View of Association between Body Mass Index and Dental Caries among 6 To 12-Year-Old School Children in Mysore City: A Cross-Sectional Study

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Association Between Body Mass Index and Dental Caries Among 6 to 12-Year- Old Schoolchildren in Mysore City: A Cross-Sectional Study

Maurya M^*1, Bennadi D², Konakeri V³, Sushma R⁴

1*Senior Lect, Dept. of Public Health Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education & Research, Mysore, India

2Reader, Dept. Of Public Health Dentistry, Sree Siddhartha Dental College and Hospital, Sri Siddhartha Academy Higher Education, Agalkote, Tumkur – 572107, India

3Reader, Dept. of Public Health Dentistry, Al-Azhar Dental College, Perumpillichira, P.O, Thodupuzha, Idukki, Kerala, India.

4Senior Lect, Dept. of Public Health Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education

& Research, Mysore, India.

*Corresponding Author: E-mail: [email protected]

ABSTRACT

OBJECTIVE: To assess association between obesity and dental caries prevalence among school children aged 6 to 12 years in Mysore city.

MATERIAL AND METHODS: With simple random technique four primary schools were selected from the list obtained by the Education Department, Mysore. A sample of 250 (125 Obese, 125 Normal weight) children were examined. Dental caries experience was recorded using WHO criteria. A questionnaire was used to collect information regarding age, socioeconomic status, oral hygiene practices, physical activity and dietary habits.

RESULTS: The study group consisted of 65 obese males and 60 obese females and 63 normal weight males and 62 normal weight females. Mean dft (decayed, filled deciduous teeth) for obese and normal weight children was 1.94 and 1.10 respectively. Mean DMFT (Decayed Missing Filled Permanent teeth) for obese and normal weight children was 0.59 and 0.30 respectively. Frequency of consumption of sweets, fruit juices, soft drinks, fried food was more among obese children when compared with normal weight children. These differences were statistically significant between the two groups.

CONCLUSION: Obesity appears to have an association with dental caries prevalence..

Keywords: Childhood obesity; BMI; Dental caries; DMFT / dft

INTRODUCTION

Food occupies the first position in the hierarchical need of a man and is recognized as important for human being in health and disease. Food is any substance consumed to provide nutritional support for an organism..^[1] Food that we eat affects our body through its Systemic and Local action. Systemic action depends on their content of nutrients on general health, growth and development, cell renewal ability of tissues to repair and resistance to disease. Local effect consists of what food can do to the tissues and their environment. In dentistry most local effects results from the interaction between the food residues and oral bacteria that leads to the plaque formation. The metabolites from the plaque bacteria have effects on the soft and hard oral tissues.^[2]

Obesity epidemic has become one of the public health problem which has impact on physical and psychological health. Obesity is one of the multifactorial non communicable disesse where environment, cultural and lifestyle preferences play a important role in making the obesity as one of the msot prevalent health issue in current scenario. [childhood obesity] The highest prevalence rates of childhood obesity have been observed in developed countries; however, its prevalence is increasing in developing countries as well.^[3]Females are more likely to be obese as compared to males, owing to inherent hormonal differences.^[4]

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Some systematic reviews^[5-7]on the association between obesity and dental caries and showed the inconclusive literature and the need for further analysis of this association and its confounding variables.

A more recent systematic review in 2015 included only longitudinal studies and concluded that the evidence of the association between obesity and dental caries was conflicting and remains inconclusive. These inconsistent results are influenced by discrepancies in assessments, setting, and measurements.^[8]

Hence an attempt has been made to know whether there is an association between obesity and dental caries prevalence among school children aged 6 to 12 years of Mysore city.

METHODOLOGY:

Comparative study was carried out to assess childhood obesity and dental caries in children aged 6 to 12 years in Mysore city. A list of schools was obtained by the Education Department, Mysore. The study was conducted with prior permission from the concerned authorities. Ethical clearance for the study was obtained from the Institutional Ethics Committee, JSS Dental College and Hospital, Mysore. 6 – 12 years age group school children from 4 schools were selected by simple random method. A questionnaire was used to collect information regarding age, socioeconomic status, oral hygiene practices, physical activity and dietary habits. A single examiner examined all the children. A total number of 1219 available subjects Height and Weight measurements were taken and BMI (kg/m2) (Quetelet’s index) status was determined for each subject (gender and age) using the system developed by the International Obesity Task Force in 2000. (Childhood obesity is defined as a BMI for age and sex greater than the 95th percentile) (BMI 16-18:Median range for normal weight children, BMI 18-20:Median range for overweight children and BMI ≥ 20 are considered Obese).^[9,10]

A sample of 250 (125 Obese, 125 Normal weight children who were the Control group was selected by matching age, sex with the study group) of 6 – 12 years age group was examined.

