By Katie Melko, RDH, MSDH
Research has linked childhood obesity to eating unhealthy foods that contain high amounts of saturated fats and sugars. Eating foods like these all day long not only can lead to a child becoming obese; it can also contribute to childhood dental caries. I believe this is an area that has not been researched enough. Most research I found on the topic was outdated or from countries other than the United States.
Families living below poverty level in areas with a low socioeconomic status often cannot afford healthy foods. Others don’t know how to effectively shop for healthy foods in an affordable way. To add to this, their children’s oral hygiene efforts are often minimal because they don’t have the proper tools and education to realize how important it is to take care of their teeth. There are multiple factors that contribute to these issues, including immigration, language barriers, financial burdens, and lack of education.
The issues surrounding the well-being of children need to be addressed because children are the future of our world. Without proper education and awareness among parents and dental professionals, obesity and dental caries among children will become progressively worse and increasingly difficult to interrupt.
Statement of the problem
An overworked human body that carries too much extra weight causes stress on the heart. Cardiovascular disease is on the rise in the US and is the number one largest financial burden in Australia.1 Additional research can shed light on this topic and lead to multidisciplinary work groups to help reduce obesity and childhood dental caries. When looking at obesity and dental caries together, there are many factors that come into play. Current research is trying to determine if childhood obesity causes an increase in childhood dental caries, the most common chronic childhood disease.5
Dental caries in an obese child can lead to a life of dental and medical issues. Dental decay that isn’t treated in a timely manner can cause pain, increased risk of infection, and can lead to extensive dental procedures. This can cause a child to grow up fearing the dentist and avoiding preventive treatment. This causes a snowball effect of dental issues and pain during their lifetime. When a child is in pain, everything else decreases - energy, attention span, communication skills, ability to eat, ability to talk, and sleep. Children need all of these things to be healthy and successful.
Current research seeks a correlation between childhood obesity and childhood dental caries in those who live in low socioeconomic areas. The data can help raise awareness of these problems. It can also show how access to care is a major difficulty for underprivileged families. This research is important to both public health professionals and underprivileged families. It can also help dental professionals when they apply for grants to help treat these populations.
There is an urgent need for multidisciplinary work groups between professionals. Resources that allow various health professionals to update one medical profile per patient will not only raise awareness of whole-body health, but will also increase referrals. This will decrease misdiagnosis and will help patients understand the connection between treating their whole body versus treating only what hurts.
Additional research will create the opportunity to increase advocacy, raise awareness, and educate communities. This will lead to implementing exercise programs for children, as well as nutritional, dental, medical, and behavioral health-care programs. Research shows that children may eat to cope with their feelings or deal with issues such as bullying, and they may not have any choice in the foods they are given at home.
Nutritional counseling can benefit families and create healthy options when it comes to food selection. If a dietician can demonstrate how to buy healthy foods at a low cost, this can help families eat healthier and have fewer medical and dental issues. The link between childhood dental caries and childhood obesity is a multifactorial issue that includes age, race, ethnicity, gender, socioeconomic status, living in a rural versus urban area, and insurance.
Does an obese child who lives in a low socioeconomic area have an increased risk of childhood dental caries? When looking at the research regarding the correlation between childhood dental caries and childhood obesity, multiple variables and factors come into play - different indexes used to collect data, surveys, the reliability of data, sample size, and time constraints to name a few.
While fluoridated water has helped ease dental caries in children, it can’t stop the disease. Early childhood caries is five times more prevalent than asthma, yet there is a lack of advocacy surrounding the issue.6 More than 50% of children ages five to nine have at least one cavity or filling, and that increases to 78% among 17-year-olds.6 More than 51 million school hours are lost due to dental-related illnesses.5
According to the European Journal of Paediatric Dentistry (EJPD), dental hygiene plays a significant role in reducing caries. Children may not brush and floss twice a day. They may have irregular home hygiene and often eat after brushing. One study looked at schools that were taking preventive steps by providing toothbrushes and toothpaste for children to brush after lunch.2
Bio Med Central reported that 99.8% of the children in their study had a dental problem, whether it was dental caries, calculus, gingivitis, or periodontal disease, with untreated dental caries being the most common. Also, boys had 100% dental issues and females had slightly less. There was no reason or evidence as to why this was the case. The study showed that the parents’ lack of education was a major issue. Many parents believe that because children’s teeth will be replaced by permanent teeth, they don’t need to take caries seriously, even though dental services for their children are covered by insurance.3
Early caries detection and noninvasive interventions are important for caries prevention according to the Journal of the American Dental Association (JADA). Not all lesions progress to cavitation, but how do we determine which white spot lesions will progress?
