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The Effect of Childhood Obesity on Oral Health Status


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Objectives: The relation between obesity and dental health status was evaluated in a group of Turkish children. Methods: Healthy(n=43) and obese children(n= 53) who attended to pediatric dentistry clinic were included in the study. Children in the control group(CG) were randomly chosen among the otherwise healthy children who attended to clinic for regular dental-check-up without any complaint of dental problem. The parents completed a questionaire composed of medical history, dietary habits, oral hygiene habits. Obese children(OC) were previously diagnosed in department of pediatric endocrinology. Intraoral examination was performed by a blind operator and DMFT, GBI (Gingival Bleeding Index) were recorded. The difference between groups was evaluated with Students T-Test and Mann Whitney U test for continuous data. Nominal variables were tested with Pearson's chi-square and Fisher's Exact-Test respectively(p=0.05). Results: Gender and age showed homogeneity among the groups. Mean age for obese and control group were 10.40, 9.88 respectively. Educational status of parents did not showed any significant difference(p=0.064). In both groups, majority of mothers were high school-graduates, while majority of fathers were university-graduates. OC had significantly more systemic disease(p=0.002) and had significantly more obese relatives(p<0.001). OC had significantly much snakes in a day time(p=0.003) and chew significantly larger bit of foods while eating. Chewing time did not differ among the groups(p=0.960). OC have more carbohydrates as snacks(p<0.001), while carbohydrate intake of CG was restricted to mealtimes(p<0.001). Children in both groups had similar oral hygiene habits. Majority of the children(%75 OC ,%81,4 CG) brush their teeth with a fluoridated dentifrice. Although DMFT and DFT scores showed similarity among the groups GBI was significantly higher in the OC (p<0.001) Conclusion: DMFT of the obese and healthy children were similar. Although gingival health was worse and snacks contained more carbohydrate the oral health status of the obese children was not adversely affected.
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Turk J Med Sci
2012; 42 (6): 970-976
e oral health status of healthy and obese children in a Turkish
population: a cross-sectional study
Günseli GÜVEN POLAT1, Sevi Burçak ÇEHRELİ2, Mehmet Emre TAŞÇILAR3,
Özlem Martı AKGÜN1, Ceyhan ALTUN4, İlker Tolga ÖZGEN4
Aim: To compare the oral health status of a group of obese and healthy Turkish children.
Materials and methods: e study involved 43 healthy (19 boys and 24 girls, mean age: 9.88) and 53 obese (18 boys and
35 girls, mean age: 10.4) children who were admitted to a pediatric dentistry clinic in 2008 and 2009. e parents were
asked to complete a questionnaire concerning medical history and dietary/oral hygiene habits. e number of decayed,
missing, and lled permanent teeth (DMFT); number of decayed, missing, and lled primary teeth (dm ); and gingival
bleeding index (GBI) scores of patients were recorded. Statistical di erences were evaluated using Student’s t-test and
the Mann-Whitney U test and the nominal variables were tested with Pearson’s chi-square test and Fisher’s exact test
(P 0.05).
Results: e educational status of parents did not di er signi cantly between obese and healthy children (P = 0.064).
On a daily basis, obese children consumed signi cantly more snacks (P = 0.003). e carbohydrate intake of healthy
children was restricted to mealtimes (P < 0.001) while obese children consumed signi cantly more carbohydrates as
snacks (P < 0.001). In both groups, the participants displayed similar oral hygiene habits and DMFT and dm scores
although GBI scores were signi cantly higher in obese children.
Conclusion: No relationship was found between obesity and the oral health status of the child population evaluated.
Similar oral hygiene habits and socioeconomic status might have contributed to this result.
Key words: Childhood obesity, dental caries, gingival health
Original Article
Received: 22.02.2012 – Accepted: 02.03.2012
1 Department of Pediatric Dentistry, Gülhane Military Medical Academy, Ankara - TURKEY
2 Department of Pediatric Dentistry, Faculty of Dentistry, Başkent University, Ankara - TURKEY
3 Department of Pediatrics, Gülhane Military Medical Academy, Ankara - TURKEY
4 Department of Pediatrics, Faculty of Medicine, Bezmialem University, İstanbul - TURKEY
Correspondence: Özlem Martı AKGÜN, Department of Pediatric Dentistry, Gülhane Military Medical Academy, Ankara - TURKEY
e increasing prevalence of childhood obesity has
become a serious health problem worldwide (1,2).
