Caries Incidence Is Associated with Wasting among Cambodian Children

Abstract

Evidence suggests that dental caries is associated with chronic and acute malnutrition, manifested as stunting and wasting in children. However, studies have not always appropriately accounted for confounding factors or for the temporal ordering between exposure and outcome. This study examined relationships between the development of caries lesions with subsequent stunting and wasting outcomes using data from a population-based cohort in Cambodia. Caries incidence was assessed based on the presence of a new cavitated carious lesion or a new pulpally involved lesion across a 6-mo observation period. Anthropometric measurements were taken at regular intervals. Effects of carious lesions on stunting and wasting were assessed using inverse probability treatment weighting, adjusting for potential confounders, using z scores for height-for-age (HAZ) and weight-for-height (WHZ) as outcomes. In total, 894 children (mean age 20 mo at baseline) were followed over 2 y. At baseline, 350 (39.1%) were identified as having stunting malnutrition. At follow-up, 58 (6.5%) had a new pulpally involved lesion. There was no association between incidence of cavitated or pulpally involved carious lesions at follow-up and stunting (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.75, 1.50). The incidence of pulpally involved carious lesions had an effect on wasting prevalence (WHZ <−2; RR = 1.35; 95% CI: 0.70, 2.62) and WHZ scores (average treatment effect = −0.294; 95% CI: −0.538, −0.050). This study offers evidence that the development of pulpally involved carious lesions has an effect on WHZ scores. Oral health promotion and clinical prevention and management of dental caries should be explored as interventions to promote normal growth and development among preschool children, particularly in low-income settings.

Sugar-Sweetened Beverages, Foods of Low Nutritional Value, and Child Undernutrition in Cambodia

“…The association between high sugar intake and undernutrition may also be mediated by dental caries. Early and frequent consumption of sugary drinks and snacks is known to cause dental caries [39], and dental caries have been shown to be associated with increased risk of stunting and wasting in low-and middle-income countries, including Cambodia [40][41][42][43]. The hypothesized mechanisms include chronic oral infection/inflammation, oral pain, difficulty eating and sleeping, and disruption of the hypothalamic-pituitary-adrenal axis [44][45][46].…”

A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6

“…A meta-analysis from cross-sectional studies using the World Health Organization’s caries diagnostic criteria showed the global prevalence of ECC was 48% [ 3 ], indicating areas of highest prevalence in Oceania (82%) and lowest prevalence in Africa (30%) with differences among regions [ 4 ]. When left untreated, ECC can cause pain and infection, with a direct impact on the oral and general health of young children [ 5 ]. Severe ECC can impact children’s quality of life affecting the child’s school attendance and performance, as well as having an impact on the family unit [ 6 , 7 ].…”