Anna Turska-Szybka1, Magdalena Świątkowska-Bury2, Agata Płusa2, Aleksandra Wawrzeńczyk-Gawałkiewicz2, Dariusz Gozdowski3, *Dorota Olczak-Kowalczyk1
Relationship between overweight/obesity and dental caries and oral hygiene among secondary-school students in Warsaw. Part I
Nadwaga i otyłość a choroba próchnicowa i higiena jamy ustnej u warszawskiej młodzieży licealnej. Część I
1Department of Pediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Student Scientific Society, Department of Pediatric Dentistry, Medical University of Warsaw
Mentor of Student Scientific Society: Associate Professor Anna Turska-Szybka, MD, PhD
3Department of Biometrics, Faculty of Agriculture and Ecology, Warsaw University of Life Sciences
Head of Department: Elżbieta Wójcik-Gront, PhD, DSc
Streszczenie
Wstęp. Zarówno nadwaga i otyłość, jak i próchnica zębów są określane mianem chorób cywilizacyjnych XXI wieku.
Cel pracy. Celem badania była ocena zależności pomiędzy chorobą próchnicową i higieną jamy ustnej a występowaniem nadwagi i otyłości u młodzieży licealnej.
Materiał i metody. Wśród 141 losowo wybranych uczniów trzech warszawskich liceów w wieku 18 lat przeprowadzono badania ankietowe dotyczące stanu zdrowia, najczęściej spożywanych produktów kariogennych w szkole oraz częstotliwości szczotkowania zębów; badanie stomatologiczne oceniające stan uzębienia (PUWZ/PUWP) i higieny jamy ustnej (PlI) oraz obliczono wartości BMI. Do analizy statystycznej wykorzystano testy t-Studenta, chi-kwadrat oraz analizę korelacji rang Spearmana (p < 0,05).
Wyniki. Włączono 118 osób. Średnia waga kobiet wynosiła 59,53 ± 11,43 kg, mężczyzn – 78,57 ± 20,29 kg. U 19 (16,1%) osób stwierdzono nadwagę, a u 3 (2,5%) otyłość. Wyższe BMI stwierdzano u mężczyzn. Produkty kariogenne spożywało więcej osób z BMI < 25. 83,3% młodzieży z nadwagą i 66,7% z otyłością najczęściej szczotkuje zęby 2 razy dziennie (różnice nieistotne statystycznie). Choroba próchnicowa występowała u 112 (94,9%) badanych. Średnie wartości wskaźników próchnicy PUWZ i PUWP wyniosły 6,52 ± 3,80 i 7,81 ± 5,66, natomiast higieny PlI – 0,75 ± 0,49. Wartości PUWZ były niższe u osób z BMI > 25, a PlI wyższe u osób z nadwagą i otyłością. Żadna z różnic nie okazała się statystycznie istotna.
Wnioski. Nie zaobserwowano zależności między wartością BMI oraz wskaźnikami próchnicy i higieny ani statystycznie istotnych różnic pomiędzy BMI a nawykami dietetycznymi. Indywidualne programy profilaktyczne i odpowiednia współpraca z lekarzem rodzinnym mogą pomóc w poprawie zdrowia jamy ustnej i utrzymywaniu właściwej wagi wśród młodzieży.
Summary
Introduction. Both overweight/obesity and dental caries are referred to as civilisation diseases of the 21st century.
Aim. The aim of the study was to assess the relationship between caries and oral hygiene and the occurrence of overweight and obesity in secondary-school students.
Material and methods. A survey on health status, the most frequently consumed cariogenic products at school and the frequency of toothbrushing was conducted; BMI was calculated; as well as dental examination to assess caries (DMFT/DMFS) and oral hygiene (plaque index – PI) was performed among 141 randomly selected 18-year-old students of three secondary schools in Warsaw. Student’s t-tests, chi-square tests and Spearman’s correlation were used for statistical analysis (p < 0.05).
