Relationship between obesity/overweight status, sugar consumption and dental caries among adolescents in South India

To cite this article:
Int J Dent Hygiene 10 , 2012; 240–244
DOI: 10.1111/j.1601‐5037.2011.00534.x Honne T, Pentapati K, Kumar N, Acharya S. Relationship between obesity/overweight status, sugar consumption and dental caries among adolescents in South India. Abstract: Objective: To evaluate the relationship between obesity/overweight status, sugar consumption and dental caries among adolescents in Udupi District, India. Methods: Study population consisted of 463 school children aged between 13 and 15 years. Information on age, sex, type of school attending and frequency of sugar consumption per day was recorded by a structured self‐administered questionnaire. Body mass index (BMI) (height in metres and weight in kilograms) and caries measurements (DMFT) were taken by a trained recorder according to standard criteria. Results: Majority of the children were having low normal weight, with 18.6% in overweight and 3.5% in obese groups. There was a significant difference in the frequency of sugar consumption between the BMI groups. Obese group of children had more caries than the overweight and low‐normal‐weight children. Correlation analysis showed significant positive relation with BMI, decayed teeth and DMFT. Regression analysis showed that caries experience had a significant association with male sex (OR = 2.09, CI = 1.01–4.33), overweight/obese (OR = 3.68, CI = 1.79–7.56) and frequency of sugar consumption more than once per day (OR = 3.13, CI = 1.25–7.85). Conclusion: There was a significant association between overweight/obesity and caries experience among school children of Udupi District. Obesity and dental caries have common risk determinants and require a comprehensive multidisciplinary approach to paediatric patients by both medical and dental healthcare professionals.     

Childhood obesity and dental caries among paediatric dental clinic attenders

International Journal of Paediatric Dentistry 2011; 21: 217–222 Background. More than one‐quarter of New Zealand children are overweight or obese. Research on the causes of obesity has found associations with high consumption of sweetened foods and beverages, which have also been shown to be risk factors for dental caries, but studies investigating a possible association between dental caries and obesity have had conflicting findings. Aim. The aim of this study was to determine whether deciduous dental caries experience was associated with BMI among paediatric dental clinic attenders. Design. This was a cross‐sectional study of clinical records of 200 children aged eight and under (70% European) treated in the University of Otago undergraduate paediatric dentistry clinic between 2004 and 2006. Height and weight were measured and used to calculate BMI. Deciduous dental caries experience was recorded. Results. The overall mean BMI was 16.0 (SD = 2.0). Pacific Island children had a higher mean BMI (at 17.0) than NZ European, Maori, and Asian/Other children (15.7, 16.8, and 15.9 respectively; P < 0.05). The dmft ranged from 0 to 15, with a mean of 6.1 (SD = 3.8); 24% had dmft <3, and 38% had dmft >8. No significant association was found between the BMI and caries experience (P‐value = 0.932). Conclusions. There was no association between BMI and dental caries experience in this convenient sample.     

BMI status in Swedish children and young adults in relation to caries prevalence

Overweight and obesity are increasing as health problems at global level. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits. The aim of the present study was to investigate the relationship between body weight status and caries prevalence in an unselected population followed from pre-school years to young adulthood. The present investigation was designed as a longitudinal analysis of the association between overweight/obesity and dental caries in one population at 3, 6, 15 and 20 years of age. The result shows that adolescents (15 years) and young adults (20 years) who are overweight/obese had a statistically significantly higher caries prevalence than normal-weight young people. At 6 years of age, the odds (OR) of having caries among obese children are 2.5 times higher than the odds for caries among six-year-old children of normal weight (p = 0.04). At 3 years of age, no association between overweight/obesity and caries was found. To conclude, overweight and obese adolescents and young adults had more caries than normal-weight individuals. The present study emphasises the need for multidisciplinary approaches to change the lifestyle factors causing both overweight/obesity and dental caries.     

Approximal caries and sugar consumption in Icelandic teenagers

The aim of this study, conducted in 1994, was to examine the association between approximal caries and sugar consumption in teenagers residing in three fluoride-deficient areas in Iceland while controlling for a number of behavioral, residential and microbiological factors. One hundred and fifty subjects (mean age 14 years) selected from the Icelandic Nutritional Survey (INS) were examined radiographically and they completed questionnaires about sugar consumption frequency. Total grams of sugar intake were obtained from the INS for each subject. Caries experience on approximal surfaces, diagnosed from radiographs, was used as the dependent variable in the analyses. Altogether 45.2% of subjects were caries free on approximal surfaces. The overall sample was found to have a mean DFS on approximal surfaces of 2.73 ( s = 4.36) per subject. Average daily total sugar intake was 170 g per subject and the mean number of sugar-eating occasions between meals was 5.32 ( s = 6.29) per subject. The regression model indicated that the frequency of between-meal sugar consumption was associated with approximal caries, with frequency of candy consumption being the most important of the sugar variables. In multivariate analysis, no relationship was found between dental caries and total daily intake of sugar, although a significant relationship between total sugar consumption and presence of caries was seen in bivariate analysis. Between-meal consumption of sugar remains a risk factor for the occurrence of dental caries, especially in populations with moderate-to-high levels of dental caries experience.     

