Table 2 Positive association between dental caries and BMI

Alm (2008) and Alm et al. (2008)

Sweden

Prospective longitudinal

402 at age 15 years

1-15; data analysed at age 15 years

Four of the 13 districts of child welfare centres in the Municipality of Jonkoping

1

10

D_ia (Initial caries)

D_ma (Manifest caries)

D_i+mFA or DF_a (Total approximal caries prevalence fillings)

Higher approximal dental caries in overweight and obese adolescents than normal and underweight.

Caries experience at 15 years predicted by early childhood caries experience at age 3, plaque on incisors at age 1 year, infrequency of tooth brushing with fluoride toothpaste , consumption of caries-risk snacks more than three times a day at age 1 years, consumption of sweets < once per week at age 3 years, parents were born abroad, parents’ poor attitudes to dental health and psychosocial factors

Initial caries: 86% of total caries experience

Approximal caries prevalent in 67% of 15 yr old children

Mn Di+mFa at 15 yrs

 Overall sample=3.21 (SD=3.95)

 Underweight = 2.94 (SD=3.62)

 Normal weight = 4.64 (SD=5.15)

 Overweight = 4.18 (SD=5.14)

 Obese = 6.29 (SD=5.04)

Mn DmFa at 15 yrs

 Overall sample 0.42 ( SD=1.13)

 Underweight = 0.35 ( SD=−0.89)

 Normal weight = 0.83 ( SD=1.93)

 Overweight = 0.84 ( SD=2.02)

 Obese = 0.79 ( SD=1.63)

BMI:

 Overweight: 16%

 Obese: 4%

 Low-normal weight: 84%

Alm et al. (2011)

Sweden

L &CS

Time 1 (aged 3): 525 Time 2 (aged 6): 506 Time 3 (aged 15): 402

1-15

Four of the 13 districts of child welfare centres in the Municipality of Jonkoping

1

10

Caries (Initial and manifest) prevalence: def in children 3 and 6 years

D_i+mFSa

Manifest caries prevalence: (D_ma)

At 3 years: No association

At 6 years: Higher prevalence of manifest caries in overweight/obese

At 15 years: Higher rates of proximal caries/fillings in overweight/obese

BMI:

 3 years:

 Normal weight: 86%

 Overweight: 12%

 Obese: 3%

 6 years:

 Normal weight: 82%

 Overweight: 14%

 Obese: 4%

 15 years:

 Normal weight: 84%

 Overweight: 12%

 Obese: 4%

Bailleul-Forestier et al. (2007)

France

CC

82

12-18

Case-match control: Treatment program for severe obesity matched for age, gender and parental socio-occupation

3 Cavity level

20

DMFT – ordinal ranking 1-8

Significant association between high dental caries and increased obesity.

Caries prevalence:

 Obese – 90%

 Control - 80%

Mn DMFT

 Obese 6.9 (SD=4.1)

 Control: 4.3 (SD=3.5)

Mn BMI:

 Obese group: 40.6 (SD= 7.3)

 Control: 19.8 (SD=2.1)

Costacurta et al. (2011)

Italy

CS

107

6-12

Paediatric Dentistry Unit of PTV Hospital, University of Rome “Tor Vergata”

1

24

Dmft/DMFT

Child physical status measured as (i) Fat Mass% (FM; using Dual energy X-ray), and (ii) BMI Children with higher body fat mass (FM%) had higher DMFT/dmft rates than those with normal FM, but compble dmft/DMFT rates with underweight children using FM%-DXA

No association found using BMI (McCarthy or WHO cut-offs) as obesity estimate

Caries Prevalence: 83.18%

Total Mn dmft= 2.07 (SD=1.21) by FM% (WHO cut offs)  Underweight = 2 (SD=0.61)  Normal weight = 1.2 (SD=0.36)  Overweight = 1.95 (SD=0.25)  Obese = 2.40 (SD=0.52)

Total Mn DMFT=2.55 (SD= 2.02) by FM% (WHO cut offs)

 Underweight = 3.6 (SD=2.7)

 Normal weight = 1.88 (SD=1.48)

 Overweight = 1.74 (SD=1.68)

 Obese = 3.10 (SD=2.11)

Physical status (FM% -Who cut-offs)

 Underweight = 4%

 Healthy weight = 22%

 Overweight = 21%

 Obese = 51%

Gerdin et al. (2008)

Sweden

L

2303

4-12

Retrospective archival study of children in single county

1 manifest caries only

10

Deft (6 yrs) DFT (10–12 yrs) DFSa (approximal surfaces of permanent teeth)

Dental caries higher prevalence in obese than non-obese

At 12-years of age, children who had a history of obesity at 4-yrs of age had higher rates of caries than children who had history of healthy weight at 4-years of age. Obese/overweight children at 4 yrs old and who remained overweight / obese at 5, 7 and 10 years of age had significantly more approximal carious surfaces (DFSa) than normal weight children in all age groups

