EurAsian Journal of BioSciences

Eurasia J Biosci 14, 4503-4506 (2020)

Association between caries experience and Body Mass

Index (BMI) among preschool children in Kuantan
Ahmad Faisal Ismail 1,2*, Anis Amira Adon 3, Amyrah Nur Fariesya Husain Ahmad 3,
Susi Sukmasari 1, Yunita Dewi Ardini 1
1
Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, International Islamic University
MALAYSIA
2
International Islamic University Malaysia (IIUM) Medical Centre, Pahang, MALAYSIA
3
Kulliyyah of Dentistry, International Islamic University Malaysia, MALAYSIA
*Corresponding author: [email protected]

Abstract
Introduction: Dental caries and obesity are significant and common oral health and general health
problems faced by children. Both caries and obesity are reported to share common risk factors. There
are conflicting results in the literatures regarding the relationship between dental caries and childhood
body mass index particularly among preschool children. Thus, this research aims to measure the
prevalence of dental caries and determine the relationship between dental caries and body mass
index (BMI) among preschool children in Kuantan. Methodology: A cross sectional study was carried
out in kindergartens in Kuantan using the convenience sampling method. A total of 180 participants
were enrolled in this study with 60 participants each for every group. The participants were classified
into underweight, normal and overweight based on their BMI. Their caries index was recorded using
WHO guidelines. For BMI, participant’s weight and height were recorded and categorized by using
the BMI Calculator for Child and Teen (CDC). Result: Pertaining to dental caries, 73.3% of the
participants had dental caries. The overweight group recorded the highest caries index and the
highest percentage of visible plaque, but the results were not significant. Conclusion: Our study
concluded that there is no association between dental caries and body mass index among preschool
children in Kuantan.

Keywords: dental caries, body mass index, obesity, preschool children

Ismail AF, Adon AA, Ahmad ANFH, Sukmasari S, Ardini YD (2020) Association between caries
experience and Body Mass Index (BMI) among preschool children in Kuantan. Eurasia J Biosci 14:
4503-4506.

© 2020 Ismail et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution License.

INTRODUCTION of oral hygiene (Ainamo, Bay. 1975).It is known that the

presence of dental plaque promotes the occurrence of
Dental caries and obesity are significant and dental caries. When cariogenic bacteria in the biofilm
common oral health and general health problems faced ingest fermentable carbohydrate, this will result in a drop
by children. Reported caries prevalence among 5-year in the pH of the dental plaque which promotes cavitation.
old children in Malaysia was found to be 71.3% while for Based on previous studies, there are no conclusive
6-year old children was 74.5% (Che Salleh, et al. results found (Yen, Hu, 2013).Three studies were found
2015).Dental caries is defined as demineralization of to have positive associations, two studies found that
tooth that occurs due to the interaction between biofilm there is an inverse association, two studies found that
and fermented carbohydrate on the tooth surface over there is no association between these two factors and
time (Heymann, Swift, Ritter, 2014).Recently, there are another study found a u-shape relationship (Chen, et al.
increasing interest in studying the relationship between 2018).The prevalence of dental caries among preschool
obesity and dental caries in children. Dental caries and children in Malaysia is increasing for all class of caries
obesity are thought to share common risk factors. It is except anterior caries. There are also no studies
also believed that understanding more about the conducted regarding the relationship between obesity
relationship between these two precursors can aid in and dental caries in Malaysia except in the east coast
controlling these two diseases at once. BMI is used to (Ruhaya, et al. 2012; Powar, et al., 2019; Motahharinia,
measure weight status based on height and weight of an
individual (Scorzetti, et al. 2013; Moghadasi,
Received: May 2019
2019).Those with higher BMI will have higher meal
Accepted: March 2020
intake that will affect oral hygiene (Nayak, et al.
Printed: October 2020
2015).Visible Plaque Index is used to measure the level

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2020).The aim of our research was to determine caries RESULTS