The child’s Medical Record, age and socioeconomic status of the children was obtained from the school authority and checked for any systemic disorders. Children with multiple congenitally missing teeth or a history of chronic infectious disease, nutritional disturbances, or endocrine disorders/ Subjects with recognized syndromes/ Children with Rampant caries were excluded from the study.

Examination Procedure:

Obese and normal weight children from class 1-7std from four schools were examined using a mouth mirror and a CPI probe under day light on a wooden chair provided by the schools with prior permission obtained by the Education authority and the schools. Data regarding dental caries experience was collected using WHO criteria of all the primary and permanent teeth both in maxilla and the mandible. Information regarding age and socioeconomic status of the children was obtained from their concerned teachers and school authority. Socioeconomic status has been classified according to B.G.L Prasad’s classification.^[11]

The questionnaire regarding the dietary habits was filled by the examiner himself by interviewing the children.Information regarding diet included qualitative information. The frequency of consumption of different food items provided the data.

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RESULTS

Study included 250 children (125-obese & 125 normal children) who were matched for their age and gender where 52% were male in each group (n=65). 66%(n=83) of obese children belonged to upper middle class where as 63% (n=79) of normal children belonged to lower middle class.

Every child used to brush at least once a day using tooth brush and paste. Snacking habit in between meals was more common among obese children (23%) compared to normal children (2.4%). In both a groups few children visited dentist for filling commonly. Statistical significant difference was observed among obese and normal children in relation to frequency of confectioneries, milk, fruit juice,soft drinks, fruits/vegetables and fried items (p<0.05) (Table 1)

TABLE 1: Dietary Habits And Frequency Among Study Population

FOOD ITEMS GROUP

FREQUENCY ONCE

DAILY

TWICE DAILY

THRICE DAILY

OCCAS-

IONAL TOTAL No. % No. % No. % No. % No. % P

SWEETS OBESE 2 1.6 2 1.6 0 0.0 121 96.8 125 100

0.131 NORMAL 0 0.0 0 0.0 0 0.0 125 100 125 100

CONFECTIONARIES OBESE 30 24 13 10.4 0 0.0 82 65.6 125 100 0.001 NORMAL 16 12.8 3 2.4 3 2.4 103 82.4 125 100 (S)

MILK OBESE 33 26.8 77 62.6 13 10.6 0 0.0 123 100 0.04

NORMAL 21 17.2 76 62.3 25 20.5 0 0.0 122 100 (S)

COFFEE OBESE 4 28.6 0 0.0 0 0.0 10 71.4 14 100

0.52 NORMAL 13 38.2 0 0.0 0 0.0 21 61.8 34 100

TEA OBESE 0 0.0 0 0.0 0 0.0 12 100 12 100

0.11 NORMAL 5 17.9 0 0.0 0 0.0 23 82.1 28 100

FRUIT JUICE OBESE 16 19.5 7 8.5 0 0.0 59 72 82 100 0.002

NORMAL 4 6.2 0 0.0 0 0.0 61 93.8 65 100 (S)

SOFT DRINKS OBESE 21 40.4 3 5.8 0 0.0 28 53.8 52 100 0.00

NORMAL 0 0.0 0 0.0 0 0.0 28 100 28 100 (S)

ICE-CREAM OBESE 1 1.4 0 0.0 0 0.0 69 98.6 70 100

0.411

NORMAL 0 0.0 0 0.0 0 0.0 47 100 47 100

FRUITS OBESE 28 27.5 5 4.9 0 0.0 69 67.6 102 100 0.00

NORMAL 19 15.2 29 23.2 0 0.0 77 61.6 125 100 (S)

VEGETABLES OBESE 22 21.8 7 6.9 0 0.0 72 71.3 101 100 0.004

NORMAL 22 17.6 29 23.2 0 0.0 74 59.2 125 100 (S)

EGG OBESE 5 10 0 0.0 0 0.0 45 90 50 100

0.801 NORMAL 5 11.6 0 0.0 0 0.0 38 88.4 43 100

FISH OBESE 0 0.0 2 14.3 0 0.0 12 85.7 14 100

0.118

NORMAL 0 0.0 0 0.0 0 0.0 16 100 16 100

POULTRY OBESE 0 0.0 0 0.0 0 0.0 52 100 52 100

NORMAL 0 0.0 0 0.0 0 0.0 52 100 52 100 -

MEAT OBESE 0 0.0 0 0.0 0 0.0 13 100 13 100

NORMAL 0 0.0 0 0.0 0 0.0 13 100 13 100 -

FRIED CHICKEN OBESE 0 0.0 0 0.0 0 0.0 26 100 26 100

0.133

NORMAL 0 0.0 0 0.0 0 0.0 20 100 20 100

FRIED POTATOES / FINGER CHIPS

OBESE 0 0.0 0 0.0 0 0.0 46 100 46 100 0.001

NORMAL 0 0.0 0 0.0 0 0.0 31 100 31 100 (S)

CHIPS / CRACKERS OBESE 0 0.0 0 0.0 0 0.0 58 100 58 100

0.79

NORMAL 3 5.2 0 0.0 0 0.0 55 94.8 58 100

Caries prevalence was more among obese children (60%) compared to normal children (table 2).

