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ORIGINAL ARTICLE
Year : 2019  |  Volume : 37  |  Issue : 1  |  Page : 12-17
 

Dental caries experience in relation to body mass index and anthropometric measurements of rural children of Nellore district: A cross-sectional study


Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication25-Feb-2019

Correspondence Address:
Dr. Veguru Prathyusha Reddy
Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_52_18

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   Abstract 


Context: The relationship between body mass index (BMI) and dental caries consists of multiple contributing factors. There have been no studies documented in the literature in this part of rural India assessing the prevalence of dental caries in relation to BMI. Hence, an attempt was made to study dental caries in relation to BMI and anthropometric measurements. Aims: The aims were to study dental caries experience in relation to BMI and anthropometric measurements of rural children in Nellore district. Settings and Design: A descriptive cross-sectional study was carried out in Nellore city. Subjects and Methods: A total of 1500 6- and 12-year-old children were examined. Dental caries was examined using the WHO dentition status criteria (1997) and 1-day diet chart was collected from each child followed by collection of anthropometric data. Statistical Analysis Used: Statistical analysis was performed using Chi-square test, Fisher's exact test, and Spearman's correlation test. Results: In the present study, out of all the participants, 59.2% of low weight children, 41.3% of normal weight children, and 25.7% of overweight-obese children were having dental caries. Dental caries was more among low weight children compared to normal weight and overweight-obese children and was statistically significant. Conclusions: All the anthropometric measurements were positively correlated with dental caries except height for age and BMI for age. There was an inverse graded association between the height for age and BMI for age with dental caries in 6- and 12-year-old children.


Keywords: Dental caries, obesity, weight


How to cite this article:
Reddy VP, Reddy V C, Krishna Kumar R V, Sudhir K M, Srinivasulu G, Deepthi A. Dental caries experience in relation to body mass index and anthropometric measurements of rural children of Nellore district: A cross-sectional study. J Indian Soc Pedod Prev Dent 2019;37:12-7

How to cite this URL:
Reddy VP, Reddy V C, Krishna Kumar R V, Sudhir K M, Srinivasulu G, Deepthi A. Dental caries experience in relation to body mass index and anthropometric measurements of rural children of Nellore district: A cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2019 Mar 26];37:12-7. Available from: http://www.jisppd.com/text.asp?2019/37/1/12/252860





   Introduction Top


Dental caries has a multifactorial etiology in which there is interplay of three principal factors: the host, the microflora, and the substrate and a fourth-factor time.[1] Untreated tooth decay can lead to difficulties such as pain, infection of the pulpal tissue, poor quality of life, and systemic health problems.[2] Dental caries and deviations from normal weight are two conditions which share several broadly predisposing factors such as genetics, diet, socioeconomic status, lifestyle, and other environmental factors.[3]

Obesity status in children is measured by assessment of body mass index (BMI) corresponding to gender and age.[1] Unlike, BMI assessments for adults, assessments for children, and teenagers take these growth- and gender-specific differences into account. These child-specific BMI values are referred to as BMI for age.[4]

The relationship between BMI and dental caries consists of multiple contributing factors, including biological, genetic, socioeconomic, cultural, dietary, and environmental and lifestyle concerns.[5] According to the literature, nutritional deficiencies may impair not only the formation of tooth structures but also the development of the salivary glands and evidence also suggests that it has an effect on dental caries.[6] Several studies have shown that, in countries where proper oral hygiene is followed, caries prevalence has decreased despite increases in sugar consumption, thus marking the importance of oral hygiene in caries etiology.[1]

There have been no studies documented in the literature in this part of rural India assessing the prevalence of dental caries in relation to BMI, daily sugar intake, and oral hygiene. Hence, an attempt was made to study dental caries experience in relation to BMI and anthropometric measurements of rural children of Nellore district.


   Subjects and Methods Top


A descriptive cross-sectional study was carried out among 6- and 12-year-old rural children between the months of March 2017 and August 2017, to study dental caries experience in relation to BMI and anthropometric measurements of rural children of Nellore district. Children present on the day of examination with informed consent from their parents/guardians were included in the study. Children with special needs and uncooperative children were excluded from the study. The ethical clearance was obtained from the Institutional Review Board of Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India. The sample size was estimated based on the prevalence of dental caries reported in the previous studies.[7]

Multistage clustered sampling methodology was followed. Nellore district was divided into five divisions. Ten mandals were randomly selected from the five divisions. Among the 10 mandals, two villages were randomly selected. Dental caries was measured by the WHO dentition status criteria, socioeconomic status was recorded, and 1-day diet chart was collected for assessing their sugar score, followed by collection of anthropometric data. Weight for age, height for age, and BMI for age were calculated using the WHO Anthroplus software. Statistical analysis was performed using SPSS software programme version 22. Chi-square test, Fisher's exact test, and Spearman's correlation test were used.


