Comparison of Association of Dental Caries in Relation with Body Mass Index (BMI) in Government and Private School Children
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1 ORIGINAL ARTICLE Comparison of Association of Dental Caries in Relation with Body Mass Index (BMI) in Government and Private School Children Prashanth S.T, Venkatesh Babu, Vivek Dhruv Kumar, Amitha H.A 1 Department of Pedodontics & Preventive Dentistry VS Dental College & Hospital, Bangalore Karnataka India Journal of Dental Sciences and Research Vol. 2, Issue 2, Pages 1-5 ABSTRACT The aim of the study was to compare, association of dental caries in relation with body mass index in Government (Group 1) and Private (Group 2) School children. 247 and 250 children in the age group of 6 to 16 yrs. were included in Group 1 and Group 2 respectively. Both male and female children were included. Dental caries was diagnosed according to WHO criteria using def/dmft index. The proportion of Caries in the Group 1 & 2 children was same and statistically there was no significant difference. But mean no. of caries teeth was more in Group 2 children compared to Group 1. It was observed from the study that 24% are overweight + obese category in Group 1, and 76% in Group 2, Mean number of caries, and (over weight + obese) children were more in Group 2. Under weight children had more mean number of caries compared to normal and (over weight +Obese) children. Key words: Government school children, Private school children, BMI, Dental caries. INTRODUCTION General health has a considerable impact on oral health and vice versa. The association of poor oral health with obesity is likely to be associated with the quality of the diet. The relationship between nutrition and dental caries is complex because it is a multifactorial disease; oral hygiene, available nutrients, saliva, and oral flora influence dental caries. Consumption of high caloric food together with less activity and exercise contributed to the increasing number of overweight children worldwide. Increased caries risk is associated with increased consumption of refined carbohydrates with poor maintenance of oral hygiene. AIMS AND OBJECTIVE The Aim of the study was to compare, association of dental caries in relation with body mass index in government and private school children MATERIALS AND METHOD A random of 497 children in the age group of 6 to 16 years of both sexes were included. Group 1 consisted of Address for correspondence: Dr Venkatesh Babu drnsvbabu@yahoo.co.in Access this article online Website: children from Government School and Group 2 consisted of 250 children from Private School. Anthropometric measurements were taken prior to dental examination by one investigator. Weight was assessed using a single calibrated scale. Height was measured using a stadiometer by having the subject standing straight without shoes. Body Mass Index (BMI) was calculated using the standard formula - Mass (Kg)/height(m). BMI percentile was calculated by Centre for Disease Control (CDC) BMI- for age growth chart Using age and gender specific criteria, subjects were categorized as underweight (<5%), normal (<5% to <85%), overweight (85 to <95 %), and obese ( 95 %). Dental caries was diagnosed according to WHO criteria using def/dmft index. All selected children were clinically examined for dental caries. The examination was carried out using a dental explorer, a mouth mirror. Teeth were considered as decayed when in addition to showing clinical signs such as colour change, wedging and catching by an explorer tip, during the examination of occlusal surface with some degree of resistance. Marthateler method was used for the proximal surfaces. According to this method, a surface is diagnosed as decayed if the explorer is retained. Data was statistically analysed using SPSS software. T-test was used to analyse the mean decayed and filled permanent/primary teeth (DFT/dft) and the difference between groups, chi square test for evaluation of association between BMI-for-age 22
