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ORIGINAL ARTICLE  
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 28-32
Relating dental caries experience with body mass index among Nigerian primary school children: A cross-sectional survey


1 Department of Preventive Dentistry, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Periodontics, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
3 Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria

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Date of Web Publication17-Jul-2013
 

   Abstract 

Objective: To determine the dental caries experience and body mass index (BMI) of primary school children from both public and private schools in Ugbowo, Benin City.
Materials and Methods: Primary school children from conveniently selected private and public schools were examined for dental caries and also underwent height and weight measurement for their BMI calculation during the Association of Resident Doctors, University of Benin Teaching Hospital School Health program in December 2010, using the WHO criteria.
Results: Of the participants, 3.8% and 5.2% of them were overweight and obese respectively. A total of 33 (15.7%) of the children had dental caries with a mean decayed, missing filled, and teeth (DMFT) of 0.25 ΁ 0.04. The prevalence of untreated caries (decayed teeth [DT]), DMFT were 30 (14.3%), 1 (0.5%), and 2 (1.0%) respectively. DT contributed 90.9% (30/33) of DMFT that for the mean DMFT in underweight children was 0.21 that for the normal weight children were 0.26 that for the overweight children was 0.50 and for the obese children was 0.18. The prevalence of dental caries was the highest among obese participants followed by normal weight, underweight and overweight participants. There was no significant association between BMI, DMFT and caries experience.
Conclusion: Dental caries experience among primary school children in Ugbowo is comparable to that reported in other Nigerian Pediatric populations and an increasing trend in the prevalence of overweight and obesity. However, non-significant association between the BMI and caries experience was noted. Success-oriented oral health promotion should take cognizance of differential prevalence of dental caries in terms of gender and type of school recorded in this study.

Keywords: Body mass index, dental caries, school children

How to cite this article:
Chukwumah N M, Azodo C C, Adeghe H A, Enabulele J E. Relating dental caries experience with body mass index among Nigerian primary school children: A cross-sectional survey. J Educ Ethics Dent 2012;2:28-32

How to cite this URL:
Chukwumah N M, Azodo C C, Adeghe H A, Enabulele J E. Relating dental caries experience with body mass index among Nigerian primary school children: A cross-sectional survey. J Educ Ethics Dent [serial online] 2012 [cited 2020 Jan 29];2:28-32. Available from: http://www.jeed.in/text.asp?2012/2/1/28/115151



   Introduction Top


Dental caries are a common oral disease in children, which cuts across all socio-economic strata. [1] However, it is the prevalence in the different socio-economic groups differ in different countries. Henshaw [2] reported that the prevalence of dental caries is higher among children of higher socio-economic class than those of lower class in many developing countries, and this was attributed to dietary factors. [2],[3] Studies have also shown that the prevalence of dental caries amongst children in developing countries varies with biological and environmental factors such as sex, birth rank, socio-economic status, parent oral health status, oral health practices, and fluoride level in water. [4]

Untreated dental caries are prevalent in developing countries, and its unesthetic nature hinders self-esteem and social development of children. [5] Untreated dental caries and associated infection cause pain, discomfort and irritability compromising the ability to eat and sleep well, and function well at home and school among children. The consequent effect of dental caries on weight, growth, hormone production, quality of life, and cognitive development of young children has been reported. [6]

The increasing prevalence of dental caries, overweight and obesity as health problems in developing countries and their linked multifactorial etiology in the form of lifestyle and dietary habits has been a trigger for studies on their relationship. The excessive consumption of refined sugar, which is associated with dental caries, has long been associated with overweight and obesity. However, studies conducted in various parts of the world to determine the relationship between caries experience and the body mass index (BMI) revealed conflicting results. [7],[8],[9],[10] Hence the need for such a study in Nigeria as literature review revealed scarce information. Research question is thus done any relationship exists between the dental caries experience and BMI among primary school children from both public and private schools in Ugbowo, Benin City. The objective of the study was to determine the dental caries experience and BMI of primary school children from both public and private schools in Ugbowo, Benin City.


