Introduction

Dentists Be Damned

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Abnormal growth/ weight gain in young children is a substantial public health problem which causes much concern among parents and health professionals.

Recent reports suggest that in many established market economies changes in dietary practices have resulted in a change in children and adolescents' body mass index. Among the reported dietary changes are alterations in the pattern of intake of carbohydrates. It would seem entirely consistent with current knowledge to assume that such changes may also impact upon dental caries in the child population.

Dental caries is a disease which attacks the dental hard tissues by demineralising the enamel. If oral conditions are favourable then this demineralisation can progress from the outer enamel layer of the tooth into the softer underlying dentine, resulting in decay. Dental decay is more common in individuals who have frequent intakes of dietary sugars (fermentable carbohydrates). Frequency of intake of carbohydrate is more predictive of the decay process than the absolute amount. Dental caries is also an extremely widespread childhood disease. It is particularly prevalent among deprived populations (Wright, 2000).

Dental caries is the most common reason for children undergoing general anaesthesia and thereby is therefore a major cause of exposure of small children to the medical risks associated with general anaesthesia (Whittle, 2000).

A number of nutritional factors, which may be factors in growth and development such as Vitamins A and D, water hardness and protein, have been hypothesised as potentially linked to dental caries (Mellanby & Pattison, 1928; East, 1941; Aptone-Merced & Navia, 1980). However, there is little evidence to substantiate that the systemic effects of poor nutrition increase the risk of dental decay, and it is generally accepted that while diet can have a profound local effect on erupted teeth, it has much less effect while the teeth are forming(Rugg-Gunn, 2000).

It has been demonstrated that low birth weight children more frequently have hypo plastic defects in the enamel of their teeth than normal weight babies, but that dental caries is also less frequent (Fearne et al, 1990).

An association between physical problems affecting the mouth, and childhood growth, has been hypothesized and it has been suggested that dentists may be ideally placed to recognize children at risk of poor growth and development (Boyd, 1998).

The concept that dental disease and child's body weight may be related was raised as early as 1982, when a retrospective case-note study examined the body weights of children attending for general anaesthetic tooth extractions, were compared to children attending for routine dental care (Miller et al 1982) and subsequent studies have suggested that treatment of caries may lead to improvement in weight gain (Acs et al, 1998, 1999; Malek Mohammadi et al, 2009) at least in children whose growth is below average.

This chapter presents evidence which strongly suggests that children's growth is affected by the state of their dental health. These relatively simple observations are very important, as they provides yet another reason for policy makers and Governments to invest time, resources and expertise in improving both children's diets, and their dental health. It is essential to remember that dental caries is one of only very few common childhood diseases which cause large numbers of the child population to undergo general anaesthesia. Children who are allowed to develop dental decay therefore suffer, not only in terms of potential effects on their growth and development, but also directly, as the treatment, if it is carried out using general anaesthesia poses a serious health risk to the children involved.

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