Relationship between Body Mass Index and Dental Caries in 13-15-Year-Old School Children of Government and Private Schools in Bengaluru City.

AIMS: The aim of the study was to assess the correlation between body mass index (BMI) and dental caries of 13-15-years-old school children in urban Bangalore and to compare the correlation between BMI and dental decay amongst government and private school children of age group 13-15 years in Bangalore city. SUBJECTS AND METHODS: A total of 660 students 13-15 years old were inducted in the study. According to these, 330 students from government schools and 330 students from private schools were examined. A specially designed structured questionnaire was used for compilation of data in the survey. BMI for age percentiles was deducted by weight in kilogram divided by height in meter square.
RESULTS: Overall a positive correlation was found between Decayed, Missing, and Filled Teeth DMFT and BMI. In government schools, Overweight children had more mean DMFT (1.43) than other BMI categories while in Private schools, At risk of overweight children had more mean DMFT (1.4) than other category of BMI children.
CONCLUSIONS: A positive correlation was found between DMFT and BMI. In government schools, Overweight children had more mean DMFT than other BMI category while in Private schools, At risk of overweight children had more mean DMFT than other category children. Copyright:

INTRODUCTION

Dental decays is the most prevalent childhood malady worldwide.[1] The generality of dental decay varies from 33.7% to 90% in the child population and is flourishing at startling rate.[2] Although different government preventive programs have curbed the dental decay, decay still remains a dominant national community health dilemma.[3] Proportion of dental caries is on the upsurge in spite of best attempts by dental health professionals to pare its extent.[4]

The WHO has affirmed that every human being has the right to access satisfactory healthy nutrition.[5] Obesity has become a universal health problem existing throughout postindustrial and developing regions.[6] Although hereditary factors play a crucial role in the development of obesity, the strikingsurge of obesity is best explained by behavioural and environmental changes such as exposure to the “obesogenic” environment which has resulted from recent advances.[7] Thus, the asserted eating pattern among overweight or obese children may be a routineliability for overweight and decay.[8]

Body mass index (BMI) is used to classify normal weight, underweight, overweight and obesity in children and adults.[9] The BMI-for-age determined for an individual indicates the relative position of the child's BMI value among children of the same sex and age.[10] BMI gradesused include underweight, normal weight, at risk of overweight and overweight. Nonetheless, there is no obese category for teenagers.[11] Childhood obesity and dental decay are among the chronic diseases with a growing global pandemic occurrence afflicting both developed and developing countries.[12] The main nutritional factor associated with the risk of caries is chronic malnutrition, and the occurrence of this condition is associated with long term cumulative abnormalities.[13]

Due to the firmdeposition, supporting the correlation of dental decay with erratic dietary patterns and also the matter that the atypical dietary intake has been linked to the evolution of obesity at a young age, correlation between dental decay and weight is biologically plausible.[14] Some studies asserts that there is no markedcorrelation between dental decay and nutritional status in a group of obese children, while some studies shows that children's dietary routine are compellingpatron to obesity and dental decay.[15] Albeit there are a few studies in India reporting the high rate of obesity or overweight, the research studying the relationship of BMI and dental decay among 13–15-year-old school children is seemingly scant.[8] Thus, the present study was conducted to evaluate the correlation between BMI and dental decay among 13–15 year old school children of Government and Private schools in urban Bengaluru.

SUBJECTS AND METHODS

Then 5 government schools and 5 private schools were chosen from the archive of schools under DDPI, Bangalore. The schools were chosen using systematic random sampling procedure. 660 students of 13–15 years age, who fulfilled the inclusion and exclusion criteria were included in the study. 66 subjects from each school were selected out of which 22 subjects from each age group were selected randomly among which 11 males and 11 females are selected randomly. According to these, 330 students from government schools and 330 students from private schools were examined. 330 females and 330 males were examined from selected schools.

Before the commencement of the research, clearance was obtained from the ethical committee of Rajarajeswari Dental Hospital, Bengaluru. Valid acknowledgement was obtained from each school separately to conduct the study.

Method of collection of data

A specially designed structured questionnaire was used for compilation of data in the survey. The proforma had 3 parts, first part consists of informed consent in both Kannada and English, second part consist of information regarding demographic details and recording of Height, weight and BMI and third part consists of information record of clinical examination where Decayed, Missing, and Filled Teeth (DMFT) were recorded.

Weight in kilograms was calculated by a standard electronic weighing machine. Height was calculated to the nearest 0.5 cm by a gauging tape. BMI for age percentiles was computed by weight in kilogram divided by height in metre square. The ensuinggrades were used (Centre for Disease Control and Prevention, 2006).[11]

Underweight-defined as BMI for age <5th percentile

Normal weight-defined as BMI for age >5th percentile but <85th percentile

At risk of overweight-defined as BMI for age >85th percentile but <95th percentile

Overweight-defined as BMI for age >95th percentile.

Clinical examination was done by using DMFT index (WHO criteria 1997).[11] The dental examination was done in classrooms in an ordinary chair under natural light.

Statistical analysis

The informationrecorded was entered in Microsoft Excel and Statistical analyses were performed using the SPSS version 22 (IBM Corp, USA). The outcome was averaged (mean ± standard deviation) for each continuous parameter measurement and categorical values were presented as number and percentage in Figures 1 and 2; Tables 1–4. The proportion was compared using Chi-square test of significance. Analysis of variance procedures were applied to compute the difference between the groups. Correlation coefficient relation was also applied to find out the relation between the 2 study parameters. Then Tukey's test was used to detect significant difference between group means.

