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Year : 2013  |  Volume : 4  |  Issue : 3  |  Page : 101-105

Exploring the association between dental caries and body mass index in public school children of Ahmedabad city, Gujarat

Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India

Date of Web Publication20-Nov-2013

Correspondence Address:
Sujal Mitul Parkar
B-25, Krishna Bunglows-I, Gandhinagar Highway, Motera, Ahmedabad - 380 005, Gujarat
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Source of Support: Self Financed, Conflict of Interest: None

DOI: 10.4103/0976-433X.121633

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Objective: The aim of this study is to assess whether dental caries was related to body mass index (BMI) in school going children of Ahmedabad city (Gujarat), India. Materials and Methods: Dental and anthropometric examinations were conducted on 750 school going children with a mean age of 10.96 ± 3.14 years from ten public schools. Dental caries was diagnosed according to World Health Organization (WHO) criteria using deft/decayed, missing and filled teeth (DMFT) index. Nutritional status was obtained using BMI and classification of nutritional status was achieved using the standards of WHO. Results: Out of the 750 children, 450 (60%) were male and 300 (40%) were female. There was a highly significant difference (P < 0.001) when the prevalence of dental caries (deft/DMFT) was compared in different age groups of children. About 653 (87.1%) out of 750 children were underweight. There was a highly significant difference (P < 0.001) when the BMI and mean deft score was compared; however, when the BMI and mean DMFT score was compared the result was not reached to the significant level (P > 0.05). Significant correlation (P < 0.001) was observed between the different age groups and caries. There was a negative correlation between deft and BMI showing a significant result. Conclusion: Increase in age and underweight children were more likely to have caries experience.

Keywords: Body mass index, dental caries, nutritional status, school children

How to cite this article:
Parkar SM, Chokshi M. Exploring the association between dental caries and body mass index in public school children of Ahmedabad city, Gujarat. SRM J Res Dent Sci 2013;4:101-5

How to cite this URL:
Parkar SM, Chokshi M. Exploring the association between dental caries and body mass index in public school children of Ahmedabad city, Gujarat. SRM J Res Dent Sci [serial online] 2013 [cited 2023 Feb 4];4:101-5. Available from:

  Introduction Top

Dental caries is a global disease with few populations exempt from its effects. In developing countries, where the fluoride is not available and populations especially the young school going children have more opportunity to consume free sugar and other fermentable carbohydrate, the prevalence of dental caries increase. [1] Under nutrition in early childhood affects skeletal growth and results in decreased height. Similarly, poor nutrition in early childhood affects tooth eruption and results in delayed emergence of the teeth. Delayed tooth eruption leads to exposure of the teeth in the oral environment for a lesser period of time. This may lead to the delay in caries acquisition. There appears to be a strong physiological association between skeletal growth and delayed tooth eruption. [2],[3] A change in the pattern of tooth eruption should result in a concomitant change in the age distribution of dental caries in the primary teeth.

There are controversial results documented regarding the relationship between the nutritional status and the occurrence of dental caries in children. It has been claimed by some reports that being overweight is linked to caries, whereas, other reports state that caries is more common in underweight children. Through literature review it was the relationship between nutritional status and the occurrence of dental caries is controversial. Some studies claims that there is no significant relationship between dental caries and nutritional status in a group of obese children, [4],[5] while other studies shows that children's dietary habits are a significant contributor to obesity and dental caries. [6],[7]

Number of Indian studies on dental caries had been carried out mostly in adult and elderly population and in relation to socio-demography, hygiene and diet while in children related to prevalence and treatment of caries. [8] However, studies showing the effect of nutrition on dental caries in Indian schoolchildren are very scanty. Because the findings on the relationship between nutritional status and caries are equivocal and to the best of our knowledge, there are no published population studies that have investigated the association between nutrition and dental caries in school going children in Western part of India so far. Hence, an attempt had been made in the present study to assess whether the dental caries was related to body mass index (BMI) in school going children of Ahmedabad city (Gujarat), India.

  Materials and Methods Top

A cross-sectional, comparative study was conducted among 750 school going children of ten randomly selected public schools in Ahmedabad city with age ranges from 5 to 18 years having mean age of 10.96 ± 3.14 years. Prior to conducting the study, the study protocol was approved by the Ethics Committee of Ahmedabad Dental College and Hospital. The permission was obtained from the school authority and the written consent was taken from the parents of the students before conducting the study for their participation in the study.