Obesity is a risk factor for several diseases such as
heart disease, hyperinsulinemia, hypertension, early
atherosclerosis, and obstructive sleep apnea, as well
as for the early onset of puberty in women (3,4).
Environmental and genetic factors, the consumption
of energy-dense and highly re ned foods, dietary
habits, and food insecurity have been identi ed as
potential contributors to obesity (5,6). Although
the contribution of genetic factors to obesity is not
yet fully understood, a possible cause appears to be
the variability in genes coding for hormones and
neurotransmitters such as growth hormone, leptin,
ghrelin, neuropeptide Y, and melanocortin (7).
Dental caries, the most prevalent chronic disease
of childhood, is a signi cant public health problem
known to a ect 58.6% of children aged 5-12 years
in the United States (8). In the search for possible
associations between childhood obesity and dental
caries, it has been demonstrated that childhood
obesity is responsible for an increase in dental caries
and alterations in dental development (9,10). Alm
et al. (11) investigated the prevalence of approximal
caries in the posterior teeth of 15 year olds and
demonstrated that overweight or obese adolescents
had a signi cantly higher prevalence of approximal
caries than did normal weight individuals. However,
a study by Chen et al. (12) failed to demonstrate
any signi cant di erence in the total decayed or
lled primary tooth (d ) scores of child groups
with di er ent body mass indexes (BMIs). Similarly,
no signi cant associations were found between
childhood obesity and caries in the United States
National Health and Nutrition Examination Survey
carried out from 1999 to 2002 (13).
Because of con icting results published thus far,
Hilgers et al. (9) suggested that there is a need for
future studies in order to assess the e ect of obesity
on caries, taking into account patient demographics
and behavioral patterns. erefore, the present cross-
sectional study aimed to compare the dietary habits,
oral hygiene, and dental caries rates of obese and
healthy Turkish children. e study tested the null
hypothesis that childhood obesity is not associated
with a higher incidence of dental caries.
Materials and methods
Patient selection
is was a cross-sectional study conducted at a
university pediatric dentistry clinic a er approval
was received from the institutional review board and
informed consent from the participants’ parents.
Inclusion criteria stipulated that the children were
living in an area without uoridated drinking water
and had not previously bene ted from any form of
systemic or professionally applied uoride.
A questionnaire that assessed dietary habits,
oral hygiene habits, familial health history, and
socioeconomic status was implemented. Among
patients who were admitted for regular check-ups
between November 2008 and February 2009, 43
healthy (19 boys and 24 girls, mean age: 9.88) and
53 obese children (18 boys and 35 girls, mean age:
10.4) who met the inclusion criteria and whose
parents agreed to their participation were included
in the study. Children in the obese group had been
previously diagnosed by the department of pediatric
endocrinology at the same institution. Participants
BMI was calculated as weight (in kg) divided by
height (in m2). Participants with a BMI above the
95th percentile for their age and sex were classi ed as
obese. Children in the control group were randomly
chosen from among otherwise healthy patients
admitted to the same pediatric dentistry clinic for
regular dental visits in the absence of any dental
e questionnaire assessed the following criteria:
A. History: Medical history and family history of
B. Parental educational status
C. Monthly income
D. Dietary habits: Snack eating (snack eating at
school, snack eating before going to bed, and snack
eating at any time during the day); breakfast eating
status; chewing rapidly or slowly; large or small bite
sizes; and intake of carbohydrates.
E. Oral hygiene habits: Tooth brushing at bedtime;
tooth brushing in the morning; brushing with
uoridated toothpaste; using ultrasonic toothbrush;
and using dental oss.
Clinical examination
e dental health status of patients was examined
using number of decayed, missing, and lled
permanent teeth (DMFT) and number of decayed,
missing, and lled primary teeth (dm ) scores.
e periodontal status was recorded in accordance
with the gingival bleeding index (GBI), based on
WHO criteria (14). An experienced pediatric dentist
performed all intraoral examinations. During the
visual examination, a dental explorer was used to
con rm questionable caries ndings (15). Dental
caries, missing teeth, and restored teeth (DMFT,
dm ) were diagnosed and recorded.
e GBI was evaluated by the same operator. In
brief, a standard periodontal probe was used to measure
the extent of gingival bleeding and periodontal
destruction at the buccal and mesiobuccal sites.
