International Dental Journal

SCIENTIFIC RESEARCH REPORT

doi: 10.1111/idj.12259

Relationship between body mass index and dental caries in

children, and the influence of socio-economic status
Santhosh Kumar1, Jeroen Kroon1, Ratilal Lalloo2,3, Suhas Kulkarni4 and Newell W. Johnson5
1
Population and Social Health Research Programme, Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith
University, Gold Coast, Queensland, Australia; 2School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia; 3School
of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia; 4Department of Public Health Dentistry, Panineeya
Institute of Dental Sciences & Research Centre, Hyderabad, India; 5Population and Social Health Research Programme, Menzies Health
Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.

Objectives: To determine the association of body mass index (BMI) with dental caries in Indian schoolchildren, and to
analyse the influence of socio-economic status (SES). Methods: The study population consisted of 11- to 14-year-old chil-
dren from Medak District in Telangana State, India. The Indian Academy of Paediatrics 2015 growth charts were used
to categorise children as underweight, overweight, normal or obese, based on their BMI. Data on the SES of the family
were collected through questionnaires. Clinical examination for dental caries was performed by a single examiner.
Results: A total of 1,092 subjects returned questionnaires and were clinically examined (giving a response rate of 85%).
There were no significant differences in caries prevalence and experience across the categories of BMI. However, caries
prevalence and experience in overweight children were 24.8% and 0.69  1.51, respectively, while the corresponding
values in normal-weight children were 35% and 0.85  1.50, respectively. Among children of high-SES families, over-
weight children had approximately 71% fewer caries than did those who were normal weight [incidence rate ratio (IRR)
= 0.29; 95% CI: 0.11–0.78)]. Conclusions: BMI was not associated with dental caries prevalence and experience in this
population. The association of BMI with dental caries varied across SES categories. In the high-SES category, overweight
children experienced fewer caries than did normal-weight children.

Key words: Body mass index, children, dental caries, obesity, overweight

complicated by many intervening variables9,10. Never-

INTRODUCTION
theless, both of these chronic diseases (obesity and den-
Dental caries is the most prevalent health condition in tal caries) share common influences, such as diet and
the world1,2. Globally, it affects 2.4 billion people2 and lifestyle, and genetic and socio-economic factors10,11.
the economic burden of treating dental diseases Evidence of the association of nutrition status with
accounts for 4.6% of global health expenditure3. dental caries is inconsistent. A recently published sys-
Dental caries, like most other chronic multifactorial tematic review found that approximately half of the
diseases, is influenced by numerous genetic, environ- studies published between 2004 and 2011 found no
mental and behavioural risk factors4,5. Dental caries is association between body mass index (BMI) and den-
predicted by many factors that range from population- tal caries, while one-third of the studies found positive
level variables to individual circumstances. Among associations and the remaining an inverse relation-
many factors, nutritional status has also long been ship11. These inconsistencies may be caused by differ-
associated with oral diseases6. Under-nutrition is asso- ences in study design, study location8, methods of
ciated with enamel hypoplasia and salivary gland atro- assessment of nutritional status and of dental caries,
phy which increases the risk of dental caries, and the and the age of the participants and their socio-eco-
effect of this is pronounced during the pre-eruptive nomic background12. Hayden et al., in their system-
stages of tooth development7. On the other hand, over- atic review, reported that high BMI is associated with
nutrition, manifesting as obesity, has also been associ- high caries experience in developed, industrialised,
ated with dental caries8. The association of obesity countries but not in developing, newly industrialised,
with dental caries is not necessarily causal and is countries such as Brazil, India and Thailand8.
© 2016 FDI World Dental Federation 1
Kumar et al.