Figure 1

Distribution of body mass index among study groups

Figure 2

School wise distribution of body mass index among study groups

Table 1

Corelation between body mass index and Decayed, Missing and Filled teeth

BMI	Decayed teeth	Missing teeth	Filled teeth	DMFT
Correlation coefficient	0.032	0.089	−0.066	0.040
P	0.414	0.022	0.089	0.306
n	660	660	660	660

BMI: Body mass index, DMFT: Decayed, Missing and Filled teeth

Table 4

Caries distribution for each category of body mass index

	Carries		Total	χ 2	P
	Caries free	With caries
Underweight	23 (25.6)	67 (74.4)	90 (100.0)	7.066	0.070
Normal	127 (36.3)	223 (63.7)	350 (100.0)
At risk of overweight	38 (28.1)	97 (71.9)	135 (100.0)
Overweight	22 (25.9)	63 (74.1)	85 (100.0)
Total	210 (31.8)	450 (68.2)	660 (100.0)

RESULTS

Results displayed that bulk of the children belonged to normal weight category (53%) [Figure 1].

Within government schools, bulk of the children belonged to normal weight category (60.6%) and it was statistically significant with P < 0.001. Among private schools, 45.5% of the children belonged to normal weight category, 12.1% of the children belonged to Underweight category, 25.8% of the children belonged to At risk of overweight category and 16.7% of the children belonged to overweight category. The results were statistically significant with P < 0.001 [Figure 2].

Correlation coefficient was compared and overall a positive correlation was found between DMFT and BMI with value of. 040but not highly significant (P =0.306) [Table 1].

Within government school children, 50 children belonged to underweight category, 200 to normal weight category, 50 to at risk of overweight and 30 to overweight category. With respect to mean DMFT for each category of BMI in government school children, the mean DMFT was slightly more for overweight (1.43) category (P = 0.323).

Within private school children, 40 belonged to Underweight category, 150 to normal weight category, 85 to at risk of overweight and 55 to overweight category. With respect to mean DMFT for each category of BMI in private school children, the mean DMFT was marginally more for At risk of overweight (1.40) category and was statistically significant (P = 0.04).

The results showed that of the 660 children examined, 31.8% of the children had a DMFT score of 0, 32.7% had a DMFT score of 1, 22.7% had a DMFT score of 2 and only 12.7% had a DMFT score of 3 [Table 2].

Table 2

Frequency of children for each Decayed, Missing and Filled teeth score

DMFT	Frequency (%)
0	210 (31.8)
1	216 (32.7)
2	150 (22.7)
3	84 (12.7)
Total	660 (100.0)

DMFT: Decayed, Missing and Filled teeth

With respect to school wise distribution of caries, the results showed that within government school children, 68.2% were having caries (P = 1.00). Within private school children, 68.2% were having caries (P = 1.00) [Table 3].

Table 3

School wise distribution of caries

	Carries		Total	χ 2	P
	Caries free	With caries
Government	105 (31.8)	225 (68.2)	330 (100.0)	0.000	1.000
Private	105 (31.8)	225 (68.2)	330 (100.0)
Total	210 (31.8)	450 (68.2)	660 (100.0)

With respect to caries distribution for each category of BMI, the results showed that in underweight category, 74.4% of the children were having caries. In normal weight category, 63.7% of the children were having caries. In at risk of overweight category, 71.9% of the children were having caries. In overweight category, 74.1% of the children were having decay. In all above scenarios “P” value was 0.070 [Table 4].

DISCUSSION

Majority of the children (52.3%) belonged to normal weight category. This is in agreement with the study done by Sadeghi et al. in Iran.[11] This is also in coherence with the study done by Thippeswamy et al. in Udupi, India.[8] This is also in agreement with the study done by Prashanth et al. in India.[16]

No compelling difference in proportion of at risk of overweight/overweight among government and private school children was noted which is in coherence with the study done by Thippeswamy et al. in Udupi, India.[8] This is also in agreement with the study done by Sadeghi et al. in Iran.[11] This is probably due to the fact that the government has introduced many food and nutrition schemes for the government school children which has helped them to attain nutritional status similar to private school children.

Overall a positive correlation was found between DMFT and BMI with value of 0.040. This in coherence with the study done by Thippeswamy et al. in India.[8]

With regard to the values discovered for the segment of the index in this research, bulk of the children existed in decayed and missing component which is in coherence with the study done by Narang et al. in Lucknow.[5] This demonstrates a dire need for dental treatment. In the study by Narang et al. in Lucknow,[5] only 1.17% of the children existed in the Filled component of the index which is similar to outcome obtained in our study. The divergenceamid the met and unmet needs of the community may be because of the dearth of understanding towards oral hygiene and low socioeconomic stature.

Among the underweight category. 25.6% of the children were caries free which is similar to the study by Sadeghi et al. in Iran.[11] Only a minority of the subjects in Normal weight, At risk of overweight and Overweight categories were decay free (36.3%, 28.1%and 25.9% respectively) which is coherence with the study by Sadeghi et al. in Iran.[11]

With respect to mean DMFT for each category of BMI in government school children, the mean DMFT was slightly more for overweight (1.43). This is coherence with the study done by Prashanth et al. in India.[16]

With respect to mean DMFT for each category of BMI in private school children, the mean DMFT was marginally high for At risk of overweight (1.40). This in coherence with the study done by Prashanth et al.[16]

Majority of the children were having DMFT score in range of 0–1 which is in coherence with the study conducted by Narang et al. in Lucknow.[5]

CONCLUSIONS

In government schools, overweight children had more mean DMFT than other BMI category while in Private schools, At risk of overweight children had more mean DMFT than other category children. Overall a positive correlation existed amid BMI and DMFT.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.