Abstract
BackgroundUntreated dental caries is reported to affect children’s nutritional status and growth, yet evidence on this relationship is conflicting. The aim of this study was to assess the association between dental caries in both the primary and permanent dentition and nutritional status (including underweight, normal weight, overweight and stunting) in children from Cambodia, Indonesia and Lao PDR over a period of 2 years. A second objective was to assess whether nutritional status affects the eruption of permanent teeth.MethodsData were used from the Fit for School - Health Outcome Study: a cohort study with a follow-up period of 2 years, consisting of children from 82 elementary schools in Cambodia, Indonesia and Lao PDR. From each school, a random sample of six to seven-year-old children was selected. Dental caries and odontogenic infections were assessed using the World Health Organization (WHO) criteria and the pufa-index. Weight and height measurements were converted to BMI-for-age and height-for-age z-scores and categorized into weight status and stunting following WHO standardised procedures. Cross-sectional and longitudinal associations were analysed using the Kruskal Wallis test, Mann Whitney U-test and multivariate logistic and linear regression.ResultsData of 1499 children (mean age at baseline = 6.7 years) were analyzed. Levels of dental caries and odontogenic infections in the primary dentition were significantly highest in underweight children, as well as in stunted children, and lowest in overweight children. Dental caries in six to seven-year old children was also significantly associated with increased odds of being underweight and stunted 2 years later. These associations were not consistently found for dental caries and odontogenic infections in the permanent dentition. Underweight and stunting was significantly associated with a lower number of erupted permanent teeth in children at the age of six to seven-years-old and 2 years later.ConclusionsUnderweight and stunted growth are associated with untreated dental caries and a delayed eruption of permanent teeth in children from Cambodia, Indonesia and Lao PDR. Findings suggest that oral health may play an important role in children’s growth and general development.Trial registrationThe study was restrospectively registered with the German Clinical Trials Register, University of Freiburg (trial registration number: DRKS00004485; date of registration: 26th of February, 2013).
Highlights
Untreated dental caries is reported to affect children’s nutritional status and growth, yet evidence on this relationship is conflicting
Description of the study sample A total of 1847 children participated in the baseline study – 624 children in Cambodia, 570 in Indonesia and 653 children in Lao Lao People’s Democratic Republic (PDR)
This study investigated the relationship between nutritional status and untreated dental caries, as well as status of eruption of permanent teeth in a community-based sample of children from Cambodia, Indonesia and Lao PRD over a period of 2 years
Summary
Untreated dental caries is reported to affect children’s nutritional status and growth, yet evidence on this relationship is conflicting. The aim of this study was to assess the association between dental caries in both the primary and permanent dentition and nutritional status (including underweight, normal weight, overweight and stunting) in children from Cambodia, Indonesia and Lao PDR over a period of 2 years. A second objective was to assess whether nutritional status affects the eruption of permanent teeth. Accumulating evidence indicates that dental caries negatively affects children’s nutritional status and growth [2]. Several mechanisms have been postulated to explain this relationship, including the direct effect of dental caries on children’s eating ability and nutritional intake [10], as well as indirect effects of chronic dental inflammation on children’s growth via metabolic and immunological pathways [11]. Evidence of the effect of undernutrition on the formation and eruption of permanent teeth is less substantial
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