There are no studies from India that have assessed considered in this study population who were in the
the association of BMI and dental caries in relation to mixed-dentition stage as its inclusion would result in
socio-economic status (SES). Therefore, the aim of over-estimation of the caries experience. The caries
this study was to determine the association of BMI outcomes used in this study were caries prevalence
with dental caries in Indian schoolchildren, and to and caries experience. Caries prevalence is the propor-
analyse the influence of SES. tion of the population with at least one decayed tooth
in either of the dentitions, while caries experience is
the total number of decayed and filled teeth in both
METHODS
dentitions.
A questionnaire was also sent to parents/caregivers,
Study population
(via their children), to obtain information on parent’s
The study population consisted of 11- to 14-year-old occupation, education and family income. With this
schoolchildren of Medak district in Telangana State, information, the SES of each family was evaluated
India. Representative children were recruited from using the Kuppuswamy scale, which is a composite
schools using a multistage sampling technique. In the instrument that has definite scoring criteria for occu-
first stage, eight subdistricts of Medak district, from a pation, education of the head of the household and
total of 46, were randomly selected. This was fol- family income17. Based on the composite score, the
lowed by randomly selecting schools, the number of SES of the family was categorised as upper (score:
which was proportional to the total number of 26–29), upper middle (score: 16–25), lower middle
schools in that subdistrict. Lastly, all sixth-grade chil- (score: 11–15), upper lower (score: 5–10) and lower
dren in each selected school were invited to partici- (score: <5). As there were very few subjects in the
pate. upper (three subjects) and lower (one subject) cate-
gories, such subjects were included in the upper mid-
dle and upper lower SES categories, respectively.
Procedure
Thus, all children were from one of three SES cate-
Children whose parents provided written consent for gories (high, medium or low). In addition, we
their participation underwent a dental examination, obtained data on oral hygiene (tooth-cleaning fre-
weight and height measurements and also responded quency and dental-visiting practices) and dietary prac-
to a questionnaire. The height of each child, without tices (frequency of consumption of fruit, sweet food
shoes, was recorded to the nearest 0.1 cm using a por- and sugared drinks), which are potential confounders.
table height meter with a horizontal headboard on a However, we could not obtain data on the use of flu-
flat surface. Weight was measured using a portable oridated toothpaste because most of the children were
balance to the nearest 100 g13. BMI for each individ- unaware of whether the dentifrice they used contained
ual was calculated as weight divided by squared fluoride.
height in metres. Height-for-age (HAZ), weight-for- Ethics approval for this study was obtained from
age (WAZ) and BMI-for-age (BAZ) scores were calcu- the Griffith University Human Research Ethics Com-
lated, using the revised Indian Academy of Paediatrics mittee, Australia (ref. no.: DOH/12/14/HREC) and
(IAP) 2015 growth charts for ages 5–18 years as a ref- the Ethics Committee of Panineeya Institute of Dental
erence14. These Z scores specific to age and gender Sciences and Research Centre, India (ref. no.: 00126).
were generated using Microsoft Excel, which was pro- This research was conducted in full accordance with
vided by the authors of the revised IAP growth the World Medical Association Declaration of Hel-
charts14. Subjects were categorised as underweight, sinki.
normal, overweight and obese based on the BAZ cut-
offs proposed by the IAP. The cut-off for underweight
Statistical analysis
in all the children was 1.88; boys and girls with
BAZ values of ≥0.55 and ≥0.67, respectively, were SPSS (IBM SPSS Statistics for Windows, Version 22.0;
considered overweight. Boys and girls with BAZ val- IBM Corp., Armonk, NY, USA) was used for statisti-
ues of ≥1.34 and ≥1.64, respectively, were considered cal analysis. Descriptive data are presented as frequen-
obese. cies and means. The Shapiro–Wilk test of normality
Clinical examination for dental caries was per- was conducted to assess the distribution of the caries
formed by a single examiner (S.K.). Caries was diag- data. As these data were not normally distributed,
nosed using criteria proposed by the World Health non-parametric tests were used. For bivariate analysis,
Organization (WHO)15 and was quantified using the the Kruskal–Wallis H-test was used to assess differ-
decayed and filled teeth index (i.e. dft and DFT for ences in dental caries experience between the cate-
the deciduous and permanent dentitions, respec- gories of BMI. The chi-square test was used to
tively)16. The ‘missing’ (i.e. ‘M’) component was not determine differences in dental caries prevalence
2 © 2016 FDI World Dental Federation
 Influence of SES on the BMI–caries association

