A twin study of body mass index and dental caries in childhood

Abstract

Sub-optimal nutrition and dental caries are both common with significant short and long-term implications for child health and development. We applied twin statistical methods to explore the relationship between body mass index (BMI) and dental caries. We measured BMI at 18 months and six years of age and cumulative dental caries experience at six years in 344 twin children. Dental caries in primary teeth was categorised into 'any' or 'advanced' and BMi was analysed as both a continuous and categorical variable. Statistical analyses included multiple logistic regression using generalized estimating equations and within/between-pair analyses. there was no association between BMi and 'any' dental caries experience at either time-point, neither overall nor in within/between pair analyses. However, 'advanced' dental caries at six years was associated with a within-pair difference in BMI of −0.55 kg/m 2 (95% CI −1.00, −0.11, p = 0.015). A within-pair increase of 1 kg/m 2 in BMi was associated with a lower within-pair risk of advanced dental caries (OR 0.68, 95% CI 0.52, 0.90, p = 0.007). These findings reveal a possible causal relationship between lower BMI and dental caries. As dental outcomes were only measured at one time point, the direction of this potentially causal relationship is unclear. Poor nutrition and dental caries are both common with significant short and long-term implications for child health and development 1,2. Understanding how growth and dental caries, a common childhood condition are linked could inform broader risk factor-based preventive strategies, and also facilitate cross-disciplinary and collaborative approaches between public health, dental and medical specialists involved in the care of children 3. Despite a number of systematic reviews, the association between BMI and dental caries remains unclear 4-7. The relationship may be bidirectional, as both altered BMI and dental caries might be perceived be an exposure or an outcome. In addition to common risk factors (such as dietary sugar intake) 3 , there are also several plausible (albeit speculative) biological causal pathways between BMI and dental caries. Additionally, the relationship may be non-linear and depend on the study setting and socioeconomic profile of participants, with higher levels of dental caries reported in both underweight children in low to middle income countries (LMICs) and in obese children in high-income countries 4,6. Observational studies of twins can provide a valuable tool to explore complex relationships such as that between BMI and dental caries, because they remove much of the bias resulting from confounding 8. As twins share genetic variation (100% for MZ twins and 50% for DZ twins) and many (but not all) environmental factors, such confounding variables can be controlled for, even if they are not directly measured. Therefore, demonstrating robust differences in outcomes between exposed and non-exposed twins may suggest consistency with causal relationships 9. Within/between-pair analyses can be undertaken ...

Relationship between Salivary Alpha-Amylase Enzyme Activity, Anthropometric Indices, Dietary Habits, and Early Childhood Dental Caries

“…Evidence shows that obesity and dental caries hold the two risk factors of dietary features and socioeconomic status in common [ 13 ]. However, contrasting reports exist regarding the association between dental caries and body mass index (BMI) as the measurement of body fatness, particularly in younger children [ 9 , 13 – 16 ].…”

Obesity and oral health in Mexican children and adolescents: systematic review and meta-analysis

“…43 Some speculative biological and biomolecular causal pathways between BMI and oral health have been defined. 44 Some biomolecular theories suggest that because of the infection caused by dental caries, chronic inflammation can be present, affecting not only oral health but also could be linked to other health issues such as anemia, which could affect weight-related outcomes. 44 Physiological theories include a compromised ability to bite or chew foods in the presence of worst oral health or caries, which could lead to an altered BMI, because teeth with more severe lesions may have a higher impact while chewing and could affect the nutritional intake of some children.…”

“…44 Physiological theories include a compromised ability to bite or chew foods in the presence of worst oral health or caries, which could lead to an altered BMI, because teeth with more severe lesions may have a higher impact while chewing and could affect the nutritional intake of some children. 44 Likewise, eating difficulties are more commonly reported in children with dental caries. 45,46 The relation of body composition and oral health outcomes among children and adolescent is complex and multifactorial.…”

Genetic and epigenetic factors of caries

“…Так, дослідникам удалось виявити, що в людей, які здобули лише початкову освіти, відмічали вищі рівні складового компонента видалених зубів і нижчі рівні компонента запломбованих у структурі індексу КПВ у порівнянні з вибіркою людей, які здобули спеціальну або вищу освіту [20]. У дослідженні Silva M. та колег на основі аналізу патології карієсу серед 345 близнюків у різні вікові періоди вдалось констатувати відсутність статистично значущої різниці показників карієсу у групах дизиготних і монозиготних пар, при цьому статистично підтверджено кореляцію між вищим ризиком виникнення карієсу, що було встановлено із впливом таких чинників, як дефіцит фторування води, вроджена гіпомінералізація молочних молярів, наявність ожиріння та дихоріонічної плаценти у матері [13,14]. Результати вивчення впливу процесу акліматизації на ризик розвитку карієсу зубів, отримані Рахмановим Р.С.…”