Results. A total of 118 students were included in the study. The mean body weight was 59.53 ± 11.43 kg for women, and 78.57 ± 20.29 kg for men. There were 19 (16.1%) overweight and 3 (2.5%) obese adolescents. Higher BMI was found in men. The intake of cariogenic products was higher among students with a BMI < 25. About 83.3% of overweight and 66.7% of obese adolescents most often brush their teeth twice a day (differences not statistically significant). Caries was present in 112 (94.9%) students. The mean DMFT and DMFS were 6.52 ± 3.80 and 7.81 ± 5.66, and the plaque index was 0.75 ± 0.49. DMFT values were lower in subjects with BMI > 25, and PI was higher in overweight and obese participants (p > 0.05).
Conclusions. There was no relationship between BMI and caries or hygiene indices, and no statistically significant differences between BMI and consuming cariogenic products. Individual prevention programmes and good cooperation with general practitioners can help improve the oral health and proper body weight in adolescents.
Introduction
The increased incidence of overweight and obesity as well as dental caries, also among adolescents, is one of the current medical problems of the modern world. The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation in the human body, which is the consequence of a long-term positive energy balance. An energy imbalance between calories consumed and calories expended is the primary cause of obesity and overweight (1, 2). Obesity is considered a disease and included in the International Classification of Diseases (ICD-Code E66) (1).
Overweight and obesity are multifactorial, including contributions of physiological, biochemical, metabolic, anatomical, psychological and social factors (2-4). Obesity can result in poor posture, high cholesterol, high blood pressure, insulin resistance and type 2 diabetes, coronary plaque formation, hyperlipemia, fatty liver, cardiovascular diseases, stroke, increased risk of cancer, atherosclerosis and serious psychosocial consequences (2-5). Metabolic syndrome is one of the most common outcomes of overweight (2). The 2021 report of the World Obesity Federation and the 2022 meta-analysis also indicate a link between obesity and psychological problems, and even COVID-19 (6, 7). Dental caries is mentioned less often, although both diseases have common, modifiable risk factors, such as diet (poor eating habits, such as intake of sweet snacks, short breaks between meals, eating late in the evening, especially after brushing teeth, excess intake of carbohydrates [simple sugars] or sweet beverages) and lifestyle. Some studies have found no relationship, while other authors have reported a positive correlation or an inverse relationship between these diseases (8-13).
Both clinical entities are also a common health problem in many countries. According to a report by the International Obesity Task Force (IOTF), more than 1.9 billion (39%) adults aged ≥ 18 years were overweight. Of these, more than 650 million (13%) were obese. It has been estimated that 5.6% of adolescents aged 10-19 are obese (14). The 2008-2019 Eurostat data indicate an increase in the prevalence of overweight and obesity from 37.6 to 39.1% and 16.4 to 19%, respectively, among adults in Poland a network of health scientists around the world that provides rigorous and timely data on risk factors for non-communicable diseases, Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) (15). In the case of people under the age of 20 years, the NCD-RisC indicates that 31% of boys and 20% of girls were overweight, and 13% of boys and 5% of girls were obese in 2016 in Poland (15, 16).
The rates of caries in adolescents reach 100% in many countries (17). The research conducted as part of the Monitoring of the Oral Health of the Polish Population in 2016-2020 showed that dental caries (DMFT ≥ 1) was present in 93.2%, and healthy periodontal tissues in 68.8% of 18-year-olds (18). Only 67.8% of study participants brushed their teeth at least twice a day (18).
Aim
The aim of the study was to estimate the prevalence of overweight and obesity among secondary-school students in Warsaw and to assess the relationship between overweight/obesity and caries and oral hygiene.
Material and methods
Randomly selected students of three secondary schools in Warsaw aged 18 years who gave written consent to participate in the survey and clinical examination were qualified for the study. Malocclusion and treatment with fixed orthodontic appliances, chronic diseases or chronic pharmacotherapy, and incorrectly completed questionnaire were exclusion criteria.