across the categories of BMI. In addition, Mann– prevalence and experience between the categories of
Whitney U-tests were also used to evaluate the differ- BMI (Table 1). However, overweight children had
ences in BAZ, WAZ and HAZ between the caries- lower caries prevalence and experience than did the
severity categories. For the latter, the study population children in other BMI categories. Caries prevalence
was categorised into high and low caries-severity and experience in overweight children were 24.8%
groups, based on the Significant Caries Index (SiC) and 0.69  1.51, respectively, and the corresponding
and the SiC1018. In SiC, high caries-severity group figures in normal-weight children were 35% and
constitutes one-third of the total study population 0.85  1.50, respectively.
with the highest caries experience. The high-caries- Mean BAZ, WAZ and HAZ values were 0.41
severity group, based on SiC10, comprises 10% of the [standard deviation (SD) = 1.09], 0.45 (SD =
total study population with highest caries experience. 1.00) and 0.35 (SD = 1.06), respectively
Dental caries experience (dft+DFT) was the out- (Table 2). There were no significant differences for
come variable used in multivariate analysis. A nega- BAZ, WAZ and HAZ scores between the categories
tive binomial regression with a log link was used for of dental caries severity. Also, BAZ (high,
multivariate analysis as dental caries experience was 0.32  1.18; medium, 0.49  1.08; and low,
widely dispersed. Furthermore, robust estimates were 0.37  1.01) and BMI (high, 17.34  3.25; med-
considered in order to avoid the effect of extreme out- ium, 16.91  2.86; and low, 17.30  2.99) scores
liers. Explanatory variables were: BMI; gender; SES of did not differ significantly between the SES categories
the family; frequency of tooth cleaning; dental practi- (not presented in the tables).
tioner-visiting habits; frequency of consumption of Gender was not related to dental caries experi-
sweet foods between meals; frequency of consumption ence. Other than SES, none of the explanatory vari-
of fresh fruit; and the frequency of consumption of ables was associated with dental caries experience in
sugared drinks between meals. Furthermore, to evalu- either bivariate or multivariate analyses (Table 3).
ate the association between BMI and dental caries Children from high SES families had 41% (IRR =
across SES categories, separate negative binomial 0.59; 95% CI: 0.44–0.79) fewer caries compared
regression analyses were conducted. Exponential esti- with children from low SES families. The associa-
mates of the unadjusted and adjusted regression anal- tion of SES with dental caries existed even after
ysis are presented as incidence rate ratio (IRR). In the adjusting for the effect of BMI, gender, oral hygi-
adjusted analysis, the effect of all other explanatory ene and dietary practices (IRR = 0.61; 95% CI:
variables was controlled. P < 0.05 was considered sta- 0.45–0.81).
tistically significant. There were differences in the association of BMI
with dental caries across the categories of family SES
(Table 4). Among children from families with high
RESULTS
SES, overweight children had approximately 71%
A total of 1,284 children were approached and 1,092 fewer caries than did normal-weight children, both
participated, giving a response rate of 85%. More before (IRR = 0.29; 95% CI: 0.11–0.78) and after
than half (58.2%) of the participating children were (IRR = 0.27; 95% CI: 0.10–0.73) adjusting for the
male. The mean age of the study population was effect of all other explanatory variables. However,
146.36  11.26 months. Based on the IAP-BMI cut- there were no differences in caries experience between
off values, 13.1% were underweight, while 9.6% overweight and normal-weight children from medium
were categorised as overweight and 3.7% as obese. (IRR = 1.10; 95% CI: 0.60–2.04) and low (IRR =
There were no significant differences in caries 0.98; 95% CI: 0.49–1.95) SES families.

Table 1 Caries prevalence and experience (dft+DFT) in relation to body mass index (BMI), gender, socio-eco-
nomic status (SES), oral hygiene and dietary practices
Variable n (%) Caries prevalence* P Mean (SD) P

BMI
Underweight 143 (13.1) 30.8 0.183† 0.80 (1.52) 0.272‡
Normal 804 (73.6) 35.0 0.85 (1.50)
Overweight 105 (9.6) 24.8 0.69 (1.51)
Obese 40 (3.7) 32.5 0.93 (1.62)

*Proportion of the population with at least one decayed tooth in either of the dentitions.
†
Chi-square test.
‡
Kruskal–Wallis H-test.
dft, decayed and filled teeth index for the deciduous dentition; DFT, decayed and filled teeth index for the permanent dentition; SD, standard
deviation.

