Associations Between Obesity, Dental Caries, Erosive Tooth Wear and Periodontal Disease in Adolescents: A Case Control-study
Condition: Obesity; Obesity, Childhood; Tooth Wear; Tooth Erosion; Dental Caries; Dental Plaque; Gingivitis
MeSH terms: Gingivitis; Dental Caries; Periodontal Diseases; Dental Plaque; Tooth Wear; Tooth Attrition; Tooth Erosion; Obesity; Pediatric Obesity
Study type: Observational

Summary: 
      Objectives To compare oral health (dental caries, periodontal status, and erosive tooth wear
      (ETW)), diet and oral hygiene habits between obese and normal weight adolescents, and to
      explore possible risk associations.

      Materials and Methods In this case-control study, a convenient sample of 81 obese adolescents
      (age range 11-18) from a rehabilitation centre, and 81 age-sex-matched normal weight
      adolescents were selected. Groups were defined using the Body Mass Index and growth curves
      for Flemish. Oral health was measured using DMFT, gingival, plaque and BEWE index. A
      validated questionnaire was utilized to assess diet and oral hygiene habits.
    

Detailed description: 
      Participants and ethical aspects For this case-control study, a total of 162 adolescents
      residing in Belgium were examined between July 2015 and October 2015.

      Height and weight were measured to calculate the Body Mass Index (BMI) of the participants.
      Obese and normal weight groups were defined using the BMI according to the European Childhood
      Obesity Group (ECOG) and the growth curves for Flemish boys and girls (2-20years). Only the
      participants with obesity were included in the case group (having a BMI above the 97th
      percentile + 2.17 to+2.18 SDS), whereas only the participants with normal weight were
      included in the control group (BMI between the 10th and 90th percentile -1.64 to +1.64 SDS).

      Clinical examination Anthropometrical and dental examinations were performed in the
      educational institutions. Before scoring, dental surfaces were dried using sterile gauze.
      Standard illumination (LED head lamps), sterile number five mouth mirrors and CPI periodontal
      probes (WHO 1997) were used. Caries experience was screened using DMFT index (Decayed,
      Missing, Filled Teeth) with a subdivision for D1 (early caries, 'white spots'), D2 (enamel
      caries) or D3 (dentine caries). The periodontal status was evaluated by measuring the
      Gingivitis index (Silness and Loë, 1963), Plaque index (Silness and Loë, 1964) and the
      presence of periodontal pockets (≥4mm) in all Ramfjord teeth (1.6, 2.1, 2.4, 3.6, 4.1 and
      4.4). Data were obtained from the neighbouring tooth in cases where one of these teeth were
      not present. Deciduous teeth and teeth with developmental disturbances were excluded.
      Regarding ETW, prevalence and severity was recorded using the Basic Erosive Wear Examination
      (BEWE index). According to this index, every permanent tooth surface is evaluated and is
      classified into a 4 score criteria, "0" being an indication for the absence of ETW, "1" being
      initial loss of surface texture, "2"* being distinct defect, hard tissue loss affecting less
      than 50% of tooth surface and "3"* being an indication for hard tissue loss and presence of
      ETW in more than the 50% of the surface (*usually involving dentin). The final BEWE sum score
      was the result of the sum of the highest score recorded per sextant .

      Reproducibility Two paediatric dentists (FM and SD) were educated, instructed and calibrated
      for DMFT index. The examiners scored twice several clinical cases in two sessions separated
      by a two-week period. Then, the examiners scores were compared against an experienced
      benchmark (LM).

      Questionnaire A validated questionnaire was applied in order to assess oral hygiene and
      dietary habits. Prior to initiation of the study, a content validation of the questionnaire
      was performed by five professors with experience in epidemiology. For the reliability of the
      questionnaire, a group of 20 students (15-year-old) were asked to complete the questionnaire
      twice separated by a two-week period. Once validated, the questionnaire was applied to each
      participant of the study on the same day of dental examination. Participants were asked to
      answer the questionnaire according to their habits just before they enter the rehabilitation
      centre.
    

Intervention name(s): Dental examination
Intervention type(s): Other
Intervention description(s): In this cross sectional observational study only Dental examination and a self response survey was applied.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Cases were all the obese children/adolescents (N=81; age range 11 to 18 years-old) who were
        recently participating in a treatment program for obese patients in a rehabilitation centre
        for chronic diseases (Zee Preventorium, De Haan, Belgium). Based on the number of cases, 81
        normal weight students of two Belgian secondary schools (Deinze, Belgium) were recruited as
        controls. Controls were sex-age-matched, had the same education level and socioeconomic
        status (SES).
      
Keywords: Tooth wear