The survey was anonymous, with each questionnaire assigned with the respondent’s number. The questionnaire included questions about socio-economic status; overweight and obesity in childhood and other family members; general health of the families of the surveyed adolescents and diseases predisposing to obesity; general diseases in adolescents; pharmacotherapy; cariogenic products most often consumed at school, and tooth brushing frequency.
Clinical examinations involved weight and height measurements and dental examination. The latter one was performed under standardised conditions, under artificial light, using a dental mirror and a WHO 621 periodontal probe. The presence of carious lesions and fillings in relation to teeth and tooth surfaces as well as teeth and tooth surfaces lost due to caries was assessed in accordance with the principles of oral examination and WHO criteria for the classification of clinical conditions (19). DMFT (tooth) and DMFS (tooth surface) and Plaque Index (PI) were determined (20).
Each participant’s BMI (Body Mass Index) was calculated (weight in kilograms divided by height in meters squared (kg/m2). Overweight was defined as a BMI of ≥ 25 and obesity as a BMI of ≥ 30, as per WHO guidance (1).
The study was approved by the Bioethics Committee at the Medical University of Warsaw (KB/210/2014).
The Student’s t-test was used to compare the means between the groups, while the chi-square test was performed to compare the fractions between the groups. Spearman’s rank correlation coefficient was used to assess relationships between selected pairs of features. Significance was set at 0.05 for all analyses. Statistica 13.3 was used for statistical analyses.
Results
Out of 141 candidates, 118 students were included in the study (75 females [63.56%] and 43 males [36.44%]). The mean body weight was 59.53 ± 11.43 kg for females and 78.57 ± 20.29 kg for males; the mean height was 166.3 ± 6.8 cm and 178.9 ± 17.1 cm, respectively. BMI values are presented in table 1. There were 19 (16.1%) overweight and 3 (2.5%) obese adolescents.
Tab. 1. BMI in the study group
| | Female | Male | Total |
| BMI | N (%) | Mean ± SD | N (%) | Mean ± SD | N (%) | Mean ± SD |
| < 25 | 64 (85.33%) | 20.34 ± 1.92 | 32 (74.42%) | 21.77 ± 1.82 | 96 (81.4%) | 20.81 ± 1.99 |
| 25-30 | 9 (12%) | 27.67 ± 1.19 | 10 (23.26%) | 26.29 ± 1. 33 | 19 (16.1%) | 26.90 ± 1.42 |
| > 30 | 2 (2.67%) | 35.00 ± 2.74 | 1 (2.3%) | 34.69 ± 0.00 | 3 (2.5%) | 34.89 ± 1.95 |
| Total | 75 (100%) | 21.51 ± 3.69 | 43 (100%) | 23.12 ± 3.13 | 118 (100%) | 22.10 ± 3.57 |
Considering the percentage of adolescents with different BMI values, no statistically significant difference was found between men and women (p = 0.278, chi-square test). On the other hand, when mean BMI was considered, a statistically significant difference between men and women was observed (p = 0.018, t-test).
Self-reported socioeconomic status (SES) was medium or high. None of the surveyed adolescents reported a low status (tab. 2).
Tab. 2. Self-reported SES by BMI and sex
| | Females | Males | Total |
| BMI | Medium N (%) | High N (%) | Medium N (%) | High N (%) | Medium N (%) | High N (%) |
| < 25 | 52 (85.2%) | 13 (92.9%) | 26 (74.3%) | 6 (75.0%) | 78 (81.3%) | 19 (86.4%) |
| 25-30 | 8 (13.1%) | 0 (0.0%) | 8 (22.9%) | 2 (25.0%) | 16 (16.7%) | 2 (9.1%) |
| > 30 | 1 (1.6%) | 1 (7.1%) | 1 (2.9%) | 0 (0.0%) | 2 (2.1%) | 1 (4.5%) |
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