© 2016 FDI World Dental Federation 3

Kumar et al.

Table 2 Association between caries severity and anthropometric measures

Caries experience n (%) BMI Z score Weight Z score Height Z score

Mean  SD Median (IQR) Mean  SD Median (IQR) Mean  SD Median (IQR)

SiC Index* P = 0.741 P = 0.340 P = 0.385

Low 728 (66.7) 0.41  1.13 0.39 (1.48) 0.43(1.02) 0.44 (1.00) 0.33  1.05 0.45 (1.32)
High 364 (33.3) 0.42  1.00 0.43 (1.25) 0.48  0.96 0.57 (1.23) 0.40  1.06 0.48 (1.36)
SiC10 Index† P = 0.773 P = 0.707 P = 0.394

Low 958 (87.7) 0.42  1.10 0.42 (1.44) 0.44(1.00) 0.44 (1.37) 0.34  1.06 0.48 (1.35)
High 134 (12.3) 0.38  1.04 0.38 (1.32) 0.47  0.98 0.45 (1.31) 0.45  1.06 0.48 (1.44)
Total 1092 0.41  1.09 0.42 (1.41) 0.45  1.00 0.44 (1.36) 0.35  1.06 0.48 (1.35)

P-values were calculated using the Mann–Whitney U-test.

*For Significant Caries Index (SiC), high refers to the group which constitutes one-third of the total study population with the highest caries
experience and low refers to the rest of the study population.
†
For SiC10, high refers to the group which comprises 10% of the total study population with the highest caries experience and low refers to
the rest of the study population.
BMI, body mass index; IQR, interquartile range; SD, standard deviation.

Table 3 Multivariate analysis with caries experience (dft+DFT) as the outcome variable and body mass index
(BMI), gender, socio-economic status (SES), oral hygiene and dietary practices as explanatory variables
Variable n (%) Unadjusted Adjusted†
IRR (95% CI) IRR (95% CI)

BMI
Underweight 143 (13.1) 0.93 (0.67–1.31) 1.00 (0.72–1.40)
Overweight 105 (9.6) 0.80 (0.52–1.25) 0.79 (0.52–1.20)
Obese 40 (3.7) 1.08 (0.62–1.88) 1.13 (0.66–1.96)
Normal 804 (73.6) 1
Gender
Male 635 (58.2) 0.91 (0.73–1.12) 0.86 (0.69–1.08)
Female 457 (41.8) 1
SES of the family
High 289 (26.5) 0.59 (0.44–0.79)* 0.61 (0.45–0.81)*
Medium 517 (47.3) 0.81 (0.63–1.04) 0.81 (0.63–1.04)
Low 286 (26.2) 1
Frequency of teeth cleaning
≤1/day 997 (91.3) 1.13 (0.77–1.64) 1.07 (0.74–1.56)
>1/day 95 (8.7) 1 1
Dental visiting practices
Had been to dentist 227 (20.8) 1.07 (0.83–1.38) 1.18 (0.90–1.53)
Never been to dentist 885 (79.2) 1 1
Frequency of sweet food consumption per day between meals
Sometimes or rarely 928 (8.5) 0.99 (0.72–1.35) 1.02 (0.75–1.40)
Once or more a day 164 (81.5) 1 1
Frequency of fresh fruit consumption per day
Once or more a day 300 (27.5) 0.82 (0.63–1.07) 0.81 (0.62–1.07)
Sometimes or rarely 792 (72.5) 1 1
Frequency of sugared drinks consumption per day between meals
Sometimes or rarely 811 (74.3) 0.85 (0.67–1.08) 0.83 (0.65–1.07)
Once or more a day 281 (25.7) 1 1

*P < 0.05.
†
Adjusted for other explanatory variables.
95% CI, 95% confidence interval; dft, decayed and filled teeth index for the deciduous dentition; DFT, decayed and filled teeth index for the
permanent dentition; IRR, incidence rate ratio.

