Department of Pedodontics, Istanbul Medipol University, Turkey
Submission: April 01, 2017; Published: April 19, 2017
*Corresponding author: Aslı Patır Münevveroğlu, Assistant Proffessor, Department of Pedodontics, Istanbul Medipol University, Cibali Mahallesi, Atatürk Blv. No:27, 34083 Unkapanı/Fatih/İstanbul, Turkey, Tel:+902124448544; Fax:(0212)5317555 ; Email:firstname.lastname@example.org
How to cite this article: Aslı P M, Beyza B A, Tuğba E, Büşra U. Relationship Between Socioeconomic Status, Body Mass Index and Dental Caries of Children. Adv Dent & Oral Health. 2017; 4(5): 555646. DOI: 10.19080/ADOH.2017.04.555646
Obesity, which is characterised as a global epidemy by World Health Organisation (WHO) , is described as a multifactorial disease characterised with metabolic, endocrinological and behavioural changes due to high levels of lipid deposition in body which occurs when the energy amount taken with nutrients is higher than the energy amount consumed with metabolism and physical activities [2,3].
The physical growth measurements are convenient criteria for evaluating the physical development in the early years of a growing child. Hence, the measurement of height and weight are basic procedures in pediatric clinical practice being particularly useful for monitoring the growth of individual children during the first six years of life . An accepted method to evaluate an individual’s body weight relative to population norms is through the calculation of body mass index (BMI) using the formula BMI=weight in kilograms/height in square meters . For 2 to 20 years old, BMI is combined with age and gender and expressed as a percentile . The Centers for Disease Control and Prevention (CDC) use BMI percentiles to classify 2 to 20 year old children into 4 weight groups. Age-and-gender-specific BMI percentiles (AGS BMI) are categorized as: 1) under weight (85th to 95th percentile) and 4) overweight (>95th percentile) [7,8].
Nutrition plays an important role in the epidemia of obesity.Beside obesity, high carbonhydrate consumption frequency and overconsumption of glucides are reported as effective for caries development . As dental caries negatively effect nutrition, wrong feeding habits also causes dental caries and impairment of oral health. It is envisioned that there is an acceptable biological relationship between dental caries and obesity, but in literature different results were reported [9-12]. Lifestyle factors (such as dietary habits) and lifestyle-influenced conditions/diseases (such as overweight/obesity and dental caries) are shown to covary with SES [11,12]. In spite of the fact that SES appears to be a confounder when the association between overweight and caries is evaluated, Hence, the aim of this study is to reveal the relationship between dental caries, BMI and socioeconomic status.
This study was carried out among a group of 856, 6 to 12 year-old children attending Istanbul Medipol University, Faculty of Dentistry, Department of Pedodontics. The study protocol was approved by the ethics comitee of Istanbul Medipol University. An informed written consent was also obtained from the parents of the children who participated in the study.
The scale which was developed by the researchers to determine the socio-economic status of families that added to the Socio-economic Status Determining Scale Study Group includes information about; educational backgrouns of parents, their proffesions, real estates, household items, average mounthly income, cars, newspaper, magazine and book reading frequency and participating to personal development programs and art and culture activities. Some articles was not distinctive so they had beenremoved from the scale. Socio-economic Status Determining Scale was evaluated by principal components analysis. The average of analysis results was 0 and standard deviation was 1. When the values was analyzed, the group less than or equal to -0.5 was accepted as low socio-economic status, the group greater than or equal to 0.5 was accepted as high socio-economic status, and the group between-0.5 and 0.5 was accepted as average socio-economic status.
The weight of each child without footwear was measured to the nearest 0.1kg, using a portable glass electronic scale. The height was measured to the nearest 0.5cm, using a portable height measuring unit. Body Mass Index (BMI) was calculated using the following formula i.e. weight in kilograms divided by height in meter square.
The number obtained was plotted for age and gender specific percentile curves on Centre of Disease Control 2000 growth charts . Based on these percentile curves, the children were grouped according to the following categories:
Underweight: BMI-for-age less than the fifth percentile
Normal: BMI-for-age greater than or equal to the fifth
percentile and less than the 85th percentile
Risk of overweight: BMI-for-age, greater than or equal to
the 85th percentile and less than the 95th percentile and
Overweight: BMI-for-age greater than the 95th percentile.
Examinations were performed according to the criteria of
World Health Organization (WHO) . For this purpose, children
were seated upright on a chair and were examined in adequate
natural day light so as to receive maximum illumination. The
Community Periodontal Index (CPI) probe was used to confirm
visual evidence of caries on the occlusal, buccal and lingual
surfaces. Training and calibration for examination of dental caries
was carried out in our department.
Statistical analysis was performed using the Statistical
Package for Social Science version 17 (SPSS; Chicago, IL, USA). The
data obtained was analyzed using Chi-square test, Fischer exact
test, and One way ANOVA. Levels of statistical significance were
set at p<0,05.
