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Adv Oral Research ORIGINAL RESEARCH All Rights Res

Journal of Advanced Oral Research, Vol 4; Issue 1: Jan - Apr 2013 www.joaor.org

Association between Dental caries and body mass

index among 12 and 15 years school children in
Shimla, Himachal Pradesh
Fotedar Shailee* Sogi GM Sharma KR
*MDS, Lecturer, Department of Public Health Dentistry, H.P Government Dental College, Shimla, Himachal
Pradesh- India,MDS, Professor, Department of Public Health Dentistry, KLE VK Institute of Dental Sciences,
Belgaum, Karnatka, MDS, Professor and Head, Department of Public Health Dentistry, HP Government Dental
College, Shimla, Himachal Pradesh, India. Email:drfotedar@rediffmail.com
Objective: The aim of our study was to evaluate the association between weight and dental caries among
12 and 15 years school children in Shimla city, Himachal Pradesh, India.
Method: A sample of 1011 school children was selected by a two stage cluster sampling method. Clinical
recording of dental caries, was done according to WHO diagnostic criteria 1997 and BMI percentile was
calculated based on age and gender-adjusted published scales. The data was analyzed by Statistical
Package for Social Sciences (SPSS) version 13. The statistical tests used were t-test, ANOVA, chi-
square test and correlation analysis. A p value < 0.05 was considered statistically significant.
Results: The lower percentage of children belonged to normal range of Body Mass Index in Government
schools as compared to private schools and the difference was statistically significant (P < 0.001).
Correlation analysis showed BMI had a negative correlation with DMFT (r = 0.312, p < 0.011).
Conclusion: This study showed higher percentage of children was in the underweight category of BMI
and the mean DMFT was higher in underweight as compared to overweight. These children would have
acute or
Serial Listing: Print-ISSN (2320-2068)
Online-ISSN (2320-2076)
Formerly Known as Journal of Advanced Dental Research
Bibliographic Listing: Indian National Medical Library, Index Copernicus, EBSCO Publishing Database,
Proquest, Open J-Gate.
chronic nutritional stress due to poor socioeconomic status and lack of knowledge about general and oral
health. Continous education and motivation of parents and children can help to some extent to improve
their health status.
Keywords: Dental caries, body mass index, school children.
Obesity and overweight are defined as having an excess of body fat related to lean mass, with
multifactorial conditions involving psychological, biochemical, metabolic, anatomic and social
alterations.[1] At present obesity among children is a problem in both developed and less developed
countries around the world. Furthermore, children who are at risk for being overweight during preschool
years carry a greater probability of being overweight by age twelve.[2]
Weight status in children is measured by assessment of body mass index (BMI) corresponding to gender
and age-ranked percentages. Children are considered to be overweight if they are between the 85th and
95th percentile of age and gender related BMI and are considered to be obese if they are at or beyond the
95th percentile of age and gender related BMI according to Center for Disease Control and Prevention
(CDC) guidelines.[3]
Childhood obesity may lead to serious disease, a decrease in life expectancy and numerous other
problems. A higher body weight is associated with a greater risk for type 2 diabetes 8
Journal of Advanced Oral Research, Vol 4; Issue 1: Jan - Apr 2013 www.joaor.org
and might be at risk factor for cardiovascular disease, asthma, arthritis, and general poor health. [4,5]
Obesity in children may also result in emotional unhealthiness.[6]
Increase of obesity worldwide is due to using non-alcoholic beverages, fast food and a decrease in
exercise.[7] Diet plays an important role in the obesity epidemic, as dietary habits in children have suffered
major changes in the last thirty years.[8] Consumption of soft drinks is associated with reduced vitamin
and mineral intake and an excess of dietary carbohydrates. The oral health implications of nutritional
practices were demonstrated by a review of childrens eating habits in the United States between 1988
and 1994.[9] The authors of that study found an association between poor dietary practices (meal
fragmentation, missed breakfast, low fruit, and higher carbohydrate intake) and caries.
Due to the strong evidence, supporting the association of dental caries with irregular dietary patterns &