A er gentle probing, the ndings were categorized as
bleeding or no bleeding. Additionally, parents were
asked about the frequency of spontaneous bleeding
and answers were categorized as “yes, “no, or
e oral health status of healthy and obese children
Statistical analyses
All data were analyzed using SPSS (Version 11.5,
SPSS Inc., Illinois, USA). Descriptive statistics
included continuous data, shown as mean ± standard
deviation, and categorical data, shown as frequency
and contingency tables. Statistical di erences
between groups were evaluated using Student’s t-test
and the Mann-Whitney U test for continuous data,
and the nominal variables were tested with Pearson’s
chi-square test and Fisher’s exact test. For all analyses,
a P-value of 0.05 was considered statistically
signi cant.
e systemic and oral hygiene status of obese
and healthy children and their cariogenic food
consumption and eating habits are presented in Tables
1-4. e mean ages of obese and healthy children were
10.4 and 9.88 years, respectively. Both sex and age
showed homogeneity among the groups (P = 0.306
and P = 0.393, respectively). e socioeconomic
statuses of families were similar for obese and healthy
children (P > 0.05). e educational statuses of the
mothers and fathers were also similar (P = 0.064),
revealing that the majority of mothers had graduated
from high school while the majority of fathers were
college or university graduates. Obese children had
signi cantly more systemic disease (P = 0.002) and
obese relatives in their families (P < 0.001) than
did healthy children, with the majority of reported
systemic diseases being metabolic syndromes other
than diabetes.
e evaluation of dietary habits showed that the
majority of obese (86%) and healthy (99%) children
had breakfast before starting the day. Obese children
consumed signi cantly more snacks during the
daytime and chewed signi cantly larger pieces of
food while eating (P < 0.05 for both). Chewing time
did not signi cantly di er among obese and healthy
children (P = 0.960). Obese children consumed more
carbohydrates as snacks while the carbohydrate
intake of healthy children was restricted to mealtimes
only (P < 0.001 for both; Table 4).
Signi cantly more healthy children than obese
children brushed their teeth at night (P = 0.011)
while tooth brushing in the morning did not di er
among the obese and healthy groups. Other than
tooth brushing at night, both obese and healthy
children had similar oral hygiene habits. e majority
of participants (75% of obese and 81.4% of healthy
children) brushed their teeth with uoridated
toothpaste and a manual toothbrush. Only a few
obese (9.4%) and healthy (11.6%) children reported
the use of ultrasonic toothbrushes. e majority of
the obese (51%) and a large proportion of healthy
(41%) children did not use dental oss.
DMFT and dm scores were similar between
groups. However, GBI was signi cantly higher among
obese children (P < 0.001) than among healthy
children. In contrast, the frequency of spontaneous
bleeding did not di er among obese and healthy
children (P = 0.151) (Table 5).
It is widely accepted that a BMI between the 85th
and 95th percentiles is de ned as overweight and a
BMI greater than the 95th percentile de nes obesity
(16). However, cross-national di erences may a ect
BMI values (17,18). For example, the 85th percentile
of children of the United States, which brings the
percentage of obesity to about 12.5%, ts into the
95th percentile of Brazilian children and the 90th
percentile of British children (18). A recent study
con rmed that data and curves of BMI values in
Table 1. Systemic statuses of obese and healthy children. Values are presented in percent (%).
Obese children Healthy children
Obesity in relatives 54.7* 4.7
Present systemic diseases 24.5** 0
* P = 0.002, ** P = 0.000
healthy Turkish children are compliant with those of
Western countries (19). us, in the present study,
the widely accepted cut-o values, in which a BMI
between the 85th and 95th percentile indicates
being overweight and a BMI greater than the 95th
percentile equates to being obese, were used for the
diagnosis of obesity.
Since the 2 prevalent diseases in this study,
dental caries and obesity, are clearly related to the
consumption of fermentable carbohydrates, it would
be reasonable to assume that they would correlate well.
However, most authors have failed to report a positive
association between dental caries and obesity. Studies
conducted within and outside the United States
have reported con icting results (9,12,13,20,21).