Anthropometric assessment was done prior to dental examination by using a 150 kg digital scale to measure weight and 200 cm tape to measure height according to World Health Organization (WHO) guidelines. [9] Body weight was recorded by using a standard beam balance scale with the subjects in barefoot and wearing light dresses. Furthermore, body height was recorded with subjects wearing no shoes, heels together and head touching the ruler with line of sight aligned horizontally. BMI was calculated by using standard formula - weight (kg)/height (m 2 ). The children were further sub-classified into underweight (<18.5), normal weight (18.5-24.99) and overweight (≥25) as recommended by WHO. [10]

The students were made to sit upright in a chair and diagnosed under full natural light with explorer and plain mouth mirror following the WHO's basic guidelines for oral health surveys. [11] Head cap, face mask, gloves and gauze were used in accordance with the infection control guidelines in the study. The dental caries was diagnosed according to WHO criteria by using decayed, missing and filled teeth (DMFT)/deft caries index. [12] Cavities in deciduous and permanent teeth in need of treatment were marked as decayed (DMFT/deft). Dressed and restored teeth that had recurrent caries were recorded as decayed. A tooth surface is diagnosed as decayed if carious lesion is defined as clinically visible cavity in which an explorer tip can penetrate deep into the soft yielding tooth material suggesting demineralization or undermining caries. Teeth missing as a result of caries were marked as missing (M). Teeth missing for orthodontic reasons, extraction or trauma were not included for scoring in the index. The teeth were marked as filled (F/f) if it has been previously filled due to caries. Teeth restored for reasons other than caries were not recorded in the index. All the examinations were carried out by Chokshi Mansi who was previously trained and calibrated by Parkar Sujal showing the inter-examiner variability of κ = 0.84.

Statistical analysis

The data were analyzed using the statistical package for the social sciences software (version 17; SPSS, Inc., Chicago, USA). Descriptive statistics that included mean, standard deviation and percentages were calculated for each of the variables. Non-parametric test Kruskal-Wallis test was used for the comparison between dental caries (DMFT/deft) and BMI. Spearman's ρ coefficient correlation was used to check the correlation between caries and BMI. Significance of all statistical tests was predetermined at a P ≤ 0.05.

  Results Top

Out of 750 children 450 (60%) were male and 300 (40%) were female children. The children were divided into three subgroups according to their schooling age - Group 1: Primary school going children (5-12 years); n = 494 (65.9%), Group 2: Secondary school going children (13-15 years); n = 219 (29.2%) and Group 3: Higher secondary school going children (16-18 years); n = 37 (4.9%).

The prevalence of dental caries in deciduous teeth (deft) in primary school going children, secondary school going children and higher secondary school going children was 27.1%, 2.1% and 0.3% respectively; whereas, dental caries in permanent teeth (DMFT) in primary school going children, secondary school going children and higher secondary school going children was 12.1%, 10% and 2.4% respectively. Statistically, there was highly significant difference when the caries prevalence was compared with different age groups (P < 0.001) [Table 1]. There was highly significant difference (P < 0.001) when the mean deft/DMFT scores were compared among three age groups [Table 2].
Table 1: Prevalence of dental caries (deft/DMFT) among different age groups

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Table 2: Mean deft/DMFT scores among the different age groups

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A total of 653 (87.1%) out of 750 children were underweight and only 88 (11.7%) children were of normal weight. The caries (deft) prevalence among underweight and normal weight children was 28.5% and 0.9% respectively showing statistically highly significant difference (P < 0.001). There was no significant difference (P = 0.161) when the prevalence of caries (DMFT) among underweight (21.2%) and normal weight (3.3%) were compared [Table 3]. The mean deft and DMFT scores were compared among the subgroups of BMI. There was statistically highly significant difference (P < 0.001) when the mean deft scores were compared however no significant difference (P = 0.166) when the mean DMFT scores were compared [Table 4].
Table 3: Prevalence of dental caries (deft/DMFT) among subgroups of BMI

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Table 4: Mean deft/DMFT scores among the subgroups of BMI

