Nutrition, Physical Activity, Mediterranean Diet Adherence, and Children's Oral Health

October 1, 2025 updated by: GÜLSEVİM ODA, Ankara Medipol University

The Impact of Nutrition, Physical Activity Habits and Adherence to the Mediterranean Diet on Children's Oral Health

The main risk factors for dental caries are inadequate oral hygiene practices, cariogenic bacteria, and cariogenic diet. Among these factors, diet has a different dual relationship with dental caries. Dietary habits have the potential to be a risk factor for dental caries impaired oral and dental health can also lead to deficiencies in dietary intake.

Studies have shown that there is a decrease in gum and periodontal diseases in the adult age group with a diet compatible with the Mediterranean diet.

This cross-sectional study aims to examine the relationship between a diet compatible with the Mediterranean Diet and dental caries and gum health status in children. We hypothesize that children will have better gum health and less tooth decay with a diet compatible with the Mediterranean diet.

Study Overview

Status

Completed

Conditions

Detailed Description

Aim and Importance of the Research:

The Mediterranean diet (AD) is a healthy nutritional model, and the risk of major chronic inflammatory diseases decreases with a diet highly compatible with MD. It is thought that the protective effect of the Mediterranean diet is related to unsaturated fatty acids, the amount of dietary fiber, bioactive components, and antioxidants. It is known that diet affects the inflammatory reaction of periodontal tissues. It is stated that inflammatory reactions in the gums cannot develop, especially with a diet that does not contain refined carbohydrates. It is reported in the literature that reducing carbohydrate intake and taking additional Omega-3 fatty acids, vitamin C, vitamin D, antioxidants and fiber is beneficial for the health of periodontal tissues.

While excessive carbohydrate intake increases dysbiosis and chronic inflammatory diseases, a decrease in gingivitis has been observed by reducing carbohydrate intake. Dietary antioxidants play an important role in the development of adequate systemic reactions against oxidative stress. Clinical and in vitro studies have shown that antioxidants in the diet have positive effects on periodontal tissues.

Current studies report that there is a decrease in gum and periodontal diseases in the adult age group with a diet compatible with the Mediterranean diet. It is known that the Mediterranean diet reduces the amount of periodontopathogenic species, especially in supragingival plaque.

This cross-sectional study aims to examine the relationship between a diet compatible with the Mediterranean Diet and dental caries and gum health status in children. Secondly, the nutritional habits and behaviors of the family and the effects of the child's daily energy and nutrient intake on oral and dental health will be examined.

It is planned to include children between the ages of 0-14 who apply to Ankara Medipol University Oral and Dental Health Practice and Research Center Pedodontics Clinic. Parents of children who meet the study criteria will be informed about the research and an informed consent form will be obtained. Parents who volunteer to participate in the study will be asked to fill out the Demographic data form, Mediterranean Diet Quality Index (KIDMED), and Family Nutrition and Physical Activity (FNPA) screening tool. Additionally, a retrospective 24-hour food consumption record will be taken. Afterwards, oral and dental examinations of the children will be performed and the data obtained will be recorded.

Information on how to reach the participants: Families and children who meet the inclusion criteria and volunteer to participate in the study will be included in the patients who apply to the pedodontics clinic.

Forms used in data collection:

  • Oral and dental examination indexes: Oral examinations of children will be performed by a single experienced pediatric dentist, using a mirror and probe, in the dentist's chair, and under appropriate lighting. Caries, extracted due to caries, filled primary and permanent teeth, and tooth surfaces in the child will be evaluated according to the caries index criteria of the World Health Organization (WHO-2013). Within the scope of evaluating plaque accumulation and gingival health, the plaque index (Silness & Löe, 1964) and gingival index (Löe & Silness, 1963) will be calculated.
  • Mediterranean Diet Quality Scale (KIDMED):

Turkish validity and reliability study of the Mediterranean Diet Quality Scale in children was conducted by Şahingöz et al. (2019) . The scale consists of 16 questions, 12 of which have positive connotations and 4 of which have negative connotations. While positive answers to questions with negative connotations are scored as -1, positive answers to questions with positive connotations are scored as +1. As a result of the scoring, data ranging from 0-12 is obtained and evaluated in 3 main groups:

