Cristina Cardoso Silva* and Beatriz Santa Carvalhinho

Department of Paediatric Dentistry, Faculty of Health Sciences, Universidade Fernando Pessoa, Portugal

*Corresponding Author: Cristina Cardoso Silva, Department of Paediatric Dentistry, Faculty of Health Sciences, Universidade Fernando Pessoa, Portugal.

Received: March 08, 2021; Published: April 06, 2021

Abstract

Aim: The present work checked the way food intake, and the type of food are related to oral health and body mass index (BMI), body weight, height, and body composition.

Methodology: A systematic review of 48 scientific research articles was carried out, including articles from several countries on all continents, seeking to specify the relationship between oral health and anthropometric profile in children, from 1 month to 18 years, attending public and private schools, coming from families with different socio-economic and regional insertions.

Result: A weaker oral health was observed in children presenting lower body mass index and obesity and in those belonging to less favored social and economic environments, with habits of high levels of sugar intake and poorer nourishment regarding healthy nutrients. Such habits cause pathologies like dental caries.

Conclusion: There is a major focus on the need to promote a wider education for oral health and dietary habits in schools and near families, emphasizing the role of teachers, dentists, family doctors and health authorities.

Keywords: Oral Health; Body Weight; Body Mass Index; Anthropometry; Dental Caries

Abbreviation

BMI: Body Mass Index

Introduction

  Society has made a marked progress in terms of health in general. Yet, in terms of oral health, there are still deficit situations, namely dental caries, and its possible relationship with obesity, as well as the association of both with the type of food intake, which in turn, is related to the low socioeconomic status of families [1,2].

  The awareness of this reality, mainly due to the transformations that have been occurring in industrialized countries, led to the need to relate parameters of anthropometric profile, such as body weight and stature, with the oral health of individuals of pediatric age. It is at this age that the problem of caries prevalence manifests itself and, if not properly solved, will tend to increase, reaching concerning proportions, such as deficient oral health in adults [3].

Objective of the Study

  The objective of the present review was to understand the relationship between dental caries and the anthropometric variables: body weight, height and body mass index (BMI).

Methodology

  For the elaboration of this review, a bibliographic research was carried on “PubMed” with the MeSH terms: “Anthropometry”, “Dental Caries”, "Overweight", "Thinness", “Body Weight", "Oral Health", "Body Mass Index". The terms were combined with the Boolean markers “AND”, “OR” and used the “Best Match” option (Table 1).

Table 1: Articles selection.

  The following inclusion criteria were employed: articles published since 2009; carried out in humans aged 1 month to 18 years, written in Portuguese, Spanish or English. Articles were first selected by title, then by the abstract and finally by full text reading. Articles that were not available in full text or investigations that were not directly related to the subject under study were excluded (Diagram 1).

Diagram 1: PRISMA flow diagram of literature search and selection process.

Discussion

  A good oral health, in its multiple components, is essential so that children can properly carry out their food, ingesting what provides them with the necessary nutrients for proper physical, psychological, and social development [4].

  If there is no care and concern for oral health, it will be harmed. It happens because oral hygiene is neglected, giving preference to less healthy habits, facilitating the appearance of dental caries. This condition is characterized by being an irreversible microbiological disease of the teeth calcified tissues, causing demineralization of the inorganic portion and destruction of the tooth's organic substances, leading to the formation of a cavity. It is a multifactorial disease with a complex etiology [5].

  It is known that developed countries and, particularly, families with higher income and better socioeconomic status, often related to higher academic degrees, knowledge, and awareness of the primary importance of their children's oral health, have more favorable results regarding oral health [6]. The opposite was observed in less developed countries [7].

  Another aspect highlighted by multiple studies of all continents and that must be safeguarded, is about different cultural and ethnic habits, as well as geographical and regional insertion. This reality can be observed in societies that have great traditions on what they consider good oral health and desirable anthropometric profile in pediatric ages, considered unequivocal patterns of their experiences and attitudes to be followed. As an example, in Pakistan, in a sample of 6363 children being used to chewing tobacco and other plants without nutritional value, 19% showed clinical anemia and 45% presented malnutrition [8,9].

It is in this duality that oral health is equated in pediatric ages:

• Cared oral health, protected and developed in more socioeconomically favorable environments and where there is more enlightenment for families, both due to their level of education and literacy, as well as their belonging to more developed means, with better monthly income. Thus, they also have more help in terms of clarification in schools, mostly private, with specific oral health screenings by medical personnel and also by teachers and family doctors, in an action concerted with a view to promote this very good, oral health [6,10,11].
• Unattended oral health, left to chance due to neglect in more disadvantaged environments, with poorly educated families and reduced financial income. Or else, zealous traditions considered, itself, as a law in life [6,12].

  The state of oral health is a condition of the greatest importance in terms of health in general and the homeostasis of the individual, being extremely important for their physical and emotional health, in an inseparable relationship with their interaction in society. Oral health is influenced by the human being's perceptions, expectations and adaptive capacity to certain situations, presenting a great weight for his well-being [4,13].

