Body mass index and dental caries in young people: a systematic review

Abstract

Background Obesity and caries in young people are issues of public health concern. Even though research into the relationship between the two conditions has been conducted for many years, to date the results remain equivocal. The aim of this paper was to determine the nature of the relationship between Body Mass Index (BMI) and caries in children and adolescents, by conducting a systematic review of the published literature. Methods A systematic search of studies examining the association between BMI and caries in individuals younger than 18 years old was conducted. The electronic bibliographic databases PubMed, MEDLINE, Embase, CINAHL, CENTRAL and Google Scholar were searched. References of included studies were checked to identify further potential studies. Internal and external validity as well as reporting quality were assessed using the validated Methodological Evaluation of Observational Research checklist. Results were stratified based on the risk of flaws in 14 domains 10 of which were considered major and four minor. Results Of the 4208 initially identified studies, 84 papers met the inclusion criteria and were included in the review; conclusions were mainly drawn from 7 studies at lower risk of flaws. Three main types of association between BMI and caries were found: 26 studies showed a positive relationship, 19 showed a negative association, and 43 found no association between the variables of interest. Some studies showed more than one pattern of association. Assessment of confounders was the domain most commonly found to be flawed, followed by sampling and research specific bias. Among the seven studies which were found to be at lower risk of being flawed, five found no association between BMI and caries and two showed a positive association between these two variables. Conclusions Evidence of an association between BMI and caries was inconsistent. Based on the studies with a low risk lower risk of being flawed, a positive association between the variables of interest was found mainly in older children. In younger children, the evidence was equivocal. Longitudinal studies examining the association between different indicators of obesity and caries over the life course will help shed light in their complex relationship. Electronic supplementary material The online version of this article (10.1186/s12887-019-1511-x) contains supplementary material, which is available to authorized users.

Obesity and dental caries in early childhood: A systematic review and meta‐analyses

“…Previous literature reports that age influences the relationship between obesity and dental caries with the evidence of this relationship being stronger and consistent for older children (having permanent dentition) compared with young . The hypothesis is that both obesity and dental caries are slowly cumulative across the life course . However, present review found a positive association between the two conditions amongst children aged 6 years and younger having primary dentition, which highlights the need for early interventions to prevent these two health conditions.…”

“…Based on the findings of this review, the recommendations for future research on this topic are presented below (many of which are consistent with previous systematic reviews): Use unified criteria for BMI categorisation and index for dental caries assessment. Use standardised overweight/obesity measurements, including trained and calibrated health professionals and related equipment and procedure. Use standardised measurements for dental caries assessment, including trained and calibrated dental examiners, and both clinical and radiographic assessment methods for better diagnostic accuracy. All the important potential confounding factors for association between overweight/obesity and dental caries should be adjusted in the data analysis using good study design practices. Longitudinal cohort studies with overweight/obesity as an “exposure” and dental caries experience as an “outcome” are needed to explore the potential relationship between overweight/obesity and dental caries in children aged 6 years and younger. Future studies investigating the complex relationship between the two conditions should employ good experimental study designs to assess the common risk factors (eg, diet, genetic, biomedical, and socio‐demographic) of overweight/obesity and dental caries using more systemic and universal measures. …”

“…The current results are consistent with a recent systematic review by Chen et al; however their review findings were solely based on cross‐sectional study designs. Conversely, systematic reviews by Paisi et al and Li et al reported conflicting results in terms of association between adiposity and dental caries in children. The recently published review by Paisi et al did not report the association patterns specifically for children with primary dentition.…”

“…Conversely, systematic reviews by Paisi et al and Li et al reported conflicting results in terms of association between adiposity and dental caries in children. The recently published review by Paisi et al did not report the association patterns specifically for children with primary dentition. In the review by Li et al, two studies found a positive association, four found no association, two found an inverse association, and three found an inconclusive association between adiposity and caries.…”

“…Several systematic reviews have been undertaken to understand the association of overweight/obesity and dental caries; however, existing evidence remains uncertain and inconclusive . Furthermore, these reviews were considered to have substantial limitations that highlight the need for an updated high‐quality systematic review on this topic (Appendix S1).…”