Association between Obesity and Oral Health in Ghanaian School Children: The Role of Dietary and Oral Hygiene Practices

Abstract

Background: Obesity is associated with diabetes, hypertension, cardiovascular diseases, caries and periodontal diseases, and other morbidities. The association between childhood obesity and oral disease is, however, not well defined. This study examined the association between obesity and oral health in school children and explored possible dietary and oral hygiene risk factors. The study hypothesized that there was poorer oral hygiene status and higher caries and gum disease among the obese than the non-obese. Also oral bacteria associated with caries and gum diseases would be more common in obese than the non-obese school children. Method: The first phase of the study consisted of a single cross-sectional survey of 547 school children from private schools in Accra made up of 233 obese and 314 non-obese schools children between the ages of 9 and 15 years. Dietary and oral hygiene information were collected and respondents were orally examined by two dental surgeons. The second phase was a case-control design of 493 public school children made of 210 cases of caries and gum diseases, and 283 controls. Bacteria samples were cultured from oral plaque samples collected from 75 obese and 75 non-obese children. Results: Mean age of the school children from the private school was 11.5 ±1.7. Dietary habits and oral hygiene practices as well as caries and gum disease prevalence were similar in the obese and non-obese children. Caries prevalence among the obese was 14.9% and among the non-obese was 15.1%. The caries experience among the 12 years old (WHO index age for caries) obese children was 15.4% and among the non-obese was 8.2%. Gum disease prevalence among the obese was 3.7% and among the non-obese was 5.5%. None of these differences was significant, p>0.05. The overall oral disease (caries and gum disease) prevalence among the children was 19.2% and not different by obesity status. In the public schools, caries experience among the obese children was 33.3% and non-obese was 19.4%. Gum disease among the obese was 38.9% and the non-obese was 33.3%, p=0.620. None of the dietary and oral hygiene factors showed any significant association with the oral conditions in the two groups. Only breakfast intake among the children in the public school was associated with low caries prevalence (p=0.0314). Streptococcus infection was significantly higher in the obese (41.3%) than the non-obese (26.0%) but this did not show any significant association with the caries experience in the two groups. Lactobacillus species was very low (1.3%) but Actinobacillus actinomycetemcometans (aa) among the non-obese was 15.6% and the obese 6.7% but was not significantly different, (p=0.068). Conclusion: Dietary and oral hygiene practices were similar between the obese and the non-obese school children, whether in private or public schools. Similarly, caries and gum disease prevalence were not significantly different in the children irrespective of weight category and obesity status and whether they are in private or the public schools. Oral microbial infections of the four bacteria investigated (Lactobacillus species, P. gingivalis, aa) were similar except for streptococcus mutans which was significantly higher in the obese but was not significantly associated with caries prevalence. Obesity in Ghanaian children was not associated with oral health status.