experience among pre-school children and to identify A total of 180 preschool children were involved in this
the association between BMI groups and dental caries study. The intra-examiner reliability score is 0.94. The
among pre-school children. mean age of the participants in this study is 5.13 with
male-to-female ratio of 45:54. Pertaining to dental
METHODOLOGY caries, 73.3% of the participants had dental caries. The
Inclusion criteria overweight group recorded the highest caries index
Participants aged 4 to 6 years old consented by the (mean dmft of 4.92) and the highest percentage of
child’s parent or legal guardian and medically fit and visible plaque (mean percentage of 25%). The mean
healthy. number frequency of food intake for overweight and
Participants underweight children are similar with the mean of 2.6
The present cross-sectional study was conducted on times daily. Overall, frequency of toothbrushing for all
preschool children in Kuantan Pahang from February groups are almost the same. From the total, 44% of the
2019 until August 2019. Eight kindergartens around participant’s parents are classified into high income
Kuantan were selected through convenience sampling group.
to be included in the study. A sample size of 180 was There is significant correlation found between visible
decided upon sample size calculation using G* Power plaque and BMI (p=0.027), and between visible plaque
3.2.9.2 with power of study of 80% based on medium and dmft (p<0.05). Our study found no correlation
sized effect and 10% drop out. The participants were between BMI value, caries index, frequency of
classified into 3 subgroups (60 participants in each toothbrushing, and amount of visible plaque.
group) according to their BMI value, which are No significant correlation was noted between the BMI
underweight, normal and overweight and obese. groups and dmft score from our study.
Clinical examination
DISCUSSION
Parents were asked to sign a consent form and fill up
questionnaires that had been given. The data was Our study utilized the cross-sectional methods and
utilized to obtain demographic data for example age, convenience sampling to determine the caries
parents’ level of education, participant’s exposure to experience and BMI index among preschool children in
fluoride and participant’s eating habits. On the day of Kuantan. The mean dmft of our participants was lower
examination, the body weight of each student was compared to previously reported studies in the same
measured while wearing minimal clothing to the nearest demographic area(Ismail, et al. 2018). but similar to the
0.1 kg with a digital scale and their height was national report (Che Salleh, et al. 2015).While the
determined without shoes to the nearest 0.1 cm, using a previous study consisted of 93.5% of parents with lower
stadiometer following the method by Azam (Goodarzi, et than average income, our study enrolled 35% of parents
al. 2019).Then, the data was used to calculate for BMI with higher than average monthly income.
value and its classification. Dental examination of the Higher intake of sugar and carbohydrates lead to an
participants was held at the corresponding school itself increase in weight of the children and also lead to
and held on the dental chair under light. Dental Caries greater accumulation of sugar in plaque that will feed the
experience is measured and recorded using dmft biofilm for the formation of dental caries. Based on
according to World Health Organization (WHO).] The current research, this can be understood due to the
decayed, missing, and filled teeth (dmft) in the students highest number of visible plaque scored by the children
were assessed by a single, calibrated dentist. Caries in the overweight group. It is agreed that plaque is one
was diagnosed on clinical and visual examination of the factors that cause the formation of dental caries.
without radiographic exposure. Even though the frequency of food intake is same as
Ethical approval other groups, it can be postulated that children in this
This study was approved by IIUM Research Ethics group may eat a larger amount of food during each meal,
Committee (IREC 2019-014). Several kindergartens which explains the high plaque score. A study also
were approached and invited to participate in this study. mentioned that there is higher significance of children
Interested participants and parents were asked to fill up with caries having visible plaque based on their research
a consent form prior to conducting the clinical (Johansson, et al. 2010).However there is a study that
examination. opposed this statement saying that these overweight
children might consume food with higher fat and
Statistical analysis
unrefined carbohydrates, but not necessarily high in
Data analysis was carried out using SPSS 21.0
sugar and refined carbohydrates (Alshihri, et al.
software package (SPSS Inc., IBM, and Chicago, IL,
2019).This could increase obesity, but not necessarily
USA). Data was analyzed by One-way ANOVA, Chi-
have a direct link to visible plaque as plaque are mostly
square and Pearson correlation coefficient software.
made up from carbohydrates (Brown, 2009).

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The current study showed that children with high BMI of plaque based on the frequency of toothbrushing of the
values did have a high dmft score compared to the groups (Lang, Cumming, Löe, 1973).It is assumed that
underweight and normal grouped but it is not significant. the amount of plaque present may be due to other
Being overweight can be due to an increased intake of factors such as oral bacterial flora and saliva. There is
dietary fats. A diet high in fat has less influence on the also research showing that the efficacy of the
development of caries than a diet high in sugar. This toothbrushing practice is rather important than the
could be a possible explanation for the lack of frequency of toothbrushing for the quality of plaque
association between obesity and dental caries (Tramini, removal (Attin, ornecker, 2005).However, numerous
et al. 2009).Furthermore, caries is a multifactorial research proposed that the frequency of toothbrushing
disease. It is more complex than could be explained by improves oral hygiene by reducing the amount of plaque
carbohydrate consumption alone. Other etiological (Barenie, Leske, Ripa, 1976. Attin, ornecker, 2005).A
factors that can cause caries in children are oral cavity study claimed that gingivitis in school children who brush
quantitative and qualitative bacterial components, more than once daily is significantly different compared
overall oral health status(Shahraki, et al. 2013).including to those that only brush once daily(Barenie, Leske, Ripa,
the frequency and efficacy of plaque removal(Alkarimi, 1976).while another study mentioned that those who
et al. 201).4and the amount and components of saliva brush their teeth frequently are less prone to new carious
(Lempert, et al. 2013). lesions (Kumar, Tadakamadla, Johnson, 2016).
Our data showed children who brushed their teeth
more has a higher visible plaque score. This might be CONCLUSION
due to incorrect toothbrushing techniques practiced by Our study concluded that caries experience among
the children and also the time when the teeth are being preschool children in Kuantan is high, and there is no
brushed. The children might also be using toothbrush association between body mass index and dental caries
longer than 3 months period which affect the quality of among the groups.
the bristle on the brush. Some researches proved that
there is an insignificant difference in plaque content
ACKNOWLEDGEMENT
regardless of the frequency of toothbrushing. (Lang,
Cumming, Löe, 1973. Attin, Hornecker, 2005). study This research project is funded financially through
stated that there is little difference between the amounts IIUM grants (IRF19-015-0015).

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