In addition, obvious ethnic and cultural di erences
between countries may limit the applicability of the
results of those studies to other nations. Obesity
alone was found to be a poor predictor of dental
caries in Finnish children aged between 7 and 16
years (20). However, the accuracy of predicting
risk of dental caries increased a er controlling for
a history of dental caries and obesity (20). Larsson
et al. (21) evaluated the relationship between dental
caries and risk factors for atherosclerosis in Swedish
adolescents. ey compared DFS scores with obesity
in 15-year-old children and found a signi cant
positive correlation between DFS scores and BMI.
e results of a recent study conducted in a Mexican
population showed that children with a high BMI had
Table 2. Oral health statuses and oral hygiene habits of obese and healthy children. Values are presented in percent (%).
Criteria Obese children Healthy children
DMFT 0.43 1
dm 1.64 2
Gingival bleeding (+) 84.8* 39.5
Tooth ossing 3.8 4.7
To ot h br u s hi n g a t ni g h t 4 1. 5 * * 6 7. 4
Tooth brushing in the morning 34.0 44.2
Using an ultrasonic toothbrush 9.4 11.6
Using uoridated toothpaste 75.5 81.4
* P < 0.001, ** P = 0.011
Table 3. Frequencies of carbonated beverage and carbohydrate consumption in obese and healthy children. Values are presented in
percent (%).
Carbonated beverages Carbohydrates
Frequency Obese children Healthy children Obese children Healthy children
1/day 11.3 7.0 11.3 7.0
2/day 1.9 7.0 1.9 7.0
4/day 1.9 0 1.9 0
1/week 34.0 30.2 34.0 30.2
2/week 11.3 14.0 11.3 14.0
3/week 1.9 2.3 1.9 2.3
4/week 1.9 2.3 1.9 2.3
None 35.8 37.2 35.8 37.2
e oral health status of healthy and obese children
lower levels of dental caries in their primary teeth,
whereas no association was detected between BMI
and DMFS scores (22). Regarding these con icting
results, the authors stated that both dental caries and
obesity are multifactorial diseases in which social
and behavioral aspects play important roles. us,
the di erent trends observed with respect to the
association between obesity and dental caries re ect
the complex etiology of both conditions.
e authors do not think that the systemic disease
of obese children would a ect the results. Although
some diseases, such as Type 1 diabetes mellitus
(T1DB), have been reported to be related with
dental caries, a recent study failed to demonstrate
the correlation (23). None of the children had T1DB
in the present study. Obese children had other
metabolic syndromes weakly related with dental
caries or periodontal disease (24).
In the present study, both DMFT and dm of
obese and healthy children were similar, resulting
in an acceptance of the null hypothesis. is might
be due to 2 factors: First, the majority of participants
brushed their teeth with uoridated dentifrice at least
once a day (in the morning). Second, and perhaps
more importantly, the socioeconomic statuses of the
parents in both groups were found to be similar. It has
been previously documented that a high prevalence
of caries is associated with low socioeconomic status
(25); therefore, the similarity in DMFT and dm
among healthy and obese children in the present
study could be attributed to the similarity of the
socioeconomic status of the parents.
Compared with the relationship between obesity
and dental caries, the association between periodontal
disease and obesity is subtle, but has been widely
acknowledged (26,27). Although the association is
still under careful evaluation, possible mechanisms
have been reported, including the interaction
between salivary ora and gut ora. Obesity resulting
from infection is known as “infectobesity” (28).
It is estimated that approximately 1 g of bacteria
(1011) is swallowed with 500-1500 mL of saliva
that is produced daily (29). It is therefore plausible
that salivary micro ora a ect gastrointestinal
micro ora. A recent study demonstrated that 98.4%
of overweight individuals were correctly identi ed by
the presence of the bacterium Selenomonas noxia at
a concentration greater than 1.05% of the total gut
ora (28).
Table 4. Eating habits of children. Values are presented in percent (%).
Criteria Obese children Healthy children
Carbohydrate intake between meals 73.6* 23.3
Carbohydrate intake during meals 24.5** 74.4
Eating fast 67.9 67.4
Chewing large pieces 60.4*** 20.9
Number of snacks 2.38 (mean)**** 1.44 (mean)
Having breakfast 86.8 97.7
* P < 0.001, ** P < 0.001, *** P < 0.001, **** P = 0.003
Table 5. Occurrence of spontaneous bleeding.