Anthropometric profile measurements, in addition to being related to oral health, are also related to each other and are indicators of growth and development [1].

  BMI is an international measure adopted to verify if the person is at his ideal weight. It is represented by the formula BMI (Kg / m²) = Weight (kg)/Height² (m²) [14].

This parameter is directly related to the diet, which can cause problems such as malnutrition or obesity, and consequences on oral health [15,16].

  The problem of overweight and obesity is seen as a 21^st century pandemic, reaching all ages in quite worrying levels. It is important to emphasize that obese children are at greater risk of becoming obese adults, with associated complications, such as type II diabetes. The curves of BMI allow us to observe the nutritional status, not only of obese children, but also of those at risk of becoming obese. According to the World Health Organization (WHO) [17], the BMI percentiles for age and sex between 85 and 95 is defined as being overweight. BMI above percentile 95 is considered obesity. The fight against overweight and obesity must be a concern of health professionals who daily relate to children and their families. Currently, it is verified that obesity is gradually increasing, which in certain cases may reach worrying proportions, as younger individuals are being classified as obese [2].

  Several studies focus on the possible relationship between BMI and oral health. Accordingly, and in general, it appears that children with a higher BMI are more likely to have oral health problems, although a linear correlation between the two realities could not be established [1,18].

  The reviewed literature focused on BMI in children having in common belonging to a low socioeconomic level family which emphasizes that, regardless of geographic location, culture, or nationality, these families live in similar realities: often struggling to survive, making more important to purchase food rather than health care, namely oral health, often due to lack of information and knowledge [19].

As for body weight, its relationship with oral health varies from author to author [1,2,20].

  Some studies presented as plausible the relationship between dental caries and excessive body weight [10,15,21], whereas other studies reported obese children with fewer caries lesions [10].

  Poor oral hygiene, associated with an unbalanced diet, is the main reason for dental caries and a major public health problem, along with obesity [2,18,20]. Food is an important factor to be considered regarding body weight, as children with a higher prevalence of caries lesions showed great difficulties while eating due to mouth pain and general malaise, affecting their appetite [11,15].

  There is also a multiple verification of the negative influence of bad eating habits on the development of tooth decay, with the ingestion of fermentable carbohydrates or processed foods, with high sugar content, which leads to dental erosion, in a vicious cycle, because chewing is impaired, endangering the definitive dentition [8]. However, there are authors who emphasize poor oral hygiene as the most important factor in caries etiology, overlapping food [22-24].

  Late tooth eruption should also be considered in children with malnutrition and with a deficient body weight, which leads to a biological deficit with negative repercussions on health in the medium and long term. Still in the biological field, it is worth mentioning that the organism presents less absorption of nutrients [25].

  As an example, a study in Pakistan with 6363 children attending primary school, showed that malnutrition was related to poor oral health, leading to nutritional deficiencies and infections, which were often caused by economic disparities: 15.1% had moderate malnutrition, 9.2% severe malnutrition and some children were addicted to chewing tobacco [9].

  Similarly, a study argues that poor nutrition can cause iron deficiency, also due to dietary habits or socioeconomic status. Caries lesions, if severe, can cause fistulas and abscesses, which impedes children from eating properly, contributing to this malnutrition [26]. Another study demonstrates the lack of a relationship between caries and body mass [27].

  It thus appears that the relationship between oral health and body weight is plausible. However, studies are inconsistent in their results, requiring further investigations [2,12,20].

  Likewise, a link can be observed between oral health and body image, regarding height and body composition, with a strong relationship between these aspects, because children and preadolescents with poor oral health are not satisfied with their body image, wishing to be taller or not obese, according to the images provided to them to be able to have their own opinion. Therefore, it is possible to establish a direct relationship between poor oral health and a non-harmonious body composition [14]. However, there are several studies that conclude that the greater the height, the greater the prevalence of dental caries, somehow equated with higher BMI [1,18].

  Regarding the prevalence of obesity, it has increased worldwide in recent decades, between 1975 and 2016, from 4.6% to 18.4%. Likewise, in European countries, such as in Portugal, during the same period, the prevalence of overweight (including obesity) in children between 5 and 19 years old, increased from 8.6% to 32.4% [28].

  In a study done in Saudi Arabia, on 801 adolescents with an average age of 16.5 who attended secondary school, 24% were obese, 16% were overweight and 60% were underweight. The general prevalence of dental caries was 24.8% in permanent dentition. The prevalence of overweight/obesity in this population was 23% [29].

  Another example from Saudi Arabia highlighted the relationship between a high prevalence of dental caries and obesity in a group of 275 female children with special needs, with a prevalence of caries dental care of 80%, the prevalence of overweight was 13.8% and obesity 23.3% [30].

  However, it is very complex to establish a linear relationship between BMI and dental caries. In some studies, a lower risk for caries was associated with obesity [3,4,5,21,23,27,31-35].

  A major concern of health authorities is overweight/obesity, defending some authors that this reality is associated with a higher prevalence of caries [2,13,16,18,19,20,23,33,35,36].