reference charts for 5- to 19-year-old subjects are

DISCUSSION
commonly used by researchers, they might not be suit-
In addition to evaluating the association between BMI able for use in the Indian population as growth pat-
and dental caries, this study also assessed the influence terns in children differ between regions based on the
of SES on this association. Subjects were categorised time of puberty and on nutritional, environmental and
as underweight, normal, overweight and obese using genetic factors19.
the 2015 growth reference charts proposed by the There was no association between BMI and dental
IAP for Indian children19. Although WHO growth caries: dental caries prevalence and experience did not
4 © 2016 FDI World Dental Federation
 Influence of SES on the BMI–caries association

Table 4 Multivariate analysis across the socio-eco- multicentric study conducted almost three decades
nomic status (SES) categories with dental caries expe- ago, in 198919.
rience (dft+DFT) as the outcome variable and body Although not statistically significant, caries preva-
mass index (BMI) as the explanatory variable lence and experience was lower in overweight children
than in children from other BMI categories. Similar
SES category n (%) Unadjusted IRR Adjusted† IRR
(95% CI) (95% CI) observation was made in a few longitudinal10,32,33
and cross-sectional studies on national representative
High SES
Underweight 48 (16.6) 1.34 (0.78–2.30) 1.32 (0.77–2.27)
samples34,35. Although the underlying reason for this
Overweight 38 (13.1) 0.29 (0.11–0.78)* 0.27 (0.10–0.73)* inverse association is unclear, several studies have
Obese 15 (5.2) 1.04 (0.46–2.35) 0.98 (0.45–2.12) attributed it to dietary habits. One of these studies
Normal 188 (65.1) 1 1
Total 289
suggested that although parents of overweight chil-
Medium SES dren may restrict the consumption of sugary food,
Underweight 65 (12.6) 0.90 (0.53–1.52) 0.85 (0.51–1.40) thus leading to development of fewer caries, the chil-
Overweight 41 (7.9) 1.10 (0.60–2.04) 1.00 (0.55–1.81)
Obese 15 (2.9) 1.19 (0.52–2.72) 1.20 (0.52–2.78)
dren remain overweight because they consume more
Normal 396 (76.6) 1 1 calories than they expend33. Another study reasoned
Total 517 that overweight children might consume more fatty
Low SES
Underweight 30 (10.5) 0.75 (0.36–1.56) 0.78 (0.38–1.60)
acids, but less sugar, compared with healthy or under-
Overweight 26 (9.1) 0.98 (0.49–1.95) 0.96 (0.48–1.92) weight children32.
Obese 10 (3.5) 1.13 (0.36–3.55) 1.14 (0.39–3.31) Children of low SES were at greater risk for dental
Normal 220 (76.9) 1
Total 286
caries compared with children of medium and high
SES. It is explicitly evident from the systematic reviews
*P < 0.05. that lower SES is associated with greater caries experi-
†
Adjusted for gender, oral hygiene and dietary practices.
95% CI, 95% confidence interval; dft, decayed and filled teeth ence, both in adults and in children36,37. For SES cate-
index for the deciduous dentition; DFT, decayed and filled teeth gorisation, the composite scale of Kuppuswamy has
index for the permanent dentition; IRR, incidence rate ratio. been used rather than SES scales based solely on fam-
ily income. Although income plays an important role
in meeting the immediate needs of the family, it is not
differ significantly between the categories of BMI. an appropriate measure of social class38.
Also, BAZ scores did not differ significantly between It was observed that frequency of consumption of
the caries-severity categories. In this study, BMI was sweet foods, fresh fruits and sugared drinks was not
also used as a continuous variable because categorisa- associated with dental caries. In this study, two
tion might lead to loss of data, despite being a useful closed-ended questions were used to assess sugar-con-
method of presentation20. The literature on the associ- sumption frequency, which might have obscured the
ation of dental caries with BMI is conflicting; three association of dietary sugar and dental caries. Further-
systematic reviews9,11,21 found no strong evidence of more, this association is mediated by several factors,
an association, while one reported a small association such as salivary flow rate and composition, fluoride
(i.e. caries in permanent dentition is more prevalent in usage, the posteruptive age of the teeth39 and the con-
obese children)8. Furthermore, caries assessment meth- sistency40 and amount of sugar41, which were not
ods and BMI classification criteria differed across the recorded in this study.
studies included in these reviews. When subgroup analysis on the association of BMI
Similarly to the above, there have been conflicting and dental caries across the SES categories was per-
findings from studies in adolescent and child popula- formed, overweight children had fewer caries than did
tions in India. Half of these studies observed no asso- those with normal BMI. This finding is consistent
ciation22–26, while the other half found a direct with results from a longitudinal study in Scandinavia,
association, with more caries being reported in chil- in which lower caries experience predicted a larger
dren who were obese or overweight27–31. An impor- increase in body weight over a period of 6 years only
tant reason for the discrepancies, that also influences in children of mothers with more than 10 years of
any comparison between the studies is non-uniform education10. In the case of our Indian families, chil-
BMI cut-off values. For example, one of these Indian dren of parents with higher SES may tend to follow
studies used the International Obesity Taskforce stan- better preventive oral hygiene practices42,43 but
dards29 and another used the Centre for Disease Con- remain overweight because of over-feeding by their
trol 2000 growth charts30. Only one study28 used parents. An overweight child is traditionally consid-
growth standards specific to Indian children, namely ered as being of normal weight44 and healthy by
the IAP 2007 growth references. Although IAP 2007 Indian parents45. This misperception about children’s
growth-chart guidelines are specific to Indian children, weight exists in parents from diverse ethnic back-
they were formulated based on the data from a grounds46,47; some studies observed that South Asian
© 2016 FDI World Dental Federation 5
Kumar et al.