Occurrence of gingival bleeding Obese children Healthy children
Yes 10% 10%
No 30% 29%
Sometimes 13% 4%
Another mechanism underlying the link between
periodontal disease and obesity may be related
to in ammatory mediators, as it is well known
that both conditions produce increased levels of
in ammatory mediators (27,30). Since adipose tissue
has been recognized as a reservoir for in ammatory
cytokines, it has been suggested that obesity can a ect
periodontal disease (30). Although the present study
did not directly aim to test the salivary microbiota
or in ammatory mediators, GBI, which was
assessed in this study, is the rst and most common
tool in the clinicians arsenal to assess periodontal
health. Further research is required to con rm the
association between obesity and gingival disease, as
well as the mechanism underlying this correlation.
Along with the strict inclusion criteria regarding
exposure to uorides, the cross-sectional design of
this study, which is inevitably limited by the sample
size, can be regarded as a technical shortcoming that
merits further improvement.
Although the frequency of spontaneous bleeding
did not di er signi cantly between healthy and
obese children, GBI was signi cantly higher in obese
children. us, obesity should be recognized as a
predisposing risk factor for gingival disease. is
interpretation is noteworthy for both the pediatrician
and the dentist who provide obese patients with
counseling regarding healthy diets in childhood and
e authors would like to thank the anonymous
reviewers for their valuable comments and
suggestions in improving the quality of the paper.
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ResearchGate has not been able to resolve any citations for this publication.
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Mayo Clin Proc., 2008, Apr.; 83(4): 460-9
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Type 1 diabetes mellitus (T1DM) is associated with various oral complications. However there is no consensus regarding the association of T1DM and caries. Critical revision of dental caries-associated risk factors and type 1 diabetes mellitus. Materials and methods: Search of the MEDLINE and LILACS databases from 2000 to 2010, using, in different combination, the key words "dental caries", "diabetes mellitus" and "type 1 diabetes mellitus". The association between T1DM and dental caries remains controversial. Although some studies demonstrate a higher prevalence of caries due to the increased concentration of salivary glucose, acidity of the oral cavity, salivary viscosity, reduced salivary flow rate, and salivary gland dysfunction; other studies report a reduction of caries levels, probably caused by decreased ucrose ingestion. Although patients with uncontrolled T1DM and poor oral hygiene may present increased prevalence of dental caries, the literature does not describe a consistent relationship between T1DM and dental caries. Further investigations are warranted. If a true association is substantiated, intervention studies to prevent or reduce the occurrence of caries in this population should follow.
Full-text available
To identify the possible association between dental caries and body mass index (BMI) and to explore the effect of BMI on tooth eruption in a cohort of elementary schoolchildren. A 4-year longitudinal study was completed. A total of 110 children from a public elementary school, located in a middle-income area of Mexico City, entered the study; of these, 88 completed the 4-year follow-up period. Dental caries assessments were carried out using the WHO criteria for decayed, missing and filled primary and permanent teeth indices (dmft and DMFT, respectively) and surface indices (dmfs and DMFS, respectively). BMI was used to classify the children's obesity status, according to the Centers for Disease Control 2000 reference charts. At 7 years of age, 29.6% of the children were in the overweight or at risk of being overweight categories and, by 11 years of age, this proportion had risen to 45.5%. The mean dmft for children aged 7 years was 2.70 and, for children aged 11 years, the DMFT was 0.54. Children in the higher BMI categories had more erupted teeth than the other children (p < 0.001). A lower dmfs index was detected in the overweight children, compared with children with a lower BMI (p < 0.001). The overweight children had more erupted teeth and a lower caries index. The complex relationships between body composition and oral health should be considered in pediatric patients.
The International Obesity Task Force (IOTF) was established in 1994 to address the increase in the worldwide prevalence of obesity. The goals of the IOTF are to 1) raise awareness in the population and among governments that obesity is a serious medical condition, 2) develop policy recommendations for a coherent and effective global approach to the management and prevention of obesity, and 3) implement appropriate strategies to manage and prevent obesity on a population basis worldwide. To assess the global prevalence of obesity in children and adolescents, the IOTF convened a workshop on childhood obesity to determine the most appropriate measurement to assess obesity in populations of children and adolescents around the world. At the workshop, a variety of issues related to this problem were considered—including the best measure of fatness, the effect of application of a variety of existing standards on the prevalence of obesity in the same population, and the role of factors such as visceral adiposity and natural history in the definition of obesity. This article and those that follow represent the information presented at the workshop. The workshop concluded that the body mass index (BMI; in kg/m²) offered a reasonable measure with which to assess fatness in children and adolescents and that the standards used to identify overweight and obesity in children and adolescents should agree with the standards used to identify grade 1 and grade 2 overweight (BMI of 25 and 30, respectively) in adults.