  1. Those with ≥8 points optimal Mediterranean diet (good)
  2. Scores between 4 and 7: Those whose compliance with the Mediterranean diet needs improvement (moderate)

  3. If ≤3 points, very low nutritional quality (low)

    • Family Nutrition and Physical Activity screening tool (FNPA): The Family Nutrition and Physical Activity Screening Tool was developed by Ihmel et al. from Iowa State University in collaboration with the Academy of Nutrition and Dietetics (American Dietetic Association, ADA) in 2009. The original language of the FNPA scale is English. The FNPA scale is a behaviorally based assessment that evaluates family environments and combines information from a variety of behaviors associated with childhood obesity and was designed as a screening tool with potential for use by obesity researchers and a variety of clinical and public health professionals. The Turkish validity and reliability study was conducted by Ekici et al. (2021). The Turkish form of this tool consists of 20 items and is evaluated in a four-point Likert type. Each item is scored as 1 (never / rarely), 2 (sometimes), 3 (often) and 4 (very often / always). Six different items were reverse coded and these are items 3, 4, 5, 7, 10 and 13. The scores given to these items are summed up with the corresponding score in reverse order when calculating the total score (4; never / rarely, 3; sometimes, 2: often and 1; very often / always). The total score obtained from the scale varies between 20-80. Since there is no cut-off value when comparing the total score, high scores indicate less risky family practices and child behaviors for child obesity, while low scores indicate high-risk family environments and practices and child behaviors.
    • 24-hour retrospective food consumption record:The study will record individual daily food consumption with a "24-hour retrospective food consumption record" using the "Food Consumption Record Form".The researcher will ask the individuals included in the study about all the foods and drinks they consumed the day before, including their quantities. Daily energy and nutrient intakes of the individuals participating in the study will be calculated using the Nutrition Information Systems 8.2 program, and the percentages of daily energy intake, macro and micronutrients will be evaluated taking into account age and gender.

Sample size: The population of the study consists of healthy children between the ages of 0-14. The sample consists of healthy children who applied to Ankara Medipol University Oral and Dental Health Application and Research Center Pedodontics Clinic and those whose families volunteered to participate in the study. The sample size was calculated with G*Power 3.1.9.2. For this purpose, information obtained from previous similar studies (Sáenz-Ravello et al., 2023) was used as a reference. Considering the effect size as 0.25, the margin of error as 0.05, and the power value as 0.80, it was determined that at least 159 subjects were required.

Statistical Method(s):

The data obtained from the study will be evaluated with the SPSS 26.0 (Statistical Package for Social Science) statistical program. First of all, the distribution and skewness of the data will be evaluated with normality tests and will be expressed as mean (χ) and standard deviation (SD) or median (M), lower and upper values. Parametric (t-test) or non-parametric (Mann-Whitney U test) hypothesis tests are suitable for numerical/quantitative data when comparing the difference between two independent groups; For qualitative data, the appropriate chi-square test (Pearson/Fisher) will be used. Appropriate correlation analysis (Spearman/Pearson/Eta coefficient) will be performed to determine the relationship between numerical and qualitative variables. The value of p<0.05 will determine statistical significance.

Study Type

Observational

Enrollment (Actual)

160

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
      • Ankara, Turkey (Türkiye)
        • Ankara Medipol University Oral and Dental Health Practice and Research Center Pedodontics Clinic

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

  • Child

Accepts Healthy Volunteers

Yes

Sampling Method

Probability Sample

Study Population

It is planned to include healthy children between the ages of 0-14 who apply to Ankara Medipol University Oral and Dental Health Practice and Research Center Pedodontics Clinic. Parents of children who meet the study criteria will be informed about the research and an informed consent form will be obtained.