parents have increased likelihood of misclassifying Acknowledgements

their overweight children as being of normal weight48.
We would like to acknowledge the support of Griffith
This study is the first to explore the effect of SES
University and Panineeya Institute of Dental Sciences
on the association of BMI with dental caries in an
and Research Centre in conducting this study. We
Indian population. The study findings have good
also thank the district education authorities of Medak
external validity as the non-response bias was minimal
district and the study participants for their co-opera-
(the response rate was 85%). The main findings of the
tion. This study did not receive financial support from
study, namely lower caries prevalence and experience
any organization.
in overweight children and the influence of SES on
this relationship, are in contrast to the literature on
Competing interest
the intake of free sugar, dental caries, and nutritional
status. This warrants longitudinal and life-course stud- The authors declare that they do not have any com-
ies on larger representative populations from diverse peting interests.
cultural backgrounds to understand the interplay
between social disparities, BMI and the severity of
REFERENCES
dental caries. In order to facilitate international com-
parisons, it would be beneficial if future studies were 1. Ferreira Zandona A, Santiago E, Eckert GJ et al. The natural
history of dental caries lesions: a 4-year observational study. J
to use uniform and appropriate methods for assessing Dent Res 2012 91: 841–846.
caries, SES, and BMI. Dentists from the study region, 2. Kassebaum NJ, Bernabe E, Dahiya M et al. Global burden of
in their position as health-care providers, can educate untreated caries: a systematic review and metaregression. J Dent
and motivate parents, particularly those children who Res 2015 94: 650–658.
are overweight, on healthy eating practices. Further- 3. Listl S, Galloway J, Mossey PA et al. Global economic impact
of dental diseases. J Dent Res 2015 94: 1355–1361.
more, health-education programmes for preventing
4. Fejerskov O. Changing paradigms in concepts on dental caries:
dental caries and obesity, with multisectoral co-ordi- consequences for oral health care. Caries Res 2004 38: 182–191.
nation between health and education departments of
5. Harris R, Nicoll AD, Adair PM et al. Risk factors for dental
the state, should be contemplated. Data obtained from caries in young children: a systematic review of the literature.
this study can act as baseline information and can be Community Dent Health 2004 21: 71–85.
helpful in evaluating the effectiveness of the imple- 6. Gilbert JW. Nutrition and dental caries. J Am Dent Assoc 1999
mented programs. 130: 160, 162.
7. Moynihan PJ. The role of diet and nutrition in the etiology and
prevention of oral diseases. Bull World Health Organ 2005 83:
LIMITATIONS 694–699.
8. Hayden C, Bowler JO, Chambers S et al. Obesity and dental
The findings of this study cannot be generalised to the caries in children: a systematic review and meta-analysis. Com-
Indian population as a whole because the sample was munity Dent Oral Epidemiol 2013 41: 289–308.
recruited from sixth-grade children of selected schools 9. Silva AE, Menezes AM, Demarco FF et al. Obesity and dental
caries: systematic review. Rev Saude Publica 2013 47: 799–812.
only. However, our subjects were representative of
10. Lempert SM, Froberg K, Christensen LB et al. Association
school-going children of the Medak district in India between body mass index and caries among children and ado-
and typical of rural/semi-urban children across the lescents. Community Dent Oral Epidemiol 2014 42: 53–60.
whole of south India. The data obtained on SES were 11. Hooley M, Skouteris H, Boganin C et al. Body mass index and
self-reported. Furthermore, nutritional status and den- dental caries in children and adolescents: a systematic review of
tal caries experience are multifactorial, and their rela- literature published 2004 to 2011. Syst Rev 2012 1: 57.
tionship is likely to be weakened by confounding 12. Costa LR, Daher A, Queiroz MG. Early childhood caries and
body mass index in young children from low income families.
variables, notably fluoride usage, which was not Int J Environ Res Public Health 2013 10: 867–878.
assessed in this study. 13. WHO. Physical Status: the use and Interpretation of Anthro-
pometry. Geneva: World Health Organization; 1995, WHO
Technical Report Series. 854
CONCLUSIONS 14. Khadilkar VV, Khadilkar AV. Revised Indian Academy of Pedi-
atrics 2015 growth charts for height, weight and body mass
Overall, BMI was not strongly associated with dental index for 5–18-year-old Indian children. Indian J Endocrinol
caries in this population. Although not statistically Metab 2015 19: 470–476.
significant, caries prevalence and experience were 15. WHO. Oral Health Surveys–Basic Methods. France: World
lower in overweight children. The association of BMI Health Organization 2013.
with dental caries varied across SES categories. Over- 16. Klein H, Palmer CE, Knutson JW. Studies on dental caries. I.
Dental status and dental needs of elementary school children.
weight children of high SES were at less risk of expe- Pub Health Rep 1938 53: 751–765.
riencing dental caries compared with normal-weight
17. Gadhave S, Nagarkar A. Kuppuswamy scale for measuring
children, while this association was not observed in socio-economic status: revised monthly income figures for
children of low and middle SES. 2015. Indian J Pediatr 2015 82: 1175–1176.