Comparison of the intakes of sugars by young children with and without dental caries experience

BACKGROUND: Relationships among sugars and dental caries in contemporary societies are unclear. The authors describe young children's intakes of nonmilk extrinsic (NME) and intrinsic/milk sugars and relate those intakes to dental caries. METHODS: The authors conducted cross-sectional analyses of dietary data collected from the Iowa Fluoride Study using three-day diaries for subjects at ages 1, 2, 3, 4 and 5 years and for subjects aged 1 through 5 years according to dental caries experience at 4.5 to 6.9 years of age. They categorized foods and beverages as containing NME or intrinsic/milk sugars. RESULTS: Subjects' total, NME, food NME and intrinsic/milk sugars intakes at ages studied did not differ between subjects with and without caries experience. Beverage NME sugars intakes at age 3 years predicted caries (P < .05) in logistic regression models adjusted for age at dental examination and for fluoride intake. CONCLUSIONS: Dental caries is a complex, multifactorial disease process dependent on the presence of oral bacteria, a fermentable carbohydrate substrate and host enamel. A simple NME-intrinsic/milk sugars categorization appears insufficient to capture the complex dietary component of the caries process. CLINICAL IMPLICATIONS: Cariogenicity is more likely a function of the food and/or beverage vehicle delivering the sugar and the nature of exposure-that is, frequency and length of eating events-than of the sugar's categorization.     

Sugar consumption and caries risk in schoolchildren with low caries experience

Abstract This paper assesses the risk from sugar consumption in a population of schoolchildren with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11–15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.     

Nutrient intake and dental caries in the primary dentition.

An extensive literature has assessed the influence of diet on dental caries, but to date dietary influences on caries of the primary dentition have not been studied widely. This study examined the role of specific nutrients in the caries experience of preschool children. A total of 628 children ages 2 to 6 years received a dental examination, parent interview, and a seven-day diet diary. The diary was completed adequately for 269 children (43%). The average daily intakes of 15 nutrients were computed and compared with recommended dietary allowances (RDA); total sugar consumption and Ca/P ratio were calculated. Each child's gender, age, fluoride history, previous dental experience, and nutrient intakes were examined as independent variables. Stepwise logistic regression showed the combination of categories most predictive of caries was older age, suboptimal fluoride consumption, and recall dental visit. No association was apparent between dental caries and the intake of specific nutrients, total sugar consumption, or Ca/P ratio.     

Obesity and dental caries in children aged 2-6 years in the United States: National Health and Nutrition Examination Survey 1999-2002

Objective: This study assessed the associations between obesity and dental caries in young children participating in a national survey. Methods: Participants included 1,507 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/m ² ) 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 (≥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 for age, race, and poverty/income ratio. However, further studies are needed to better understand this relationship.     

Sugar consumption and dental caries experience in Kenya

Introduction: There have been claims that dental caries experience and prevalence in Kenya has been increasing as a result of increased sugar consumption. A review of the literature in 1986 failed to link dental caries experience with an increase in gross national sugar consumption. Subsequently, a number of studies were conducted, necessitating further review to examine trends in dental caries experience and to relate this to changes in per capita sugar consumption. Methods: Studies conducted since 1980 for children 3–15 years of age were examined. Dental caries prevalence and experience for 3–5 years’ (deciduous teeth) and 12 years’ (permanent teeth) age groups were analysed. Calculation of per capita sugar consumption was performed using gross national annual sugar consumption for 1969–2009 national population census years. Results: There was a gradual increase in per capita sugar consumption, from 35.5 g/day in 1969 to 60.8 g/day in 2009. Dental caries experience in deciduous teeth for children 3–5 years of age increased from a decayed, missing and filled teeth/decayed and filled teeth (dmft/dft) index of 1.5 in the 1980s to 2.95 in the 2000s. At 12 years of age, caries experience for permanent teeth increased from a DMFT of 0.2 to a DMFT of 0.92 over the same period. Dental caries prevalence for both deciduous and permanent teeth also increased with time. Conclusion: These observations suggest that dental caries prevalence and experience increased with time, in parallel to an increase in per capita sugar consumption. However, a clearer understanding can be derived from longitudinal studies, based on actual household age-specific sugar consumption and dental caries incidence.Key words: Sugar, caries experience, socio-economic development     

