Diet nutrition and dental health

It has been well-documented in animals that early malnutrition affects tooth development and eruption (Mellanby, 1928) and can result in increased dental caries later in life. But in humans, a causal relationship between nutritional status and dental health has not been directly demonstrated (Alvarez & Navia 1989). However two separate cross-sectional studies in Peruvian children have shown that malnutrition is associated with delayed tooth development and increased caries experience (Alvarez et al, 1988, 1990). However it has been shown beyond reasonable doubt that there is a distinct relationship between diet and dental caries (Gustafsson et al, 1954). These effects are accepted, but there are two important aspects to the relationship; food choice and nutrient intake, both may affect and be affected by, poor dental health.

The role of nutrition in the maintenance of health is well known. Nutritional deficiencies in the growing child, whether due to deprivation, over-indulgence, or mal-absorption syndrome may have significant impact on somatic growth (Root et al, 1971). The potential impacts of eating disorders on overall health have also been established (Gross et al, 1986). The constellation of poor dietary habits which result in early childhood caries is currently most recognized for its impact on the dentition, rather than on overall health. However recently, some reports have claimed that severe dental decay could be a contributing factor for poor growth in children (Miller et al, 1982; Acs, 1992; Ayhan et al, 1996; Malek Mohammadi et al, 2009).

One of the most important indicators of health is normal growth and normal growth is an indicator of nutrition. The health of the dentition would appear to have some effects on nutrition. Therefore, there may be a relationship between the health of the dentition and growth. Miller's study (as mentioned above), showed that 1105 children with severe dental caries who needed extractions of deciduous teeth under general anaesthesia (GA) were significantly lighter than 527 control children (Miller et al, 1982). One part of the study was a retrospective comparison of clinical records. The children were weighed as a routine and their height measured as well. A control group was selected from children who were attending for routine dental care (DC). The children in the GA group were lighter than those in the DC group and in the GA group 31.3% were below the 23rd percentile compared with only 17.1% in the DC groups. The second part of the study compared the diet history of the two groups. The frequency of eating was higher in GA group. The DC group ate animal protein more frequently than the GA group and the GA group had a higher fat intake. There was a significant difference between the groups, in their intake of refined solid carbohydrate between meals.

Another retrospective case control study was conducted in a paediatric population by Acs in 1992 and a review of anaesthesia records of children with nursing caries was undertaken (Acs, 1992). The weights of 115 children with no special medical history were compared to subjects matched for age, gender, race and socioeconomic status. The study group had at least one pulpally involved tooth and the comparison subjects had no gross carious lesions. The weight of children with caries was significantly lower than the control group and 8.7% of children with caries weighed less than 80% their ideal weight, compared with only 1.7% of the comparison group. The mean age of the low weight children with caries was significantly greater than for children at or above their ideal weights. This was interpreted as indicating that progression of caries may affect growth adversely.

In a similar study in Ankara similar results were obtained (Ayhan et al, 1996). In this study, the mean weight of 126 children, aged 3 to 5 years old with caries was compared with the mean weight of children with no caries but similar age and sex. The mean weight of case children was between 25th and 50th percentiles while the mean weight of control group was between 50th and 75th percentiles. Seven percent of children with caries weighed less than 80% of their ideal weight compared 0.7% of the control group children. Evaluation of height showed that it was similar to weight but head circumference was not statistically different in the two groups.

In a recent published study, data analysis from National Oral Health Survey in Philippines (Benzian et al, 2011) showed that prevalence of low BMI was significantly higher in children with odontogenic infections as compared with children without odontogenic infections.

The regression coefficient between BMI and caries was highly significant (p < 0.001). Children with odontogenic infections (PUFA + pufa > 0) [PUFA/pufa is an index used to assess the presence of oral conditions and infections resulting from untreated caries in the primary (pufa) and permanent (PUFA) dentition] as compared to those without odontogenic infections had an increased risk of a below normal BMI.

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