Overweight / obese children at 4 yrs old but with normal weight at 5, 7 and 10 yrs of age had significantly fewer approximal carious surfaces than children with normal weight from 4 to 10 years of age Gender: Girls at 10 and 12 yrs old had more caries affected teeth than boys SES: Caries prevalence decreased with increasing SES

Caries Prevalence:

 Age 6= 31%

 Age 10= 23.1%

 Age 12= 32%

Mn Dft/DFT:

 Age 6= 3.8

 Age 10= 1.9

 Age 12 = 2.1

BMI:

 Age 4:

 Normal BMI= 87.2%

 Overweight= 10.8%

 Obese= 2.0%

 Age 5:

 overweight/obese = 14.2%

 Age 6: Not reported

 Age 7: overweight/obese =  17.1%

 Age 10:

 Overweight: 17.5%

 Obese= 4.3%

Hilgers et al. (2006)

USA

CS

178 sample of convenience

8-11

Convenience sample – participants of dental treatment program Smile Kentucky – dental needs with no dental insurance

1

4

Interproximal caries in primary and permanent molars Ordinal ranking, 1=incipient, 2=dentine involvement, 3= pulpal involvement; 4= nonrestorable/missing

Severity index calculated by averaging primary and permanent tooth scores (c-avg and C-avg)

Higher permanent molar caries average associated with higher BMI

C-avg (severity measure for permanent teeth) ranged from 0 to 4.0

 Low BMI:C-avg = 0.08 (0.06)

 Normal BMI: C-avg 0.19 (0.05)

 High BMI: C-avg= 0.51 (0.09)

BMI  Ranged from 11.43-35.7

Hong et al. (2008)

USA

CS

1507

2-6

NHANES (1999–2002)

2

4

Dft 0, 1–5, >5 teeth

Higher caries rates significantly associated with higher BMI in 5–6 yr olds and in Hispanic and non-hispanic blacks

S-ECC: Logistic regression found BMI did not predict of caries experience but Age and poverty index did

Caries prevalence 42%  Mn dft 1.79(.09)

BMI  Mn BMI 16.2 (.01)  Underweight 4.2%

 Normal 73.9%

 At risk 11.3%

 Overweight 10.6%

Ismail et al. (2009)

USA

L & CS

788

0-5

A two-stage area probability selection of representative sample of low-income African-American in Detroit Michigan. Dyads tested in 2002–3 and 2004-5

2

4

Non-cavitated lesions: (d1-2)

Cavitated/dentinal lesions: (d3-6)

Filled lesions (f); missing lesions (m) d3-6mfs; d1-6mfs

Higher caries (dmft:1–6) associated with higher weight-for-age. For d1-6mfs: higher consumption of soda drinks, older child age, higher weight-for-age, visiting a dentist for treatment, higher baseline caries level of the child and caregiver, fatalistic belief of the caregiver, and living in relatively disadvantaged low-income neighbourhood.

 Almost 25% of children had low  weight for age

Marshall et al. (2007)

USA

L

427

1-11

IOWA fluoride study

3- cavity level

4

Caries experience dichotomised =/>0

Caries experience associated with: At-risk of overweight lower family income Less educated parent Heavier mothers Higher soda pop intake by age Final prediction model: mother’s education and ‘at risk of overweight’

Caries Prevalence: 31%

BMI:

 Underweight 3%

 Normal 72%

 At risk overweight 19%

 Overweight 5%

Martinez-Sotolongo & Martinez-Brito (2010)

Cuba

CS

649

8-13

The primary schools and one seconday school in Santa Marta, Varadero

3 unclear whether initial caries included

51

DFT/dft

Higher dental caries associated with higher BMI

Caries Prevalence:

 Normal weight: 41.77%

 Obese: 89.7%

BMI:  Obese: 37.3%  Normal weight; 62.71%  Underweight: 0%

Modeer et al. (2010)

Sweden

CC

130

10.3-18.3

Case-matched control study

1

10

Decayed surfaces DS(>0) DMFT indices

BMI-sds associated with Decayed surface (DS>0) OR 1.31 (unadjusted): Age, gender, chronic disease, medication, salivary flow, bleeding on probing visible plaque index, tooth-brushing infrequency (evening and morning), parental country of birth, and educational level No association between BMI-sds and DFT/DMFT

Caries prevalence not provided  Obese:

 Mean dmfs:2.2 ( SD = 2.8)

 Mean dft:2.2 ( SD = 2.5)

 Mean ds:0.7 ( SD = 1.6)