   Materials and Methods Top


This study was conducted in Ugbowo, Benin City, Nigeria as part of the general and oral health awareness campaign of Association of Residents Doctors of the University of Benin Teaching Hospital which is a tertiary hospital. Ugbowo which houses a tertiary institution and the hospital is part of Benin City, a metropolitan city and the capital of Edo State. There are 12 public and 28 private primary schools in this local government area. However, 210 pupils aged 7-15 years in two conveniently selected public and private schools in Ugbowo, Benin City based on accessibility to these schools and the ability to get consent from the head teachers and parents, constituted the study population. Pupils diagnosed of systemic diseases, which have a likelihood of increasing propensity to dental caries like asthma were excluded. The data collection was carried out at the end of the general and oral health awareness campaign. Parental consent was obtained and permission was obtained from the school authorities before the study. The participants were informed about the study and their consent and assent sought before the interview aimed at eliciting the information on demography. Thereafter, clinical oral examination was carried out by calibrated dental residents of the hospital to assess the presence of dental caries missing and filled teeth (FT) using a mirror and probe using in accordance with the World Health Organization criteria, which was used subsequently to calculate the decayed, missing, filled teeth (DMFT). This included examination being carried out with the pupil sitting on a comfortable chair in the classroom with a high back rest and the examiner standing in front of the chair, the lighting was consistent as it was carried out using the natural light, the teeth were dried before examination using cotton wool rolls, and examined using a plain mouth mirror and probe. A tooth was recorded as carious when there was a frank cavitation, undermined enamel or a detectable softened floor or wall, which caught the probe. The mouth mirror and probe was sterilized using hot air oven. The weight and height of subjects were also measured using a bathroom scale and a meter rule respectively. The BMI was calculated using the standard formula of body weight divided by the square of height, and the participants were categorized into underweight, normal, overweight, and obesity using the BMI percentile set thresholds for children of the same sex and age in Centers for Disease Control and Prevention growth charts. [11] A total of 10 dental surgeons did the examination with eight [8] of them doing the oral examination and the remaining two [2] measuring the height and weight used for the calculation of the BMI. The assessment of inter examiner reliability during examiners calibration revealed intra-class correlation coefficient of 0.9 value, which was high. The data were analyzed using the SPSS version 17.0. For the purpose of analysis of caries experience, the participants with DMFT 0 were categorized as having no dental caries while those with DMFT of 1 or more were categorized as having dental caries. Test for significance was carried out using the Chi-square statistics, independent t-test, ANOVA, and logistic regression. P > 0.05 was considered as a significant.


   Results Top


The majority of the subjects in this study were aged 10-12 years followed by the 7-9 years and then 13-15 years, the male population constituted 52.4% and the female 47.6% while the public school children made up 56.2% of the study population and the private 43.8% [Table 1].
Table 1: Demographic characteristics of the participants

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A total of 3.8% and 5.2% of the participants were overweight and obese respectively [Figure 1]. The mean BMI was significantly associated with age and the school with younger participants and participants from the private school having higher mean BMI [Table 2]. Of the participants, 33 (15.7%) of the children had dental caries with a mean DMFT of 0.25 ± 0.04. The prevalence of untreated caries (decayed teeth [DT]), the FT and the missing teeth (MT) were 30 (14.3%), 1 (0.5%) and 2 (1.0%) respectively. DT contributed 90.9% (30/33) of DMFT. The mean DT, FT, and MT were 0.23 ± 0.04 0.00 ± 0.00 and 0.01 ± 0.01 respectively. Younger participants, male and those attending private school had higher mean DMFT. However, there was no significant association between the age, gender, type of school, and DMFT [Table 3]. The mean DMFT in underweight children was 0.21, that for the normal weight children was 0.26, that for the overweight children was 0.5 and for the obese children were 0.18 [Figure 2]. The prevalence of caries was the highest among obese participants followed by normal weight, underweight, and overweight participants. There was no significant association between the BMI category and caries experience [Table 4]. The multivariate analysis in form binary logistic between the caries experience and age, gender, school, and BMI revealed non-significant association [Table 5].
Figure 1: The body mass index categories among the participants

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Figure 2: Decayed, missing filled and teeth and body mass index category among the participants

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Table 2: Demographic characteristics and mean body mass index among the participants

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Table 3: Demographic characteristics and mean DMFT among the participants

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Table 4: Caries experience and BMI category among the participants

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Table 5: Logistics regression of caries experience among the participants

