observed in children with sECC. The mean values of anthropometric measurements were lower in the sECC group as compared to the controls (Wt ~ 850gms less). Similar results have also been reported earlier in 3 year old children with nursing caries. [19],[20],[21]

After dental rehabilitation, there was a significant improvement in the QoL of sECC group children. The mean values of growth parameters were still higher in the control group as compared to sECC group; however, the difference in values was less as compared to baseline. There was a significant increase in Wt of the children after dental rehabilitation, which was similar to that reported in earlier studies. [22] Overall intergroup comparison after dental rehabilitation showed that sECC group no longer differed from the controls in relation to various growth parameters.


   Conclusions Top


Present study provides additional data on effect of sECC on growth parameters and QoL of lower socioeconomic children. It also highlights the importance of timely intervention and management of dental caries in children. A comprehensive health care programme including awareness, access to oral health care services, and education regarding ECC to parents, physicians, nutritionists and pediatric dentists would be beneficial to improve oral and physical health of children. Further studies incorporating a larger sample size and longitudinal evaluation of the obtained results are warranted to confirm the results of this study.

 
   References Top

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2.Chawla HS, Gauba K, Goyal A. Trend of dental caries in children of Chandigarh over the last sixteen years. J Indian Soc Pedod Prev Dent 2000;18:41-5.  Back to cited text no. 2
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12.Clarke M, Locker D, Berall G, Pencharz P, Kenny DJ, Judd P. Malnourishment in a population of young children with severe early childhood caries. Pediatr Dent 2006;28:254-9.  Back to cited text no. 12
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16.Pahel BT, Rozier RG, Slade GD. Parental perceptions of children's oral health: The Early Childhood Oral Health Impact Scale. Health Qual Life Outcomes 2007;5:6.  Back to cited text no. 16
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17.WHO child growth standard 2007. Available from: http://www.who.int/childgrowth/en/. [Last accessed on 2008 Oct 10].  Back to cited text no. 17
    
18.Miller J, Vaughan-Williams SE, Furlong R, Harrison L. Dental caries and children's weights. J Epidemiol Community Health 1982;36:49-52.  Back to cited text no. 18
    
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22.Acs G, Shulmann R, Ng MW, Chussid S. The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatr Dent 1999;21:109-13.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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