Associations Between Obesity, Dental Caries, Erosive Tooth Wear and Periodontal Disease in Adolescents: A Case Control-study

December 3, 2021 updated by: University Ghent

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

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.

Study Type

Observational

Enrollment (Actual)

125

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

11 years to 18 years (ADULT, CHILD)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

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).

Description

Inclusion Criteria:

  • obesity in case group (having a BMI above the 97th percentile + 2.17 to+2.18 SDS),
  • normal weight in the control group (BMI between the 10th and 90th percentile -1.64 to +1.64 SDS). 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).

Exclusion Criteria:

  • smoking
  • chronic disease
  • receive treatment with antibiotics three months prior to the study
  • consume medications with side effects on the gums
  • wearing orthodontic appliances
  • other ethnicity (not Belgian) were excluded as ethnicity is an influential factor in the relation between caries and obesity.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Group Obese adolescents
BMI above the 97th percentile + 2.17 to+2.18 SDS
Other: Dental examination
In this cross sectional observational study only Dental examination and a self response survey was applied.
Group Normal weight adolescents
BMI between the 10th and 90th percentile -1.64 to +1.64 SDS
Other: Dental examination
In this cross sectional observational study only Dental examination and a self response survey was applied.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Oral health status
Time Frame: Once on the day of dental examination
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).
Once on the day of dental examination
Association of oral health status and diet/oral hygiene habits
Time Frame: Once on the same day of dental examination
A validated questionnaire was applied in order to assess oral hygiene and dietary habits. 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.
Once on the same day of dental examination

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University Ghent

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

July 1, 2015

Primary Completion (ACTUAL)

October 25, 2015

Study Completion (ACTUAL)

October 25, 2015

Study Registration Dates

First Submitted

December 9, 2019

First Submitted That Met QC Criteria

December 3, 2021

First Posted (ACTUAL)

December 6, 2021

Study Record Updates

Last Update Posted (ACTUAL)

December 6, 2021

Last Update Submitted That Met QC Criteria

December 3, 2021

Last Verified

December 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 670201423056

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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