Association of dental caries with socio-demographic and nutritional factors among school children in Guntur district of Andhra Pradesh,India

ObjectiveThe main objective of the study was to determine the association of dental caries with socio-demographic factors like age, gender and socioeconomic status (SES); second is to explore the relationship between dental caries and nutritional status in school going children of Guntur district, Andhra Pradesh.MethodsIn this cross-sectional study, SES of 1022 children aged between 5 and 11 years were assessed according to modified kuppuswamy SES scale. The body mass index (BMI) values were calculated and then the children were grouped into 3 categories (underweight, normal, overweight + obese) based on revised World Health Organization (WHO) growth charts. Caries index (deft+/DMFT) of each child was recorded using American Dental Association (ADA) Type 3 examination. Data was analysed and the tests employed were Chi-Square (X2); Analysis of Variance (ANOVA) and Logistic regression analysis.ResultsThe prevalence of dental caries was 57.14% and underweight was 40.3% among Guntur district school children. A significant association between dental caries and SES was noticed (OR = 1.74). However, no significant association of dental caries experience with other factors like age, gender and BMI was observed.ConclusionNutritional status of children may not show association with dental caries, but SES influences the caries prevalence in children.     

The consumption of processed sugar- and starch-containing foods,and dental caries: a systematic review

The relationship between high dietary intakes of sugar (sucrose) and dental caries is well established. Processed sugars and starches have been associated with greater dental caries experience in retrospective studies. The aim of this systematic review was to determine the relationship between the consumption of processed sugar- and starch-containing foods, the frequency of consumption of these foods, and dental caries. Prospective studies were identified in databases searched from 1970 to July 2020, and relevant retrieved papers that examined associations between the consumption of sugar- and starch-containing foods by human participants and dental caries were eligible for inclusion. Five cohort studies were identified for inclusion, all of which evaluated caries risk in young children or pre-adolescents. The between-meal consumption of processed sugar- and starch-containing foods was consistently found to be associated with greater caries experience. There were mixed findings on total consumption of processed sugar- and starch-containing foods, owing to a range of confounding factors, including the simultaneous consumption of caries-protective foods at mealtimes. Although there is a paucity of research of the dietary effects of frequent consumption of processed sugar- and starch-containing foods on dental caries, there is some evidence of plausible associations between this dietary behaviour and dental caries. Future research should investigate the effectiveness of interventions to change the dietary behaviour of high-frequency consumption of processed sugar- and starch-containing foods to decrease the risk of dental caries.     

The relationship between obesity and dental caries according to life style factors in schoolchildren: a case-control study

Abstract

Objectives: To evaluate the association between obesity and dental caries in terms of life-style habits and socio-economic status in Turkish school children.

Materials and methods: This case-control study was undertaken with 178 children aged 6–11 years in a Turkish government children’s hospital. The case group consisted of 86 obese children who were categorized in ≥95 percentile according to the BMI. The control group consisted of 90 non-obese children that would not raise any doubts about the teeth disease. Data of demographic features and life-style habits were obtained by a questionnaire at the dental examination. Caries experience was measured with DMFT and dmft indices.

Results: No difference was found between obesity and caries prevalence in primary dentition (p?=?.957); however, there was a statistically significant association in the permanent dentition (p?=?.002). Also, no differences were found in children with healthy natural teeth between the study groups according to education level, family income and food consumption during TV viewing in primary dentition (p?=?.297; p?=?.652; p?=?.023).

Conclusions: It can be concluded that obesity appears to be not a possible risk factor for dental caries in primary dentition, but would be a probable endangerment in the permanent dentition.     

Eating patterns, diet and dental caries

There is new evidence showing that excessive sugar consumption increases the risk of caries, even if the correlation between sugar intake and dental health has weakened due to exposure to fluoride. Moreover, there are still patient groups whose fluoride exposure seems to be insufficient to tolerate the generally increased level of sugar intake. CLINICAL RELEVANCE: Patients with high caries risk and/or insufficient fluoride exposure need personal advice and recommendations related to the use of sugars, sweets, sweet juices and soft drinks, even today. Patients with increased risk of obesity may also benefit from dietary recommendations conducted by dental professionals.     