Description

Inclusion Criteria:

  • Between the ages of 3-14
  • Not having a chronic/systemic disease (diabetes, allergies, etc.)
  • Not having received radiotherapy or chemotherapy treatment
  • Not having a mental or psychiatric disorder
  • Agreeing to participate in the study

Exclusion Criteria:

  • Over 14 years old and under 3 years old
  • Having a chronic/systemic disease (diabetes, allergies, etc.)
  • Having received radiotherapy or chemotherapy treatment
  • Having a mental or psychiatric disorder
  • Not agreeing to participate in the study

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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Caries experiences
Time Frame: during enrollment once
Oral examinations of children will be performed by a single experienced pediatric dentist, using a mirror and probe, in the dentist's chair, and under appropriate lighting. Caries, extracted due to caries, filled primary and permanent teeth, and tooth surfaces in the child will be evaluated according to the caries index criteria of the World Health Organization (WHO-2013).
during enrollment once

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
plaque index measurement
Time Frame: during enrollment once
Oral examinations of children will be performed by a single experienced pediatric dentist, using a mirror and probe, in the dentist's chair, and under appropriate lighting. Within the scope of evaluating plaque accumulation the plaque index (Silness & Löe, 1964) will be calculated.
during enrollment once
gingival index measurement
Time Frame: during enrollment once
Oral examinations of children will be performed by a single experienced pediatric dentist, using a mirror and probe, in the dentist's chair, and under appropriate lighting. Within the scope of evaluating gingival health, the gingival index (Löe & Silness, 1963) will be calculated.
during enrollment once
Mediterranean Diet Quality Scale (KIDMED):
Time Frame: during enrollment once

The scale consists of 16 questions, 12 of which have positive connotations and 4 of which have negative connotations. While positive answers to questions with negative connotations are scored as -1 score, positive answers to questions with positive connotations are scored as +1 score. As a result of the scoring, data ranging from 0-12 is obtained and evaluated in 3 main groups: ≥8 points optimal Mediterranean diet (good), between 4 and 7: Those whose compliance with the Mediterranean diet needs improvement (moderate), ≤3 points, very low nutritional quality (low)b. Scores between 4 and 7: Those whose compliance with the Mediterranean diet needs improvement (moderate) c. If ≤3 points, very low nutritional quality (low)

  1. Those with ≥8 points optimal Mediterranean diet (good)
  2. Scores between 4 and 7: Those whose compliance with the Mediterranean diet needs improvement (moderate)
  3. If ≤3 points, very low nutritional quality (low)
during enrollment once
Family Nutrition and Physical Activity screening tool (FNPA):
Time Frame: during enrollment once
20 items :Each item is scored as 1 (never / rarely), 2 (sometimes), 3 (often) and 4 (very often / always). Six different items were reverse coded and these are items 3, 4, 5, 7, 10 and 13. The scores given to these items are summed up with the corresponding score in reverse order when calculating the total score (4; never / rarely, 3; sometimes, 2: often and 1; very often / always). The total score obtained from the scale varies between 20-80. Since there is no cut-off value when comparing the total score, high scores indicate less risky family practices and child behaviors for child obesity, while low scores indicate high-risk family environments and practices and child behaviors.
during enrollment once
24-hour retrospective food consumption record:
Time Frame: during enrollment once
The study will record individual daily food consumption with a "24-hour retrospective food consumption record" using the "Food Consumption Record Form".The researcher will ask the individuals included in the study about all the foods and drinks they consumed the day before, including their quantities. Daily energy and nutrient intakes of the individuals participating in the study will be calculated using the Nutrition Information Systems 8.2 program, and the percentages of daily energy intake, macro and micronutrients will be evaluated taking into account age and gender (16).
during enrollment once

Collaborators and Investigators

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

Sponsor

Ankara Medipol University

Investigators

  • Principal Investigator: Gülsevim ODA, PhD, Ankara Medipol University Faculty of Dentistry
  • Principal Investigator: Merve Ekici, PhD, Department of Nutrition and Dietetics, University of Health Sciences

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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)

October 17, 2023

Primary Completion (Actual)

March 1, 2025

Study Completion (Actual)

April 1, 2025

Study Registration Dates

First Submitted

November 7, 2023

First Submitted That Met QC Criteria

November 11, 2023

First Posted (Actual)

November 14, 2023

Study Record Updates

Last Update Posted (Estimated)

October 2, 2025

Last Update Submitted That Met QC Criteria

October 1, 2025

Last Verified

October 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • AnkaraMedipolGuls

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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