Aim: It is difficult to project the prevalence of obesity and overweight among children in India since there is no nationally representative data from India. We determined the time trends in childhood obesity in a representative sample of schoolchildren from Raichur District, Karnataka and investigated the relationship of obesity with blood pressure. Materials and methods: We used a stratified random cluster sampling method to select the children. Anthropometric data were collected from 23,842 students, 5-16 years of age, during 2005-06. Blood pressure and anthropometric data were collected from 19,263 students during 2007-08. Overweight and obesity were defined by body mass index for gender and age. Gender, age, and height were considered for determining hypertension. Results: The rate of overweight children increased from 4.94% of the total students in 2005 to 6.57% in 2007 (OR: 1.36; 95% CI: 1.25-1.47; P < 0.0001). The increase was significant in both boys and girls. The rate of overweight children was significantly higher in urban regions and in private schools, and the rising trend was limited to private schools. Systolic or diastolic incident hypertension was found in 17.34% of overweight children versus 10.1% of the remaining students (OR: 1.87; 95% CI: 1.60-2.17; P < 0.0001). Conclusion: The present study shows that, childhood obesity showed a rising trend in a period of 2 years. The results put forward the need for greater public awareness and prevention programmes on childhood obesity and hypertension. Hypertension was common in overweight children. Overweight is a rising health problem in children and adolescents in Raichur city.
Purpose: The purpose of this study was to determine if increased body mass index (BMI) is associated with accelerated dental development in children ages 8 to 15. Methods: The dental development ages of 104 children were determined using the Demirjian method and panoramic radiographs. Using the system developed by the International Obesity Task Force, BMI status was determined for each subject (63 normal weight, 23 overweight, and 18 obese subjects). The difference between chronologic age and dental age was analyzed against BMI, age, and gender using 3-way analysis of variance. Results: Dental development was significantly accelerated with increased BMI, even after adjusting for age and gender (P < .01). The mean difference between chronologic and dental age among all subjects was 0.68 +/- 1.31 years. The mean dental age acceleration for overweight and obese subjects was 1.51 +/- 1.22 years and 1.53 +/- 1.28 years, respectively. Conclusions: Children who were overweight or obese had accelerated dental development, even after adjusting for age and gender. Accelerated dental development in obese children is an important variable to consider in pediatric dental and orthodontic treatment planning where timing is crucial.
Objective: This study assessed the associations between obesity and dental caries in young children participating in a national survey. Methods: Participants included 1507 children aged 2-6 years who received dental examinations and had at least 10 primary teeth in the National Health and Nutrition Examination Survey 1999-2002. Decayed/filled teeth (dft) counts of primary dentition were obtained, and weight and height were measured. Body mass index (BMI; kg/m2) was calculated, and participants were categorized using age- and gender-specific criteria as underweight (<5th percent), normal (5th-85th percent), at risk for overweight (>85th and <95th percent), and overweight (> or =95th percent). With appropriate sample weighting, relationships between dft and BMI were assessed using the Kruskal-Wallis test and multivariable logistic regression. Results: Seventy-four percent of children were classified as normal weight, 11 percent as at risk for overweight, and 11 percent as overweight; 58 percent did not have caries; 30 percent had 1-5 dft and 12 percent had >5 dft. When caries experience was compared across BMI categories stratified by age and race characteristics, statistically significant association between caries and obesity was found only for 60- <72-month age group. In the comparison between children with normal and at-risk BMI only, significant associations were also found in the Hispanic and non-Hispanic Black strata. In multivariable logistic regression models to predict caries experience, family income and age were statistically significant predictors for severe early childhood caries only. Conclusions: There appears to be no significant association between childhood obesity and caries experience after controlling forage, race, and poverty/income ratio. However, further studies are needed to better understand this relationship.