Some research included questionnaires to gain information on fluoride intake from water, dietary fluoride supplements, and fluoride dentifrices. The fluoride intake was used as a control variable in models developed to predict caries risk.4 Studies show that topical fluoride can also aid in caries reduction and remineralization of enamel. It is recommended that fluoride varnish be applied at least every six months to be effective in caries reduction.
The research I found was able to present evidence that in some aspects there is a direct correlation between obesity and childhood dental caries; however, I feel more research needs to be conducted on this topic. Both childhood obesity and caries risk have many factors as separate entities. Combining the two makes it much more complex. Different aspects of this topic need to be evaluated in depth to give more concrete, valid, well-rounded research results with an adequate sized study population. RDH
School-based dental sealant programs
According to the CDC, children in low socioeconomic areas are less likely to have dental sealants placed and have more urgent dental needs than children in high socioeconomic areas. Having a dental sealant program in schools located in low-income areas will help reduce decay, increase early detection of decay, and educate children on oral health care. These programs have been very impactful in these communities. Research has also shown that most children in low-income areas aren’t using their insurance and often go without dental care. By placing sealants on children in school, we can reduce the time lost in the classroom due to illness or pain and get children the care they need. Dental sealants and preventive care can help improve children’s oral health and reduce the risk of their having pain and fearing the dentist.
Here are three standout statistics the CDC released in October 2016 from research gathered from school-based sealant programs. These statistics speak volumes!
- “About 43% of six- to 11-year-old children had a dental sealant. Low-income children were 20% less likely to have sealants than higher-income children.”
- “School-aged children without sealants have almost three times more cavities than children with sealants.”
- “Applying sealants in school-based programs to the nearly seven million low-income children who don’t have them could save up to $300 million in dental treatment costs.”
Children from low-income areas often eat their meals through food plans at their school, local food pantries, and soup kitchens. The foods provided aren’t always the healthiest and definitely aren’t the best for the children’s teeth. These factors play into childhood obesity and high dental decay in children. How can we bridge the gap? How can we give more access to care to these children?
Multidisciplinary workforces can help these children by offering education, dental care, medical care, behavioral health care, and nutritional counseling. Dental therapists can also help bridge this gap, working in public health settings and bringing care to children. Dental sealants are a great way to help fight against decay, and if we put all these working pieces together, the results can have a huge impact!
- Katie Melko, RDH, MSDH
Katie Melko, RDH, MSDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She sits on three workgroups, two for ADHA and one for NBDHE, and has practiced dental hygiene since 2009.
References
1. Alswat K, Waleed SM, Moustafa AW, Ahmed AA. The association between body mass index and dental caries: cross-sectional study. J Clin Med Res Journal of Clinical Medicine Research 8.2 (2016): 147-52. Web.
2. Costacurta ML, DiRenzo L, Sicuro L. Dental caries and childhood obesity: analysis of food intakes, lifestyles. European Journal of Paediatric Dentistry (2014): n. pag. Web.
3. Yang RJ, Sheu JJ, Chen HS, Lin KC, Huang HL. Morbidity at elementary school entry differs by sex and level of residence urbanization: a comparative cross-sectional study. BMC Public Health 7.1 (2007): 358. Web.
4. Marshall TA, Eichenberger-Gilmore JM, Broffitt BA, Warren JJ, Levy SM. Dental caries and childhood obesity: roles of diet and socioeconomic status. Community Dentistry and Oral Epidemiology 35.6 (2007): 449-58. Web.
5. Oral Health in America: A Report of the Surgeon General (Executive Summary). N.p., n.d. Web. 26 Apr. 2016.
6. Werner S, Phillips C. Association between childhood obesity and dental caries. Pediatric Dentistry 34.1 (2012): 23-27. Web.