quality and also the fact that the abnormal dietary intake has been linked to the development of obesity at
a young age[10], a link between dental caries and weight is biologically plausible. So, the present study
was conducted to evaluate the relationship between BMI and dental caries among 12 and 15-year old
school children in Shimla city, Himachal Pradesh, India.
Materials and Method:
A cross sectional epidemiological study was conducted among the school going children aged 12 and 15
years in Shimla city. Ethical approval to conduct the study was obtained from the Institutional Review
Board of H.P. Government Dental College and Hospital, Shimla. Written consent for the participation of
the children in the study was obtained from the Principals of the concerned schools.
A pilot study was conducted by randomly selecting one government and one private school from the
available list of schools obtained from the Directorate of Education H.P. Results from this pilot study
showed the prevalence of dental caries was 23.4%. The sample size was calculated by taking this
prevalence rate and computed using the Epi Infoversion 6 statistical package at 95% confidence interval
which came out to be 985.
The sample frame consisted of middle and high schools (public and private) in Shimla city, obtained from
the Directorate of Education H.P. The study sample was recruited by a two-stage cluster sampling
technique. For the purpose of the study, Shimla city was arbitrarily divided into 4 geographical regions,
which correspond to the four varying demographic areas of the city: Shimla municipal and 3 Shimla
Planning Areas (Dhalli, Tutu and New Shimla). Schools from each region were randomly selected to
obtain the desired sample size, such that there was an equal representation from each of the four zones.
Out of the total number (43) of government (26) and private schools (17), 7 public and 5 private schools
were randomly selected. In the second stage, eligible school children were stratified according to age and
gender, and randomly selected in proportion to the total number of 12 and 15 years old students enrolled
in each school to reach the sample of about 1011 subjects over a period of three months April- June 2009.
The fluoride levels in water in Shimla city is less than 1.5.[11]
All the children were clinically examined for dental caries by one of the authors (SF) trained for clinical
examination during several educational and clinical sessions in the department of Public Health Dentistry,
Government Dental College, Shimla. The procedure, diagnostic criteria were those recommended by the
World Health Organization (1997)[12] for assessment of dental caries. Data regarding general information,
was obtained through interview and recorded on a modified WHO proforma. The subjects were examined
by Dunning type III[13] clinical examination in their respective schools on a comfortable chair.
Body weight was recorded to the nearest 100-gram using a standard beam balance scale with the subject
barefoot and wearing light dresses. The balance was calibrated at the beginning of each working day and
at frequent intervals throughout the day. Body height was recorded to the nearest 0.5 cm according to the
following protocol: no shoes, heels together and head touching the ruler with line of sight aligned
horizontally. To avoid subjective errors, all the measurements were done by the same person and by one
recording assistant. Body Mass Index (BMI) was calculated using the standard formula Mass
(Kg)/height (m). BMI percentile was calculated by Center for Disease Control (CDC) BMI- for age
growth chart. Using age and gender specific criteria, subjects were categorized as underweight (<5%),
normal (<5% to <85%), overweight (85 to <95 %), and obese (95 %).[3]
Intra-examiner reproducibility as determined using Kappa statistic was 0.85. Five students were randomly
selected by asking the teacher to send any five of the students examined 9
Journal of Advanced Oral Research, Vol 4; Issue 1: Jan - Apr 2013 www.joaor.org
the previous day and re-examined the next day to determine intra-examiner reproducibility.
Table 1. Schools Male n % Female n % Total n %
Distribution of
according to
gender and
schools Age
12 years Govt. 156 48.4% 73 41.7% 229
Private 166 51.6% 102 58.3% 268 (53.9%)
Total 322 100.0% 175 100.0% 497 (100.0%)
15 years Govt. 148 48.7% 102 48.6% 250
Private 156 51.3% 108 51.4% 264 (51.4%)
Total 304 100.0% 210 100.0% 514 (100.0%)