   Results Top


[Table 1] illustrates that 45.5% of the study population was male and 54.6% were female. About 74.6% of people were in the lower middle class and 25.4% people were in the lower class of socioeconomic status. Nearly 23.9% of the study population was in watch out zone in accordance with sugar score.
Table 1: Distribution of study population according to gender, socioeconomic status, and sugar exposure

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[Table 2] shows the relationship of dental caries with socioeconomic status. About 33.2% of the study population in lower middle class was having dental caries and 69.6% of the lower class population was having dental caries. There was highly significant difference between the socioeconomic status and dental caries of primary teeth, permanent teeth, and both primary and permanent teeth.
Table 2: Dental caries in relation with socioeconomic status

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[Table 3] shows the relationship between BMI for age and dental caries in primary and permanent teeth. In the present study, out of all the participants, 59.2% of low weight children, 41.3% of normal weight children, and 25.7% of overweight-obese children were having dental caries. Dental caries was more among low weight children compared to normal weight and overweight-obese children and was statistically significant. There was 0.48 times less risk of having dental caries in normal weight children compared to low weight children and 0.24 times less risk of having dental caries in overweight-obese children compared to low weight children.
Table 3: Body mass index for age and relation with dental caries in primary and permanent teeth

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[Table 4] shows the relationship between sugar exposure and dental caries in primary and permanent teeth. There was 0.69 times more risk of having dental caries in good zone of sugar exposure. There was 5.19 times more risk of having dental caries in watch out zone of sugar exposure compared to excellent group. There was statistically high significant difference in between sugar exposure and dental caries in primary and permanent teeth.
Table 4: Sugar exposure and relation with dental caries in primary and permanent teeth

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[Table 5] shows correlation of anthropometric measurements with dental caries in primary and permanent teeth. Height, weight, BMI, weight for age, skinfold thickness subscapular and triceps, body fat percentage, waist circumference, hip circumference, and mid-upper arm circumference were positively correlated with dental caries of primary and permanent teeth, and the difference was statistically significant except for waist circumference and hip circumference. Height for age and BMI for age were negatively correlated with dental caries in primary and permanent teeth, and this difference was statistically significant.
Table 5: Correlation of anthropometric measurements with dental carie

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   Discussion Top


Dental caries during childhood continues to be a significant public health concern. Oral health problems not only affect oral health but also has a psychological and emotional impact on the children as they interfere with learning, and thus, the child is not grown up to their full potential.[8] There are conflicting reports in the literature on the association between anthropometric measurements and dental caries among children and due to the limited data availability in India regarding association between anthropometric measurements and dental caries a study was conducted with an aim to study dental caries experience in relation to BMI and anthropometric measurements of rural children of Nellore district.

In the present study, 45.4% of the study population was male and 54.6% were female. The prevalence of dental caries was high among females (45.1%) than males (39.2%), which was statistically significant (<0.05). Similar results were obtained in the studies done by Yee and McDonald,[9] Elías-Boneta et al.,[10] Jamelli et al.,[6] and Narang et al.,[11] This might be due to the difference in snacking habit of girls compared to boys and may also be attributed to the fact that girls permanent teeth erupt at an early age than in boys. Other risk factors for girls include a different salivary composition and flow rate, hormonal fluctuations, dietary habits, genetic variations, and particular social roles among their family.[12]

In our study, the prevalence of dental caries was high among lower class of socioeconomic status (69.6%) than in lower middle class of socioeconomic status (33.2%), which was highly statistically significant (<0.001). Similar results were obtained in a study done by Sogi and Bhaskar,[13] where lower socioeconomic status group showed a high prevalence of dental caries and this was in accordance with studies conducted by Dummer et al.[14] and Warnakulasuriya.[15] Research in industrialized countries has revealed that children of high social class families experience less caries than those of lower social classes. Individuals with lower socioeconomic background are more likely to eat low-cost foods containing more sugar and fat, which increases the risk of obesity and dental caries.[13]