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   Discussion Top


In this study, the prevalence of overweight and obesity were 3.8% and 5.2% respectively. This is higher than the prevalence of overweight (3.7%) and obesity (0.4%) reported among 10-19-year-old children in Lagos state, Nigeria [12] reflecting an increasing unhealthy body weight among adolescents in Nigeria. The mean BMI was significantly associated with age and school with younger participants and the participants attending the private school having higher mean BMI. This confirms higher abnormal BMI among children of higher socio-economic status in Nigeria as already established that children of higher socio-economic status attending private school and this contrasted with findings in developed countries were higher BMI was found more among children of lower socioeconomic status. [13] Besides socio-economic status children attending private schools and public schools differ in the following ways: Firstly, children in private schools have more access to refined carbohydrates than those in public schools as most are given more money to spend during their break periods and have more variety in the types of refined sugars sold on their school premises. As opposed to those in public schools who have less money to spend and a reduced variety of refined sugar. Secondly, teachers in public schools are paid better (government funded and with specified salary scales) have better job security and retirement plans than teachers in private schools (personally funded by the proprietor and at his/her discretion) thus, might be a factor in which teachers in public schools take their time to teach their students health related subjects better than those in private schools. The increased mean BMI among the younger participants may be a reflection of dietary trends toward snacking and sugary diet.

The dft and DMFT for deciduous and permanent teeth were merged to allow for a simpler interpretation of the results were "d" and "D" were represented by "D" while "f" and "F" were represented by "F." The prevalence of dental caries in this study was 15.7% with a mean DMFT of 0.25 ± 0.04. Dental caries experience among primary schoolchildren in Ugbowo is comparable to that reported in other Nigerian Pediatric population. [1],[14] However, it is lower than that reported in studies among school children in Lagos [15],[16] and Enugu States of Nigeria. [17],[18] This was also lower than the findings of survey among adolescents in Egor local area of Benin. [19] The slight variation in age of the studied population and restriction of the studied schools to the inner city neighborhood may have contributed to the difference. The Decayed component constituted 90.9% (30/33) of DMFT indicating that the untreated dental caries is prevalent in low DMFT representing a high unmet treatment need among the participants.

Younger participants, males, and those attending private school had higher mean DMFT. However, there was no significant association between the age, gender, type of school, and DMFT.

The non-significant difference in DMFT among gender has been documented. [1] However, the higher mean DMFT among males than females is in tandem with findings of a previous Nigerian study; [4] but in contrast with other studies, which reported a higher prevalence in females [17],[19] and amongst African-American youths. [20]

The mean DMFT were higher among private school children than public school children, which is in keeping with other Nigerian studies. [1],[19],[21] The study is in accord with an earlier study by Du et al. [22] which said that dental caries were on the increase in urban areas where socio-economic development has been greater and further buttressed by this study, which showed there was an increased DMFT in the private school compared with that of the public school.

Studies on the relationship between the caries experience and the BMI revealed conflicting results. [7],[8],[9],[10] In this study, there was no significant association between BMI category, caries experience and DMFT. The non-significant association between increased BMI with increased DMFT found in this study was also noted in previous studies. [23],[24] However, the prevalence of dental caries in terms of caries experience was the highest among obese participants followed by normal weight, underweight, and overweight participants while the highest mean DMFT was noted among overweight school children followed in descending order by normal weight, underweight and obese children. The excessive consumption of refined sugar, which is associated with the dental caries, may be adduced as an explanation for the link between caries experience and obesity and also for the high DMFT among overweight participants. However, the inconsistencies in the relationship between BMI and dental caries assessed in terms of caries experience and DMFT may be connected with the low caries prevalence noted in this study thereby suggesting a similar study among participants with the high prevalence of dental caries. Fat in the diet is a major predictor of body mass and various studies have been carried out relating the body adiposity to the BMI but are unrelated to dental caries and thus were not considered hence the results cannot be considered in the context of dietary fat intake. Prospective studies are being carried out to asses if this increased BMI, body adiposity, and dietary fats provide a level of protection against dental caries.

The limitation of this study includes the fact that this study was carried out using a convenience sampling method, which does not significantly cover the entire population. Furthermore, with the age groups studied in this work, deciduous and permanent teeth were examined and had to be merged for convenience considering the indices for dental caries in the deciduous dentition is the decayed and FT (dft) and that for the permanent dentition is the DMFT.


   Conclusion Top


Dental caries experience among primary schoolchildren in Ugbowo is comparable to that reported in other Nigerian Pediatric populations and an increasing trend in the prevalence of overweight and obesity. However, non-significant association between the BMI and caries experience was noted. Success-oriented oral health promotion should take cognizance of differential prevalence of dental caries in terms of gender and type of school recorded in this study.

 
   References Top

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Correspondence Address:
C C Azodo
Department of Periodontics, New Dental Complex, University of Benin Teaching Hospital, Benin City, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.115151

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