European Journal of Cardiovascular Medicine

The World Health Organisation (WHO) defines obesity and overweight as conditions marked by an abnormal and excessive buildup of fat that may be harmful to health. An imbalance between calories consumed and intake is the main cause of this illness. According to a recent survey, the frequency of obesity and overweight increased globally between 1980 and 2014.¹ It's interesting to note that around 2.5 billion persons over the age of 18 suffer from obesity and overweight, according to a 2014 WHO report^.1 This is equivalent to about one-third of all people on Earth. Moreover, obesity is regarded as the world's fifth greatest cause of death and has been linked to a number of non-communicable illnesses, including musculoskeletal disorders, cardiovascular disease, and several cancers, including breast, prostate, liver, and colon cancer.² As the most common disease in the world, dental caries has long been regarded as one of the biggest threats to oral health worldwide. It affects between 60% and 90% of school-age children and 100% of adults.⁴ Although the pathobiology and aetiology of dental caries are complex, oral flora, saliva, nutrition, and oral hygiene all play a major role in the development and progression of caries.⁵ There is debate over the relationship between a patient's weight and oral health.⁶ The nature of the published studies, which concentrated on kids through population sampling, is partly to blame for this controversy. Six It's interesting to note that Thippeswamy et al⁷ found a substantial correlation between school-age overweight/obesity and caries rates; the obese kids had more caries than both the overweight and normal weight children. Likewise, Modéer et al⁸ revealed that obese subjects exhibited a higher number of decayed surfaces compared to non-obese subjects.  Furthermore, Willershausen et al⁹.'s study of 2071 elementary school students, ages 6 to 10, revealed a significant relationship between the frequency of caries and body mass index (BMI); a low BMI was associated with a lack of carious lesions, while a high BMI was associated with a high number of caries lesions. In young adult participants, dental caries and BMI were found to be significantly correlated most recently.¹⁰ On the other hand, BMI was significantly correlated with periodontitis but not with dental caries in a recent study involving adult participants.¹¹ However, research by Sede et al.¹² found that BMI did not correlate with periodontitis or dental caries, although it did show a substantial relationship between the gingival bleeding index and BMI. In addition, several studies failed to demonstrate a significant relationship between childhood obesity and dental caries.^13–15 Given the current debate, this study, therefore, aimed to assess the relationship between teeth status represented by decayed, missed, filled teeth index (DMFT), and BMI among healthy adults

This cross-sectional investigation was carried out at the Dr. R.R. Kambe Dental College and Hospital in Akola, at the Department of Public Health Dentistry. The criteria for selecting subjects were convenience as well as being an adult who was at least 18 years old and no older than 35, and they had to be free of systemic disease, even if under treatment. The Institutional Review Board of the Dr. R.R. Kambe Dental College and Hospital in Akola granted ethical approval for the study. A consent form was given to each subject, and all procedures followed the guidelines set forth in the Helsinki Declaration.

Participants were disqualified if they had undergone orthodontic treatment, were female patients who were pregnant or using an oral contraceptive, had any chronic medical conditions that could negatively affect oral and/or systemic health status (e.g., diabetes), or had acquired or genetic tooth anomalies like fluorosis or amelogenesis imperfecta. A thorough medical and medication history was recorded.

Using sterile dental examination tools on a dental unit with a standard white headlight, subjects who met the inclusion criteria underwent a standard dental inspection conducted by an experienced and calibrated dental specialist. In order to determine whether each subject had hidden proximal caries in their posterior teeth, two bilateral bitewing radiographs were taken.

The WHO criteria, the DMFT, were used to diagnose and record the severity of dental caries. The index shows how many of each patient's teeth are filled (F), missing (M), and decaying (D). A tooth is deemed decaying (D) if it has cavities or if it has a filling and gets cavities again. The term "filled teeth" (F) describes the quantity of teeth that have restorative fillings. Missing teeth (M) is defined as the total number of teeth extracted as a result of dental caries. The teeth that were pulled due to trauma or genetic deformities were not included in the total number of missing teeth. 

The research's participants' BMI was calculated to categorise them as overweight or obese. A digital scale that had been calibrated was used to measure each subject's height and weight (Beurer, Germany). According to WHO guidelines, participants were split into four groups based on their BMI: (1) obese (BMI >30 kg/m2), overweight (BMI 25–30 kg/m2), normal weight (BMI 18.5–25 kg/m2), or underweight (BMI <18.5 kg/m2). With IBM SPSS version 22.0, Armonk, data was analysed. P-values less than.05 were regarded as statistically significant. The frequency distribution of the dental variables (DMFT, DT, MT, and FT) was examined using the Kolmogorov test as a means of testing for normality. While frequencies and percentages were used for expressing qualitative factors, means and standard deviations were used to represent quantitative data. The non-parametric quantitative variables were subjected to the Mann-Whitney and Kruskal-Wallis tests. Dichotomous variables were subjected to the chi-square test. The study employed a multinomial logistic regression model to identify significant predictors of the DMFT score.

502 subjects who fulfilled the inclusion criteria out of the 578 patients who were first evaluated for study enrollment were then subjected to a thorough examination and analysis. With mean ages of 26.5 (4.8) and 22.8 (4.5), respectively, the 502 individuals were made up of 192 men (38.2%) and 310 females (61.8%) (Table 1). The average DMFT of the research participants was 13.28 (3.8), with the average DMFT of the male and female participants being 13.1 (4.0) and 13.4 (3.7), in that order. With the exception of MT, there was no discernible correlation between the individuals' gender and the DMFT, DT, or FT (Table 2). Additionally, compared to younger participants, older subjects had a much higher number of filled and missing teeth, whereas the younger group had a somewhat higher amount of tooth decay.