 Control:  Mean dmfs: 2.6 ( SD = 3.8)  Mean dft: 2.1 (SD = 2.7)  Mean ds:0.1 (SD = .4)

Mean BMI:

 Obese: 36.8 (SD=5.8);  Control: 19.7 (SD=2.4)

Reifsnider et al. (2004)

USA (Mexican-American sample)

L

104

1-2

Obese babies enrolled in Special Supplemental Nutrition Program for Women, Infants and Children

4

4

Ordinal: Caries free = 0, white spots =1, filling = 2, frank caries = 3

Higher dental caries associated with higher BMI

Dental insurance, transportation issues, lack of knowledge of where to obtain dental care for children and mother's perception of the condition of her children's teeth

BMI: 20.3 (SD = not provided)

Sharma & Hedge (2009)

India

CS

500 sample of convenience

8-12

Department of Pedodontics and Preventive Children Dentistry, A.B Shetty Memorial Institute of Dental Sciences, Mangalore

2 – whether initial caries was included is not specified

134

DMFS/dmfs

Higher rates of dental caries (DMFS) in overweight and obese children than normal weight children.

Underweight children had significantly higher DMFS rates (but not dfs) than normal weight, overweight and obese children.

Overweight children had higher preference for fatty and sweet foods than normal weight children

Mean DFMS (SD not provided):  Underweight: 3.11 Normal  weight: 1.58  Overweight: 2.48  Obese: 2.85

Mean dfs:

 Underweight: 2.00

 Normal weight: 2.14

 Overweight: 4.79

 Obese: 3.25

BMI:

 Underweight 8.6%

 Normal weight 58.4%

 Overweight or at risk for  overweight 22.2%

 Obese 10.8%

Vazquez-Nava et al. (2010)

Mexico

CS

1160

4-5

Cohort study of children in three cities, Tampico, Madero, and Altamira in Mexico

3* with white spots coded as initial caries

57

deft, defs

Overweight and at-risk overweight children had higher caries prevalence than children who were not overweight

Caries also associated with sugar consumption, bottle feeding, smoking at home and tooth brushing ≤ once per day

Caries Prevalence 17.9%

 19.6% boys

 16.4% girls

Mn deft:

 Total sample = 1.08 (2.33)

 Normal weight= 0.70 (1.94)

 At -risk overweight =1.50 (2.57)

 Overweight = 1.51 (2.71)

Mn defs:

 Total sample = 1.43 (3.28)

 Normal weight = 0.93 (2.64)

 At-risk overweight = 1.95 (3.49)

 Overweight= 2.04 (3.97)

BMI:

 Normal weight: 53.7%

 At-risk overweight: 14.2%

17.1% girls

11.3% boys

 Overweight: 32.1%

Willershausen et al. (2007a)

Germany

CS

1290

6-11

5 elementary schools in a medium sized city

2

9

DF-T df-t

Higher rates of dental caries associated with higher BMI in both primary and permanent dentition

Higher rates of caries also associated with Age (older), Gender (M), daily consumption of sweets

Caries Prevalence: 61.4%

Mn df-t

 Underweight= 1.43 (2.02)

 Normal weight= 1.82 (2.41)

 Overweight= 2.3 (2.75)

 Obese= 2.21 (2.8)

Mn DF-T

 Underweight= .38(1.28)

 Normal weight= 0.53 (1.2)

 Overweight= 0 .85(1.4)

 Obese= 0.82 (1.3)

BMI:

 Underweight 3.6%

 Normal weight 74.7%

 Overweight, 11.8%

 Obese 9.7%

Willershausen et al. (2007b)

Germany

CS

2071

6-10

5 elementary schools in Mainz

2

9

DF-T df-t

Dichotomised DF-t/df-t>0

Higher rates of dental caries associated with higher BMI in both permanent and deciduous dentitions; Age

Caries Prevalence 54.1%

Mn df-t + DF-T ranged from 1.4– 2.6

Mn df-t +DF-T

 Underweight= 1.67

 Normal weight = 2.15  Overweight = 2.64

 Obese= 2.7

BMI:

 Underweight 6.8%

 Normal 76.4%

 Overweight 10.5%

 Obese 6.3%

Willershausen et al. (2004)

Germany

CS

842

6-11

4 elementary schools of diverse social background from single medium sized city

2

9

DF-T df-t

Higher rates of dental caries associated with higher BMI in both permanent and deciduous

Gender (slightly higher cavities prevalence in boys, particularly in the DF-T-index and if overweight.

Caries prevalence: 63%

Mn DF-T

 Normal weight=0.57  Overweight = 0.91  Obese = 0.88

Mn df-t  Normal weight = 2.08  Overweight = 2.48  Obese = 2.23

BMI:

 Underweight 2.1%

 Normal weight 71.7%

 Overweight 12.0%

 Obese 13.3%