Abstract In an earlier study on a selected group of adolescents with high caries prevalence we found dietary habits that resembled those considered to promote the development of atherosclerosis. In the present study we have compared DMF-score with factors traditionally associated with the risk for development cardiovascular diseases (CVD), All 15-yr-olds living in an urban community in Northern Sweden 1987–1989 were included. Medical variables related lo the risk of developing CVD were evaluated in groups of adolescents with various levels of manifest caries expressed as decayed and filled surfaces (DPS). The proportion of individuals with no medical risk factor at an unfavorable level was significantly higher in a caries free than in a high-caries (DFS9) group. Adolescents with two or more medical factors reaching unfavorable levels had a significantly higher caries score than the group with no factor at unfavorable level. A significant positive correlation was found for the whole group between DFS-score and relative body weight (body mass index) in an univariate correlation test as well as multiple linear regression analysis. The hypothesis that high caries score can be an indicator for unfavorable levels of traditional risk factors for CVD is not contradicted by the results in the present study but supported by the observed covariation with BMI. We therefore suggest that dietary counseling to adolescents with a high caries score in combination with a moderate obesity can be of advantage in reducing the caries risk as well as the risk for development of CVD at higher ages.
Dental caries is still a common disease among children and adolescents. The aims of the present thesis were therefore: 1) to investigate the approximal caries prevalence in posterior teeth in 15-year-olds, 2) to study past caries experience in the primary dentition in relation to future caries development and need for treatment, 3) to investigate factors during early childhood which are associated with caries development later in life, and 4) to study the association between age-specific body mass index (isoBMI) and approximal caries status in 15-year-olds. Paper I has a retrospective design and the analyses were based on record data from a randomly selected sample. Papers II, III and IV are based on radiographic analyses of posterior teeth in 15-year-olds followed longitudinally from 1 to 15 years of age. The data for these studies were selected from examinations, interviews and questionnaires from early childhood and school health care records at 15 years (isoBMI values). The result showed that the approximal caries prevalence in 15-year-olds is underestimated in official caries data, since initial caries lesions are not included in these statistics. Two thirds of all 15-year-olds had approximal caries and initial caries constituted 86% of the total number of caries lesions. There was a strong relationship between caries in early childhood and approximal caries prevalence in the posterior teeth at 15 years of age. Children with caries experience at 6 years received significantly more treatment in the primary dentition during the period from 7 to 12 years compared with children who were caries free at the same age. Further, it was pointed out that parents' attitudes to dental health and psychosocial factors during early childhood have an effect on approximal caries in 15-year-olds. Additionally, plaque on primary incisors at 1 year of age and infrequent toothbrushing at 3 years of age were associated with a high caries experience at 15 years. It was also demonstrated that adolescents with overweight and obesity had a significantly higher approximal caries prevalence than those of normal weight. Furthermore, it was shown that children's unfavourable snacking habits at 1 and 3 years of age were associated with approximal caries at 15 years. The main conclusions from this thesis are that: 1) epidemiologicalcaries data should include initial caries lesions on approximal tooth surfaces, in order to show the actual caries prevalence, 2) there is a strong relationship between caries in early childhood and approximal caries prevalence in the posterior teeth at 15 years of age, 3) the psychosocial environment in which children live during their childhood has an impact on dental health later in life, 4) good oral hygiene habits including the use of fluoride toothpaste, established in early childhood, provide a foundation for good dental health in adolescence, and 5) future preventive programmes should include, at a multidisciplinary level, strategies to prevent and reduce both dental caries and obesity at an early age.
Only a few studies have examined the association of metabolic syndrome with periodontal infection and dental caries. The aim in this study was to examine the association of metabolic syndrome with periodontal infection and dental caries using the European Group for the Study of Insulin Resistance (EGIR) definition and its separate components. This study population consisted of dentate, non-diabetic individuals aged 30 to 64 years (N = 2050) who had never smoked. Relative risks (RR) were estimated with Poisson regression models. Metabolic syndrome was associated with teeth with deepened periodontal pockets 4 mm deep or deeper [adjusted RR 1.19 (95% CI 1.01-1.42)], with pockets 6 mm deep or deeper [adjusted RR 1.50 (95% CI 0.96-2.36)], and carious teeth [adjusted RR 1.25 (95% CI 0.93-1.70)]. The results suggest that metabolic syndrome or some of its components are associated weakly with periodontal infection.