                                              Table 1-Distribution of study subjects by gender and age.

Table 2-The relationship between dental and demographic variables

Data are mean (standard deviation). DMFT: decayed, missed, filled teeth index; DT: decayed teeth; MT: missing teeth; FT: filled teeth. Statistical analysis by Mann-Whitney test.

There was no statistically significant relation between BMI categories and either gender or age of subjects (Table 3) (Chi-square test, P=.23) and no statistically significant correlation between BMI categories and dental caries severity. However, after taking the age and gender into consideration, the relationship between the dental variables and body mass index categories showed that the mean value of DMFT was significantly greater among underweight older males compared with other age groups (P<.001). A multiple regression model found that gender and age were significant in relationship to DMFT (odds ratio 2.3, confidence interval=0.13, 1.56, P=.021), and (odds ratio 4.94, 95% confidence interval (CI)=0.11, 0.26, P<.001) with an adjusted R-square of 0.042, respectively. A multiple regression model found that gender and age were significant in relationship to DMFT, male subjects had more than 2 times risk for caries development compared to females, while the risk of caries development was increased by about 5 times for each year of age (odds ratio 2.3, confidence interval=0.13, 1.56, P=.021), and (odds ratio 4.94, 95% confidence interval (CI)=0.11, 0.26, P<.001), respectively, with an adjusted R-square of 0.042.

Table 3-Distribution of gender and age by category of body mass index

Data are number (percentage). Age groups in years. Underweight <18.5 kg/m², normal 18.5–25 kg/m², overweight 25–30 kg/m², obese >30 kg/m²

Table 4-Statistical comparison of dental variables by body mass index

Data are mean (standard deviation). DMFT: decayed, missed, filled teeth index; DT: decayed teeth; MT: missing teeth; FT: filled teeth. BMI: body mass index. Statistical analysis by Kruskal-Wallis test.

Age, educational attainment, social class, genetic predisposition, fluoride content in drinking water, and dental awareness all have a substantial impact on the severity and occurrence of caries.⁵ As a result, researching factors linked to caries is difficult. The disparity in the dental caries scale across different research can be explained by these factors. Globally, dental caries severity varies widely, ranging from less than 5 to more than 20 (DMFT index).^{17, 18} The WHO caries severity scale classifies the study's mean DMFT of 13.3, which is deemed severe.17 Our results were in line with those published in the US, Russia, and Australia, among other nations.¹⁷

The present research sought to ascertain the relationship between an adult's BMI category and dental caries; however, it is widely recognised that age above 35 is a risk factor for tooth loss due to periodontal diseases.19 Consequently, our investigation's participants were restricted to persons 35 years of age and younger in order to rule out any external age-related factors that might negatively influence the oral health status of study subjects.¹⁰ There is no clear correlation between dental caries and BMI. A systematic review conducted in 2012 included 48 publications that evaluated the probable relationship between dental caries in children and adolescents and BMI. Of those studies, 23 found no association, while the remaining 25 indicated the opposite, making it impossible to draw firm conclusions.20 It is crucial to remember that the majority of earlier research—whether positive or negative—that discovered a connection between dental caries and BMI was carried out on minors under the age of eighteen.^20–22 However, not much research has been done to examine this association in adult participants. Furthermore, a systematic evaluation was out in 2006 revealed that only one study with a strong degree of evidence indicated a direct and meaningful correlation between dental caries and obesity^.21

A research investigation conducted in 2016 on adults among the ages of 18 and 35 identified a significant correlation between high BMI and DMFT; however, the study only included 200 participants, and no logistic regression model was used to examine the impact of confounders.10 However, the current investigation discovered a statistically significant link between elderly and underweight males and dental caries. Similar findings from a prior study were linked to the detrimental effects of caries lesions on a child's development.22 However, there were numerous reasons why these results could not be applied to our investigation. First off, eight-year-old youngsters were used in the research rather than adults. Furthermore, a logistic regression model containing.

We believe that genetic susceptibilities to obesity and dental caries, as well as food and lifestyle choices specific to each community and demographic, may be the cause of the studies' inconsistent and diverse findings. To obtain a more accurate estimate of the link between BMI and dental caries, all of these variables must be included in a future longitudinal study with bigger cohorts from multiple geographical areas. This paper, like other published studies, has several limitations. Any cause-and-effect link between the variables could not be found due to the cross-sectional character of the study. A further drawback was the dearth of knowledge regarding the subjects' eating habits. The one-center design was still another drawback. Nonetheless, the participants' age and gender were nearly identical to those reported by the Saudi National Office of Statistics;²³ as a result, our study is likely representative of the healthy adult population in Saudi Arabia. Additionally, the obesity rate seen in our study was in line with earlier findings from Saudi cohorts in published publications^{. 24,25} In particular, our research revealed that the obesity rates for men and women were 23.9% and 17.8%, respectively. These findings are consistent with those of a study conducted in the Riyadh region by Al-Hazzaa et al. They found that the obesity rates for men and women were, respectively, 22.7% and 13.8%.24 Despite the fact that 95% of the participants identified as middle class, the current study may also be limited by the absence of comprehensive data on the participants' socioeconomic position.

Dental caries was not associated with BMI but age significantly influenced the DMFT index and gender was associated with more missing teeth. Further longitudinal studies with larger cohorts from several geographic regions are warranted.

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