Association between obesity and dental caries in a group of preschool children in Mexico

Objective: The aim of this study was to determine the association between obesity and caries by utilizing the data of a cohort of preschool children aged 4‐5 years. Methods: Data were obtained from a cohort of 1,160 children. Dental caries detection was performed according to the World Health Organization criteria. The caries index was measured as the number of decayed (d), extracted (e), and filled (f) teeth (t) (deft), or surfaces (defs). The body mass index (BMI) in units of kg/m² was determined, and children were categorized according to age‐ and gender‐specific criteria as normal weight (5th‐85th percentile), at‐risk overweight (≥85th‐<95th percentile), and overweight (≥95th percentile). Odds ratios were determined for at‐risk overweight and overweight children using logistic regression. Results: The prevalence of dental caries was 17.9 percent. A slightly higher percentage of dental caries was found in boys (19.6 percent) than in girls (16.4 percent). From the total sample, the mean BMI was 17.10 ± 3.83. Approximately 53.7 percent of children were classified as normal weight, 14.2 percent as at‐risk overweight, and 32.1 percent as overweight. At‐risk overweight children were higher among girls (17.1 percent) than among boys (11.3 percent). When adjusted for covariates, the logistic regression model showed that there was a significant association between at‐risk overweight children (P < 0.001), overweight children (P < 0.001), and caries in the primary dentition. Mean (SD) deft value of the sample was 1.08 (2.34), while the corresponding defs value was 1.43 (3.29). Conclusion: Obesity appears to be associated with dental caries in the primary dentition of preschool Mexican children.     

Relationship among microbiological composition and presence of dental plaque, sugar exposure, social factors and different stages of early childhood caries

Objective

This cross-sectional study aimed to investigate the relationship among microbiological composition of dental plaque, sugar exposure and social factors, as well as the presence of visible plaque in preschoolers with different stages of early childhood caries.

Design

A total of 169 children were clinically examined according to the World Health Organisation criteria + early caries lesions and were divided into three groups: caries-free (n = 53), early caries lesions-ECL (n = 56), and cavitated caries lesions-CCL (n = 60). The presence of clinically visible dental plaque on maxillary incisors was recorded. After that, dental plaque from all buccal and lingual smooth surfaces was collected and the number of colony-forming units of mutans streptococci and total microorganism, as well as the presence of lactobacilli was determined. Daily frequency of meals containing sugar was assessed by a diet chart whereas social factors were evaluated by a questionnaire. The data were analysed by chi-square test followed by multiple logistic regressions (α = 0.05, confidence interval = 95%).

Results

High levels of mutans streptococci (OR = 2.28), high total sugar exposure (OR = 5.45) and presence of dental plaque (OR = 2.60) showed significant association with ECL (p < 0.05). High total microorganism count (OR = 5.18), high solid sugar exposure (OR = 2.50) and the presence of lactobacilli (OR = 24.99) revealed significant association with CCL (p < 0.05).

Conclusions

These results support the conclusion that dietary sugar experience influenced the microbiological composition of dental plaque. Moreover, the early stage of caries is highly affected by mutans streptococci and visible dental plaque on maxillary incisors whereas cavities are strongly related to lactobacilli and total microorganism.     

Relationship of oral hygiene and sugar consumption to risk of caries in children

Abstract The associations of denial caries with poor oral hygiene and high sugar consumption were analyzed taking into account possible confounding and factor interaction. The series consisted of 543 children from low-fluoride areas (0.10–0.46 parts/10⁶), aged 5, 9 and 13 years Plaque accumulation and sugar consumption were slightly confounded throughout the observations. Effect-modification appeared to exist, since the effect of one factor was greater at higher levels of the other. The association between the amount of plaque and dental caries was statistically significant at all levels of sugar consumption. With increasing total sugar consumption the risk of caries increased significantly only when oral hygiene was simultaneously poor. Effect estimates (E) and attributable risk estimates (AR) were calculated for increased plaque accumulation and sugar consumption. For the total sets of tooth surfaces in the various age groups the proportions of the total caries load associated with increased plaque accumulation were 35.2–63.0%, and those associated with higher total sugar consumption 0.7–5.4%. The fractions varied greatly with the tooth group. The effect estimates for the two factors in combination were always greater than the sums of the separate effects, indicating synergistic interaction between the two caries determinants.     