Childhood obesity and dental caries are multifactorial in nature and both result from complex interactions among the risk factors.[8] Malnutrition could also predispose to dental caries. Deficiencies in protein or energy foods may lead to protein-energy malnutrition, decreased salivary flow, calculus formation, high levels of caries, and reduced growth. Chronic malnutrition, particularly during the early years, has been shown to increase susceptibility to dental caries in the primary dentition due to enamel hypoplasia and salivary hypofunction. Alternatively, both outcomes could be influenced by a third variable such as those associated with socioeconomic status. The WHO recommended BMI for age as the best indicator for use in children and adolescents.[16] In the present study, population 59.2% of low weight children, 41.3% of normal weight children, and 25.7% of overweight-obese children were having dental caries. The prevalence of dental caries was more among low weight children compared to normal weight and overweight-obese children and was statistically significant. In this study, it was observed that as the body weight increases, the prevalence of dental caries decreases. BMI for age showed a negative correlation with dental caries and was statistically significant. Ambarkova and Gracija[17] conducted a study to investigate the relationship between BMI and mean decayed, missing, and filled teeth (DMFT) score of 12-year-old school children and concluded that being overweight was found to be negatively associated with mean DMFT score. Another study was conducted by Shakya et al.[18] to evaluate the correlation between malnutrition and dental caries among 6, 10, and 12 years children in Mangalore and suggested that children with less BMI score tend to have more carries affected teeth than children with normal BMI. Thus, similar studies conducted by Ambarkova and Gracija[17] Alkarimi, et al.[19] Sudhakar et al.,[20] and Kopycka-Kedzierawski, et al.[21] showed a negative association between obesity and dental caries and were in accordance with the results of the present study, which might be due to the malnourishment during the early age causing enamel hypoplasia and salivary hypofunction leading to decreased salivary flow rate and increase in plaque accumulation possibly causing dental caries. The findings of this study were in contrast with the studies conducted by Chopra et al.,[12] Costacurta, et al.[22] Parkar and Chokshi,[23] and Trikaliotis et al.[3] who reported a positive association between body weight and dental caries. The reason for this positive correlation might be due to the complex relationship between BMI and dental caries in children. Caries is higher in obese children due to increased intake and prolonged exposure to carbohydrates in various dietary forms. The possible reason could be due to high family income that has led to easy access to high caloric food (fast foods and junk foods) and availability of less physically active recreation environment to these children. Few studies conducted by Kumar (2017),[24] Gupta, et al.[1] Begum et al.,[25] Alves et al.,[26] and Shakya et al.[18] showed no association between body weight and dental caries, which might be attributed to the fact that both obesity and dental caries are multifactorial in etiology and various genetic and environmental factors have an impact on them.

The rising prevalence of childhood overweight and obesity cannot be addressed by a single etiology. Multiple factors such as lack of physical activity, unhealthy eating habits, or a combination of both with genetics and lifestyle play an important role in determining children body weight.[25] Another risk factor common to both obesity and dental caries is high sugar intake.[1] The association between caries and sugar consumption to a great extent has disappeared in the developed countries, probably due to massive preventive measures such as use of fluorides for self-care (fluoridated dentifrices and mouth rinses) and at dental clinics, whereas in developing countries this relationship can still be observed.[27] In the present study, risk of having dental caries was 5.19 times more odds in watch out zone followed by 0.69 times more odds in good zone compared to excellent zone of sugar exposure and the risk of dental caries increases with increase in sugar exposure in dietary intake. There was statistically high significant difference in between sugar exposure and dental caries in primary and permanent teeth. Burt and Pai[28] conducted a systematic review to examine the relation between sugar consumption and dental caries experience and concluded that restriction of sugar consumption is most important aspect in the prevention of dental caries and these results were in accordance with our study as high caries prevalence was observed in watch out zone of sugar exposure compared to excellent and good zone of sugar exposure. Another study was conducted by Gupta et al.[1] to correlate the prevalence of dental caries to BMI, daily sugar intake, and oral hygiene status of 12-year-old school children and concluded that only oral hygiene status had a significant effect on caries prevalence, whereas daily sugar intake and BMI had no significant effect on caries prevalence and these results were not in accordance with the present study.

In the present study, height, weight, BMI, weight for age, skinfold thickness subscapular and triceps, body fat percentage, waist circumference, hip circumference, and mid-upper arm circumference were positively correlated with dental caries of primary and permanent teeth, and the difference was statistically significant except for waist circumference and hip circumference, which were not statistically significant. Height for age and BMI for age were negatively correlated with dental caries in primary and permanent teeth, and this difference was statistically significant. Studies done by Alkarimi, et al.[19] Köksal et al.[29] and Jamelli (2010)[6] stated that height for age, weight for age, and BMI for age showed a negative correlation with dental caries and these results were in accordance with this study.

Limitations

  • As only two age groups were taken into consideration. The results cannot be generalized
  • The sample was taken from the rural population, which represented low socioeconomic status. This limits the possibility of generalizing the association between socioeconomic status and dental caries.



   Conclusions Top


All the anthropometric measurements were positively correlated with dental caries except height for age and BMI for age. There was an inverse graded association between the height for age and BMI for age with dental caries in 6- and 12-year-old children, indicating that as height for age and BMI for age decreased the severity of dental caries increased.

Recommendations

  • Furthermore, longitudinal studies are needed to explore the relationship between obesity, dental caries, and sugar consumption
  • All WHO age groups should also be included in the future studies
  • As there is lack of awareness on oral hygiene practices health education programs should be planned regarding oral hygiene practices
  • Further studies should be planned in such a way that all the rural and urban population should be equally included in the study population.


.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Jamelli SR, Rodrigues CS, de Lira PI. Nutritional status and prevalence of dental caries among 12-year-old children at public schools: A case-control study. Oral Health Prev Dent 2010;8:77-84.  Back to cited text no. 6
    
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[PUBMED]    
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    Tables

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



 

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