2 Vol. 2, Issue 2, September 2011 and gender, and multiple linear regression for evaluation of association between BMI-for-age and DFT/dft indices. P 0.05 was considered statistically significant. RESULTS Study population and Sex Chi-square test of significance is used to test the association between group and sex of the child. Group consists of Government and private schools. The proportion of male and female children in Group 1 was 48.7% and 50.6% respectively. The proportion of male and female children in Group 2 were 51.3% and 49.4% respectively ( Table 1). Study population and Caries The proportion of Caries in the Group 1 & 2 school children was 56.5% and 43.5% respectively. Statistically there was no significant difference. (Table 2) The mean no. of caries teeth in Group 1 was 2.11 whereas it was 2.72 in Group 2. This difference was significant (Table 3). STUDY POPULATION AND BMI In Group 1 24% of them were overweight and obese, whereas it was 76% in Group 2. This difference was significant (Table 4). 68% of female children were either overweight or obese whereas 32% of male children were overweight or obese. This difference is statistically significant (Table 5). Under weight children had more mean number (3.03) of caries compared to normal (2.18) and (overweight +obese) children (1.88) ( Table 6) DISCUSSION Diet plays an important role in the obesity epidemic, as dietary habits in children have suffered major changes in the last thirty years. Consumption of soft drinks is associated with reduced vitamin and mineral intake and an excess of dietary carbohydrates. Dental caries is a public health problem affecting infants and preschool children around the world, although caries prevalence and severity has substantially declined over the past 40 years. TABLE 1: Gender Distribution FEMALE MALE TOTAL Group (50.6%) 115 (48.7%) 247(49.7%) Group (49.4%) 121 (51.3%) 250(50.3%) TOTAL 261(100%) 236(100%) 497(100%) TABLE 2: Caries Proportion CARIES PRESENT NO CARIES TOTAL Group 1 78 (56.5%) 169 (47.1%) 247(49.7%) Group 2 60 (43.5%) 190 (52.9%) 250(50.3%) TOTAL 138 (100%) 359(100%) 497(100%) 23
3 Journal of Dental Sciences and Research TABLE 3: Mean Caries N MEAN ± SD Group ± 2.39 Group ± 2.80 [1] Dental caries is a multifactorial infectious disease. Factors affecting the onset of carious lesions include oral h y g i e n e, d i e t c o m p o s i t i o n a n d f r e q u e n c y, socioeconomic status, salivary immunoglobulin's, [2] bacterial load, and fluoride intake. Recent evidence has shown that the importance of oral health in the management of systemic health, and many of diseases [3] have been linked to indicators of oral disease. Caries, in particular, has been linked to syndromes causing xerostomia, endocrine pathology, and medication [4] intake. The relationship between childhood obesity and dental caries is complex and varies depending on many factors, such as age, gender, race, and family income. According to study done by Ana F Granvile-Garcia et al DMFT were significantly higher in Group 1 than Group 2 which is contradictory to this study which showed no stastically significant difference between Group 1 & 2 children, But when involvement of mean number of dental caries is considered it was more in Group 2 compared to Group 1 [5] children. It may be due to soft drinks and chocolates, which are readily accessible, and frequently consumed, represent high sugar source that may contribute to the potential for tooth decay. In the present study there was high prevalence of overweight and obese children in Group 2 (76%) compared to Group 1 (24%). It was similar to study done by Ana F Granvile-Garcia et al, and Partrica vasconcelos [5,6] leitao moreira (2006). It may be due to genetic and environmental factors, and also imbalance between food consumption and energy expenditure and changes in the dietary practices like as they eat more of refined carbohydrates and fatty food. The predominant number of children in the present study were with normal BMI percentile which is similar to [7,8] study done by Willerhausen et al and Marshall et al. Present study showed 68% of female children were either overweight or obese whereas 32% of male children were TABLE 4 : BMI Distribution NORMAL UNDER OVER WEIGHT WEIGHT WEIGHT & OBESE TOTAL Group (51.4%) 74(50.3%) 6 (24.0%) 247(49.7%) Group (48.6%) 73 (49.7%) 19 (76.0%) 250 (50.3%) TOTAL 325 (100%) 147 (100%) 25 (100%) 497 (100%) TABLE 5: BMI and Gender distribution GENDER NORMAL UNDER OVER WEIGHT WEIGHT WEIGHT & OBESE TOTAL FEMALE 184 (56.6%) 60(40.8%) 17 (68.0%) 261(52.5%) MALE 141 (43.4%) 87 (59.2%) 8 (32.0%) 236 (47.5%) TOTAL 325 (100%) 147 (100%) 25 (100%) 497 (100%) 24