Obesity and periodontitis in Australian adults: A population-based cross-sectional study

Objectives: Obesity and periodontitis are public health issues in Australia. This study aimed to determine the association between overweight/obesity and periodontitis in Australian adults. Materials and methods: The cross-sectional National Survey of Adult Oral Health 2004–2006 data were analysed. Body mass index was calculated, and a self-reported questionnaire was used to measure the estimated daily intake of added sugar. The mean number of sites with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 4 mm and presence of periodontitis were used as outcome measures. CDC/AAP periodontitis case definition was adopted. Bivariate analyses and multiple variable regression models were constructed. Results: The study sample was 4,170 participants. The proportion of people that were overweight/obese was 51.9% [95% confidence interval (CI): 48.1%, 54.1%]. Overall 21.3% (95% CI: 19.3%, 23.5%) people experienced periodontitis. The mean number of sites with PD ≥ 4 mm and CAL ≥ 4 mm were recorded as 0.7 (95% CI: 0.5, 0.9) and 2.4 (95% CI: 2.1, 2.6), respectively. Multiple variable analysis suggested that periodontal parameters [sites with PD ≥ 4 mm (0.13, 95% CI: −0.86, 0.35) and sites with CAL ≥ 4 mm (0.11, 95% CI: −0.58, 0.35) and presence of periodontitis (1.23, 95% CI: 0.96, 1.57)] were not associated with overweight/obesity when controlled for putative confounders. Conclusion: A positive association was found between overweight/obesity and periodontitis (PD and CAL). However, the statistical significance disappeared in the multiple variable regression analysis, where age, sex, smoking and dental visiting behaviour were found to be key determinants of periodontitis.Key words: Periodontal disease, obesity, oral health, public health, chronic disease, body mass index     

Caries status and overweight in 2- to 18-year-old US children: findings from national surveys

Abstract – Background: The prevalence of overweight children in the United States continues to increase. Objectives: To examine the relationship between being overweight and caries in primary and permanent dentition in a nationally representative sample of children. Methods: Data from the NHANES III (1988–1994) were analyzed using logistic regression and controlling for potential confounders for 10 180 children 2–18 years of age and from the NHANES 1999–2002 for 7568 children 2–18 years of age. Results: For children 2–5 years of age, there was no difference in caries experience among normal weight, at risk for overweight or overweight children for NHANES III and for NHANES 1999–2002. For children 6–11 years of age (NHANES III), at risk for overweight and overweight children were less likely to have caries experience in the primary dentition than normal weight children; overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 12–18 years of age (NHANES III), overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 6–11 years of age and 12–18 years of age (NHANES 1999–2002), there was no difference in having caries experience among normal, at risk for overweight and overweight children. Conclusions: The data from NHANES III and NHANES 1999–2002 provide no evidence to suggest that overweight children are at an increased risk for dental caries. Although no differences in caries rates by weight were found in younger children, interestingly results from NHANES III suggest that being overweight may be associated with decreased rates of caries in older children.     

Association of maternal risk factors with early childhood caries in schoolchildren of Moradabad, India

International Journal of Paediatric Dentistry 2011 Background. Children who have caries in their primary teeth in infancy or toddlerhood tend to develop dental caries in their permanent dentition. Although risk indicators are helpful in identifying groups at risk, they give little information about the causes of difference in caries experience. Aim. To identify the association between maternal risk factors and early childhood caries among 3‐ to 5‐year‐old schoolchildren of Moradabad City, Uttar Pradesh, India. Design. A total of 150 child–mother pairs participated in the study. The maternal risk factors were assessed by a pretested questionnaire. After obtaining the consent, the mothers and their children were clinically examined for dental caries using Radike criteria (1968). Saliva was collected from all the participating mothers for assessing the Streptococcus mutans level. Results. Significant differences were found in mothers’ caries activity, high level of S. mutans, educational level, socioeconomic status, frequency of maternal sugar consumption, and their child’s caries experience (P < 0.001). Conclusions. Differences between children’s situations in these underlying factors play out as consequential disparities in both their health and the health care they receive.     

Diet and general health: dietary counselling

Dietary guidelines are designed to maintain an adequate intake of nutrients and to protect against diet-related disease, particularly cardiovascular disease and obesity. Current population dietary guidelines advocate a reduction in total fat intake, particularly saturated fat intake, to 25-35% of the energy intake and an increased intake of carbohydrate to more than 55% of the dietary energy intake, which should mainly be derived from starch. There is a positive relationship between total sugar intake and the incidence of dental caries where dental hygiene is poor and exposure to fluoride is low. However, this relationship is stronger for frequency of consumption of sugary foods. The frequent consumption of acidic food and beverages should be also avoided as this can result in erosion of the tooth enamel. Risk of caries can be minimised by good oral hygiene, appropriate exposure to fluoride and by restricting the intake sugar containing snacks between meals to no more than four occasions per day. A need for randomized controlled trials to assess the effectiveness of dietary modification on oral health in adults is identified.