6 © 2016 FDI World Dental Federation

 Influence of SES on the BMI–caries association

18. Bratthall D. Introducing the Significant Caries Index together 35. Macek MD, Mitola DJ. Exploring the association between
with a proposal for a new oral health goal for 12-year-olds. Int overweight and dental caries among US children. Pediatr Dent
Dent J 2000 50: 378–384. 2006 28: 375–380.
19. Khadilkar V, Yadav S, Agrawal KK et al. Revised IAP growth 36. Schwendicke F, Dorfer CE, Schlattmann P et al. Socioeconomic
charts for height, weight and body mass index for 5- to 18- inequality and caries: a systematic review and meta-analysis. J
year-old Indian children. Indian Pediatr 2015 52: 47–55. Dent Res 2015 94: 10–18.
20. Alkarimi HA, Watt RG, Pikhart H et al. Dental caries and 37. Kumar S, Tadakamadla J, Kroon J et al. Impact of parent-
growth in school-age children. Pediatrics 2014 133: e616–e623. related factors on dental caries in the permanent dentition of
21. Kantovitz KR, Pascon FM, Rontani RM et al. Obesity and den- 6-12-year-old children: a systematic review. J Dent 2016 46:
tal caries–a systematic review. Oral Health Prev Dent 2006 4: 1–11.
137–144. 38. Gaur KL. Socio-economic status measurement scale: Thirst area
22. Elangovan A, Mungara J, Joseph E. Exploring the relation with changing concept for socio-economic status. Int J Inno
between body mass index, diet, and dental caries among 6–12- Res Dev 2013 2: 139–145.
year-old children. J Indian Soc Pedod Prev Dent 2012 30: 293– 39. Sheiham A, James WP. A reappraisal of the quantitative rela-
300. tionship between sugar intake and dental caries: the need for
23. Gupta P, Gupta N, Singh HP. Prevalence of dental caries in new criteria for developing goals for sugar intake. BMC Public
relation to body mass index, daily sugar intake, and oral Health 2014 14: 863.
hygiene status in 12-year-old school children in Mathura city: a 40. Touger-Decker R, van Loveren C. Sugars and dental caries. Am
pilot study. Int J Pediatr 2014 2014: 921823. J Clin Nutr 2003 78: 881S–892S.
24. Chakravathy PK, Chenna D, Chenna V. Association of anthro- 41. Moynihan P, Petersen PE. Diet, nutrition and the prevention of
pometric measures and dental caries among a group of adoles- dental diseases. Public Health Nutr 2004 7: 201–226.
cent cadets of Udupi district, South India. Eur Arch Paediatr 42. Kumar S, Panwar J, Vyas A et al. Tooth cleaning frequency in
Dent 2012 13: 256–260. relation to socio-demographic variables and personal hygiene
25. Sharma S, Shukla AK, Parashar P et al. Association between measures among school children of Udaipur district, India. Int J
dental caries and BMI-for age with sugar consumption among Dent Hyg 2011 9: 3–8.