  However, the reverse is also seen: children and young people with higher BMI may present a low index of dental caries, when oral hygiene is practiced with rigor. It can also be explained by the fact that such young people do not resort to “snacks” among main meals, consuming in these larger amounts of fat, but less sugar [4,21,29,32]. Nevertheless, poor eating habits are also associated with obesity, through intake of foods rich in fats and carbohydrates [21,23,29].

  In the other way, there are authors who defend the opposite, emphasizing the fact that children with lower BMI, have more caries lesions than the control group, considered healthy [1,4,9,12,22,25,26,33,37-39]. This fact can be explained by multiple factors: less food intake due to oral pain which, in turn, are caused by severe caries associated with periodontal disease, for example abscesses or fistulas, which leads to hypoplasia and hyposalivation. It is an unhealthy food which impacts on growth and cognitive development, especially in populations with low resources, due to lack of sleep and poor chewing [7,8,11,38].

  Cultural and ethnic differences also influence the nutritional status and oral health of individuals. In communities located in rural areas far from health resource centers, as with a tribe in rural Africa, that practices rituals of removing healthy primary teeth (canines) by the belief that such teeth may cause high fevers and diarrhea. Removing these teeth may cause problems with speech, affect growth, and cause serious repercussions on the definitive dentition. Socioeconomic status, associated with less academic training, which results in a lack of essential knowledge, for example, regarding good oral hygiene, can also influence the nutritional status. It should be noted that each ethnic group has its own specific culture, conditioning ancestral ritualized practices, taken as the norm to follow, very often causing nutritional impoverishment and negative attitudes about oral hygiene [5,8,22,24].

  All studied articles associate low socioeconomic status with the high prevalence of dental caries. The authors verified the existence of negative consequences of this fact, as these children normally miss school and do not reach satisfactory cognitive and educational development, which later does not allow them to achieve the desired equal opportunity [13,18,19,25,27,31,37,40-46].

  Considering the gender, some authors defend a higher rate of dental caries in females, as in a study developed in India, where the prevalence of caries was 45.1% in the female population, against 39.2% in the male population [5,18,22].

  In other studies, there was no difference in results by gender, as in the cases of New Zealand [40] where there was a decrease in dental caries, due to oral health education in schools. In other countries, this difference was also not observed [15,31,34,47].

  However, there are still studies that verify a greater presence of caries in males. This was the case of a study carried out in Australia, with 502 children with an average age of 4.9 years, in which boys were twice as likely to develop tooth decay when compared to girls [3,32,37,38].

On the other hand, other studies prefer to emphasize anthropometric data other than height and BMI, both related to age [22].

  Health authorities have a fundamental role regarding oral health, on par with general health, as deficient oral health has negative consequences in general health, affecting physical, psychological, and social development, as well as school performance, conditioning future aspects, which makes it compulsory to implement a preventive oral health policy [6,11].

  Thus, in parallel with the measures of family doctors and dentists, it is essential to develop an education focused on oral hygiene and instructions at schools, and promote physical activities which lead to a well-being, positive self-image, and improvement of general health. These factors, if fulfilled, will lead to greater educational success and happier and more capable citizens [8,13,15,21].

Conclusion

  In the present systematic review, some limitations were identified in the generalization of results on the relationship between the presence of dental caries and anthropometric factors, influenced by regional, cultural and ethnic variations.

  The relation of the prevalence of dental caries associated with foods rich in sugar was verified and in children with high BMI, but also with low weight. Poor oral hygiene was also found to cause cavities in a large percentage. The negative influence of the most disadvantaged socio-economic circles was also clear. These aspects require appropriate attitudes in the near future, to achieve a real decrease in the prevalence of dental caries.

  Regarding anthropometric data, dental caries is more frequently related with BMI, both high and low, being the first associated with greater intake of carbohydrates and the second with hyposalivation. Likewise, it can be concluded that practical nutrition and poor oral hygiene are also associated with the development of dental caries [2,18]. However, it is important to note that these three basic aspects (BMI, practiced diet, deficient oral hygiene) are conditioned by risk factors, such as food, family, parents with low education and information, dysfunctional families, possible health problems related to genetic susceptibility, or even poor yields. In this sense, there appears to be a complex relationship between health behaviors, genetic factors and social determinants that lead to both dental caries and obesity [3,27,32].

  Thus, it is not possible to establish an unequivocal relationship between anthropometric data (BMI, body weight, height and body composition) and socioeconomic status in the prevalence of dental caries in childhood [2,20,48].

There is an urgent need to implement a stronger awareness campaign at the level of schools, health centers and media to assist dentists in their practice.

  Oral health will make further progress if serious preventive measures are taken, with significant repercussions on general health and on the future socio-economic insertion of children, promoting well-being and the development of society in general.

Conflict of Interest

The authors declare they have no conflict of interest.

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Citation

Citation: Cristina Cardoso Silva and Beatriz Santa Carvalhinho. “Oral Health and Anthropometric Profile in Pediatric Ages: Systematic Review”. Acta Scientific Dental Sciences 5.5 (2021): 14-21.

Copyright

Copyright: © 2021 Cristina Cardoso Silva and Beatriz Santa Carvalhinho. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.