4 Vol. 2, Issue 2, September 2011 overweight or obese. It was contradictory to study done by Willerhausen et al where in his study 70% and 30% male and female children were overweight category [8] respectively. The current study showed high prevalence of dental caries in underweight children, similar to study done by [9] (Ayhan1996). These children would have acute or chronic nutritional stress due to poor socio economic status and lack of knowledge about general and oral health. Contradictory to this, study done by Mostafa et al, Amitha.M. Hegde (2009), Larsson (1995) and Kantovitz et al, showed high prevalence of dental caries in [10,11,12,13] overweight +obese children.. According to the study done by Tuomi 1989, Chen 1995, Kim 2006, Tramini et al, Moreira et al and Macek & Mitola, there was no statistically significant association between dental caries and different categories of BMI i.e either in normal, underweight, overweight and obese [14,15,16,17,6,18] category. The dental team should be in the forefront in promoting good nutrition for general health and oral health by informing caregivers and parents about the importance of integrating healthful snack and meal patterns into their oral hygiene practices. CONCLUSION TABLE 6: BMI and Mean Caries N MEAN CARIES ± SD NORMAL ± 2.38 UNDER WEIGHT ± 3.04 OVER WEIGHT +OBESE ± 2.31 In summary, given the strong evidence supporting the association of dental caries with irregular dietary patterns, abnormal dietary intake has been linked to the development of obesity at a young age. Mean number of caries and over weight + obese children were more in private school children compared to Government school children. More no. of female children were either overweight or obese category. It may be due to genetic and environmental factors, and also imbalance between food consumption and energy expenditure and changes in the dietary practices like as they eat more of refined carbohydrates and fatty food. Parents should encourage their children to eat balanced diet than over consumption. The study showed more no. of children were in normal BMI percentile, and overall under weight, children had more mean number of caries compared to normal BMI and over weight +Obese children. These children would have acute or chronic nutritional stress due to poor socio economic status and lack of knowledge about general and oral health. Continuous education and motivation of parents and children can help to some extent to improve their health status. REFERENCES 1) Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007 jan 6; 369: ) Caufield PW, Li Y, Dasanayake A. Dental caries: an infectious and transmissible disease. Compend Cont Educ Dent 2005; 26: ) Tennenbaum H, Mathews D, Sandor G, McCulloch C. Oral health-systemic health: what is the true connection? Interviews by Sean McNamara. J Can Dent Assoc 2007; 73: ) Van den Berg I, Pijpe J, Vissink A. Salivary gland parameters and clinical data related to the underlying disorder in patients with persisting xerostomia. European journal of oral science 2007;vol 115 issue 2, ) Andres pinto, Sunn kim. Is there is an association between weight and dental caries among pediatric patient in an urban dental school? Journal of dental education 2007,7(11); ) Moreira PV, Rosenblatt A, Severo AM. Prevalence of dental caries in obese and normal-weight Brazilian adolescents attending state and private schools. Community Dent Health Dec; 23(4): ) Willerhausen et al, Association between body mass index and dental health in 1,290 children of elementary schools in a German city; Clinical oral investigation 2007 feb 9 Sep;11(3): ) Marshall TA, Eichenberger-Gilmore JM, Broffitt BA, Warren JJ, Levy SM. Dental caries and childhood obesity: roles of diet and socioeconomic status. Community Dent Oral Epidemiol. 2007; 35: ) Ayhan H, Suskan E, Yildirim S. The effect of nursing or rampant caries on height, body weight and head circumference. J Clin Pediatr Dent 1996; 20(3): ) Mostafa et al plasma levels of gherlin hormone in lean,overweight and obese saudhi females.journal of dental research 2007 volume 1 page
5 Journal of Dental Sciences and Research 11) Amitha M Hegde Relationship between BMI,dental caries and dietary preferences in children. Journal of Clinical paediatric dentistry 2009 volume 34, number 1, page ) Larsson On Dental Caries and Caries-Related Factors in Children and Teenagers Journal of community dentistry and oral epidemiology 2005 volume23, issue 4 pages ) Kantovitz KR, Pascon FM, Rontani RM, Gaviao MB. Obesity and dental caries a systematic review. Oral Health Prev Dent 2006; 4: ) Thoumi Journal of clinical paediatric dentistry 2010 volume 34, no 2 page ) Chen W Lack of association between obesity and dental caries in three-year-old children. Journal of peadiatric health dentistry 2010 vol 70, issue 2,pages ) Kim S, Wadenya R, Rosenberg H. Is there an association between weight and dental caries among pediatric patients in an urban dental school? A correlation study. J Dent Educ. 2007; 71: ) Association between Caries Experience and Body Mass Index in 12-Year-Old French Children, P. Tramini, N. Molinari, M. Tentscher, C. Demattei, A.G. Schulte,Caries Res 2009;43: ) Macek MD, Mitola DJ. Exploring the association between overweight and dental caries among US children. Journal of Pediatric Dent 2006; 28:
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