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Spearman's ρ coefficient correlation test was carried out to check the association between age groups, BMI and dental caries [Table 5]. There was a significant correlation between age groups and deft/DMFT (P < 0.001). There was a negative correlation (ρ = −0.18; P < 0.001) between BMI and deft showing statistically highly significant result. However, there was no significant correlation between BMI and DMFT.
Table 5: Correlations between age groups, BMI and dental caries

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  Discussion Top

In developing countries life-style and nutritional transitions contribute to rapidly growing rates of overweight. [13] Despite the escalating problem of obesity, underweight also remains a major public health problem in the developing countries. [14] Overweight and underweight both exhibiting the cumulative environmental effects of dietary factors, which could be responsible for the higher rates of dental caries in these children. [15] There are conflicting reports in literature on association between BMI and dental caries. Hence, the present cross sectional study was conducted to assess the relationship between BMI and dental caries among 5-18 years old school going children attending the public schools in Ahmedabad city. Public schools were chosen for the present study in order to maintain the homogeneity as these may share similar characteristics probably because overall the sample presented a low socio-economic level.

The results of the present study shows that the caries experience significantly increases with age and is evident from the fact that mean DMFT score of age Group 1 was 0.35 compared with mean DMFT score of 1.32 in the age Group 3. One of the possible explanations could be that caries is an age related cumulative condition and thus older group is more likely to exhibit higher values.

The result of this study revealed that a large proportion of the school children (87.1%) examined were underweight, which was in accordance with Narang et al. [16] but in contrast with the study conducted by Sudhakar et al. [17] and Gangadhar et al. [18] who reported the majority of school children have normal weight. The discrepancy observed was possible due to the social class difference between the types of schools studied (public and private schools). High percentage of underweight children is probably because of poor dietary habits and living standards.

The current study showed a high prevalence of dental caries in underweight children, similar to study done by Prashanth et al. [19] and Ayhan et al. [20] These children might have acute or chronic nutritional stress due to poor socio-economic status and lack of knowledge about general and oral health. Contradictory to this result, study done by Kantovitz et al., [7] Daghestani, [21] Sharma and Hegde [22] and Alm [23] showed high prevalence of dental caries in overweight children.

In the present study, the mean deft score was observed to be significantly higher in underweight children. This might be due the fact that caries in the primary dentition is associated with under nutrition in early childhood. Nutrients such as vitamins A and D, calcium, phosphorus and fluoride have effects on the gross and microscopic morphology, chemical composition and tooth eruption patterns. [24] These factors in turn determine the susceptibility of a tooth to dental caries. However, no significant difference was found between caries in the permanent dentition (DMFT) and BMI. This is in accordance to Narang et al., [16] Sudhakar et al. [17] and Silvia et al. [25] Dissimilar results were obtained in the studies carried out by Alvarez et al. [3] who found a statistically significant association between chronic malnutrition and dental caries.

Spearman's correlation coefficient test was done to assess whether there is any relation between BMI and caries. Negative correlation was found between deft and BMI. This result was similar to the findings of Macek and Mitola [5] and Kopycka-Kedzierawski et al. [26] More negative correlations than positive indicate an inverse relationship between BMI and caries in deciduous teeth. This reassure the established fact that dental caries experience in normally fed children is less. Poor dental health and toothache due to caries may contribute to children's low weight gain and the growth and cognitive development of young children. [27]

The results of this study have to be interpreted with cautions as some potential limitations of this study should be taken into account. First, no cause-effect relationship can be deduced from a cross-sectional design study such as this. Longitudinal designs would increase the knowledge on the determinants of dental caries. Second, numerous questionnaires and confounding variables related to socio-economic factors, dietary pattern and oral hygiene practices among schoolchildren had not been taken into consideration, which may play a major role. Third, as only public school going children were chosen, which represented low socio-economic status and whose population was largely underweight thus limiting the possibility of analyzing any possible association between caries and overweight.

  Conclusion Top

This study indicates a close relationship between nutritional status and dental caries in schoolchildren. Thus, future preventive measures must include strategies to provide proper nutrition, particularly in children and adolescents, besides promoting dental hygiene alone. The significant success in the reduction of caries prevalence with preventive programs in schools and continuous education as well as motivation of parents could represent an exemplary concept for corresponding health efforts in the area of nutritional guidance and an increase in quality-of-life, which has an impact on self-esteem, eating ability and healthy social functioning.

  References Top

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

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