school children. Asian Pac J Health Sci 2014 1: 58–62. 43. Gambhir RS, Brar P, Singh G et al. Utilization of dental care:
26. Tripathi S, Kiran K, Kamala BK. Relationship between obesity An Indian outlook. J Nat Sci Biol Med 2013 4: 292–297.
and dental caries in children–a preliminary study. J Int Oral 44. Jani R, Mihrshahi S, Mandalika S et al. Accuracy of mothers’
Health 2010 2: 65–72. perceptions of their child’s weight status. Indian Pediatr 2014
27. Thippeswamy HM, Kumar N, Acharya S et al. Relationship 51: 412–413.
between body mass index and dental caries among adolescent 45. Bhave S, Bavdekar A, Otiv M. IAP National task force for
children in South India. West Indian Med J 2011 60: 581–586. childhood prevention of adult diseases: childhood obesity.
28. Sakeenabi B, Swamy HS, Mohammed RN. Association between Indian Pediatr 2004 41: 559–575.
obesity, dental caries and socioeconomic status in 6- and 13-year- 46. Lundahl A, Kidwell KM, Nelson TD. Parental underestimates
old school children. Oral Health Prev Dent 2012 10: 231–241. of child weight: a meta-analysis. Pediatrics 2014 133: e689–
29. Honne T, Pentapati K, Kumar N et al. Relationship between e703.
obesity/overweight status, sugar consumption and dental caries 47. Arcan C, Hannan PJ, Himes JH et al. American Indian parents’
among adolescents in South India. Int J Dent Hyg 2012 10: assessment of and concern about their kindergarten child’s
240–244. weight status, South Dakota, 2005–2006. Prev Chronic Dis
30. Subramaniam P, Singh D. Association of age specific body mass 2012 9: E56.
index, dental caries and socioeconomic status of children and 48. Black JA, Park M, Gregson J et al. Child obesity cut-offs as
adolescents. J Clin Pediatr Dent 2011 36: 175–179. derived from parental perceptions: cross-sectional questionnaire.
31. Sharma A, Hegde AM. Relationship between body mass index, Br J Gen Pract 2015 65: e234–239.
caries experience and dietary preferences in children. J Clin
Pediatr Dent 2009 34: 49–52.
Correspondence to:
32. Werner SL, Phillips C, Koroluk LD. Association between child-
hood obesity and dental caries. Pediatr Dent 2012 34: 23–27. Santhosh Kumar,
33. Sanchez-Perez L, Irigoyen ME, Zepeda M. Dental caries, tooth
Population and Social Health Research Programme,
eruption timing and obesity: a longitudinal study in a group of Menzies Health Institute Queensland and School of
Mexican schoolchildren. Acta Odontol Scand 2010 68: 57–64. Dentistry and Oral Health,
34. Kopycka-Kedzierawski DT, Auinger P, Billings RJ et al. Caries Griffith University,
status and overweight in 2- to 18-year-old US children: findings
from national surveys. Community Dent Oral Epidemiol 2008
Queensland, Australia.
36: 157–167. Email: [email protected]

© 2016 FDI World Dental Federation 7