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TABLE 2: Distribution Of Study Population According To Caries Prevalence

GROUP TOTAL

OBESE NORMAL

No. % No. % No. %

Caries affected 84 59.6 57 40.4 141 100 Caries free 41 37.6 68 62.4 109 100 Total 125 50 125 50 250 100 CC=0.213, P=0.001

The mean caries experience (decayed, missing, and filled teeth [DMFT]) was higher in permanent dentition of overweight children 0.59 compared to normal children 0.30. and similar in deciducous dentition as well (obese mean dft 1.94 ±1.78 & 1.10 ±1.12 among normal children). Chisquare test revealed a statistical significant difference among obese and normal children

There was statistical significant difference was observed between mean DMFT in relation to gender among obese and normal children where males are commonly affected (obese & nomal male mean dmft 1.82 ±1.28 0.87 ± 0.92- Graph 1)

Graph 1: Mean Decayed, Missing And Filled Permanent Teeth Among The Study Population According To Sex:

DISCUSSION

Diet play a vital role in the causation of dental caries as well as obesity. Indian food has its own benefits but entry of modern civilization food has made a tremendous changes in our younger generation diet. Now a days the younger generation population are getting addicted to fried and refined carbohydrate rich diet. Exposure to this type of food might be one of the cause for dental caries and obesity. Some studies^[12,13] emphasize that frequent and excessive intake of fermentable sugars is the critical common predisposing factor for obesity and dental caries.

There was a preference for inclusion younger population is mainly due to easily available sample and it is established that as individuals grow, their dietary habits will constantly change due to

0 0.1 0.2 0.3 0.4 0.5 0.6

Mean (D) Mean (M)

Mean (F) Mean DMFT

Frequency

Obese Normal

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peer influence and show an increased tendency toward consumption of refined diet rich in carbohydrate leading to an increased body weight and dental caries.^[14,15]

The prevalence of dental caries among obese children was 60% which was higher compared to 8- 13 yr obese children of Bhopal City^[14] lower in comparision with National oral health survey Oral Health Survey 2002–2003^[16] conducted in India where prevalence in 12-year-old urban children was 79.72%. It might be due to awareness and good oral health maintenance practices among children.

In the present study, we observed a significant association between overweight and dental caries which is consistent with the previous studies.[14, 17-19]

Mean DMFT was higher among abese children and similar treand was seen in other studies Marshall et al. ^[19], Larsson et al. ^[20] and reddy et al ^{[14] .}It might be due to caries related dietary practices during early childhood time may be continued during adulthood too which affected permananent teeth too. Even deciduous dentition showed high dft among obese children compared to normal Similar findings were seen among Mexican preschool children. ^[21] some studies ^[22-24] showed that prevalence of dental caries was more among underweighted children

In our study, there was difference in caries experience between normal weight and overweight children. Contrary findings seen with studies done by Tuomi ^[25] Chen et al.^[26], Moreira et al.^[27], and Assi et al.^[28] , cureus 2019^[24] This might be due to cultural, dietary difference among different areas

Limitations & recommendations:In the present study the dietary habit was assessed only qualitative data and it depended only on the information given by the subjects, which may not be reliable. The sample size in each age group was small. It is advised to include larger population in different age groups.Since obesity and dental caries are, in principle, caused by the poor dietary habits, further studies should evaluate the relationship between these two most prevalent health and oral problems.Further studies have to be conducted among heterogenous population including urban and rural areas as this study included sample of urban area.Many adult health problems have their early origins in childhood, because this is the time when lifestyles are formed (e.g. eating patterns, physical activity / exercise).

Prospective studies has tobe conducted in this regard to assess the associated variables too. As with this study showed that obese children were more affected with dental caries than normal children. Diet is common factor for obesity and dental caries. Our oral health messages should be in a such a way that it should address the diet as a risk factors for oral health problems.An overall rational approach to dietary counseling is advised, as dietary patterns together with physical activity, determine both oral and overall health and well being of obese children. Parents and teachers should engage in and promote more healthful dietary intakes and active lifestyles (e.g., increased physical activity and more healthful dietary behaviors).

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