Among the 856 children examined, 384 were males
(44,85%) and 452 (55,15%)were females. A higher percentage of
underweight children (61,71%) belong to the lower class, whereas
higher percentages of risk of overweight (15%) and overweight
(15%) were observed in upper class respectively (Table 1).
The mean dmft score was highest (1,32) in underweight
children which was highly significant compared to that of children
with normal BMI-for-age (0,89). The DMFT scores of children at
risk of overweight (1,34) as well as of overweight children (1.22)
were significantly higher when compared to that of underweight
children (0,6) (p ≤ 0,01) (Table 2 and 3).
Table 4 presents the distribution of caries lesions respectively
relative to socioeconomic status. The mean dmft score was highest
among children in lower class (Mean±SD; 3,89±4,93), compared
to risk of children in middle (Mean±SD; 0,03±0,94) and upper
class (Mean±SD; 0,87±1,01). The differences were statistically
significant. However, in the permanent dentition, the mean
DMFTscore was highest among upper class (Mean±SD; 1,63±2,85)
compared to risk of children in lower (Mean±SD; 0,32±1,48) and
middle class (Mean ±SD; 0,09±1,76). This difference was also
Similar to obesity, dental caries is a chronic, highly prevalent,
multifactorial health problem. In addition to being influenced by
oral hygenie, bacterial pathogenicity, and saliva characteristics,
dental caries is associated with SES, much like obesity [9,14].
Based on the concept that a common dietary pattern contributes
to the development of dental caries and overweight, pediatric
dentists have been suggested to be one of the cornerstones in
Obesity has become an important public health problem as it
continually increases in developed and developing countries. The
MONICA study, which WHO carried out in six different regions
of Asia, Africa and Europe discovered a 10-30% increase in the
prevalence of obesity . Our country, Turkey, has the same
problems with both the developing and developed countries
about nutritional status. Regions, seasons, SES and urban-rural
settlement affects the nutritional status of Turkish people. There
aren’t any published paper at national level about the obesity
prevalance among children and adolescents in the literature, but,
on the other hand there are lots of studies done at regional or local
levels. The Turkish Obesity Research Association (TOAD) studied
1821 children of the 12-15 age group in Istanbul. The study
found that the percentage of children with a BMI of 18-25kg/ m2 (overweight) is 9.9%, while 6.2% have a BMI of greater than
30kg/m2 (obese). A study from Kayseri, done with 3703 children
reported that 10.6% of the children were overweight (BMI 85-95
persantile) and 1.6% of them were obese (BMI 95 persantile) .
In accordance with the wide spectrum of obesity rates in studies
in the literature, our study resulted with 4.8% underweight and
3.2% overweight rates.
The relationship between BMI and dental caries in children
is more complex than can be explained by carbohydrate
consumption alone. [17,18]. Social status is reported to be a
powerful determinant to affect child’s general and oral health
[19,20]. Previous studies that examined the relationship between
socio-economic level and dental caries reported quite different
results. Saores et al. indicated that there has been a reduction
in dental caries experience in developed economies in the past
decade, but an increase in developing economies . Sogi et al.
 have reported that children with low SES tend to have more
dental caries. As mentioned above, ın this study, dmft score was
highest among children in lower class compared to children in
middle and upper classes.
Dietary factors and SES were hypothesised to be common risk
factors that associated with obesity and dental caries . Marshall
et al.  suggested that neither ‘obesity increases risk of caries’
nor ‘caries increases risk of obesity,’ but rather a common risk
factor increased the likelihood of both disease . In this study,
more children from the lower class were underweight. Children
become more independent in food choice with increasing ages.
During the formative years, unbalanced diet and poor nutritional
habits cauld be effective to increased caries in the primary
dentition. Consuming more snacks causes caries in the permanent
dentition and we think that this is the main cause of higher caries
rates in permanent teeth of upper class children in our study. Also
lifestyle changes like frequent consumption of aereated drinks,
carbonhydrate rich foods and unsupervised oral hygiene practices
may make them more vulnerable to caries . On the previous
studies from USA, it was reported that normal weight children
were more likely to have caries than overwieght children. The
main reason for this is that obesity is a major health problem in
USA and that counseling services are provided to the families of
overweight children .
Economic status has significant influnces on a child’s
development. Obesity and caries are multifactorial diseases
that follow similar risk patterns. In the present study caries was
not confined to any particular BMI category and socioeconomic
class. This indicates that body weight exhibits the cumulative
environmental effects of dietary factors, which could be
responsible for the occurrence of caries in various socioeconomic
Given the importance of overweight as a public health
problem, medical and dental professionals should assess health/
risk behaviors, connections between oral and systemic health, and make interdisciplinary communications for diagnosing and
treating precocious signs of dental diseases among children and