EBD spotlight: Does dental caries increase the risk of undernutrition in children?

Manas Dave reflects on topics discussed in our sister journal Evidence-Based Dentistry.

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Does dental caries increase risk of undernutrition in children? was published in JDR Clinical & Translational Research.¹ A commentary on the paper was published in Evidence-Based Dentistry.²

Research has shown malnutrition in children to decrease salivary flow,³ delay exfoliation of primary teeth, delay eruption of permanent teeth⁴ and cause developmental tooth defects. The combination of these risk factors has linked malnutrition with an increased risk of dental caries.⁵ The aim of this systematic review was to determine the link between severity of dental caries and malnutrition (through assessing wasting or stunting in children).^1,2

Methods

An electronic database search of Medline and Embase was conducted in March 2018 with an update in July 2019. Hand searches of citation lists were undertaken, and experts consulted to identify further studies. No date or language restrictions were used. Participants were children aged 0-18 years in low-middle or high income countries. The exposure variable was dental caries, and the outcome variable was undernutrition (including stunting which is low height for age and wasting which is low weight for height). Quality assessment was undertaken using a previously published assessment tool.⁶

Results

• Permanent dentition - severity of dental caries with wasting and stunting: 17 studies reported an association of severity of dental caries in the permanent dentition and risk of wasting. Six studies showed a positive association, three studies a negative association and eight studies no association. Two studies reported an association of severity of dental caries in the permanent dentition and stunting, with one study showing a positive association and one study showing a negative association

• Primary dentition - severity of dental caries with wasting and stunting: 15 studies reported an association of severity of dental caries in the primary dentition and risk of wasting. Twelve studies showed a positive association, one study a negative association and two studies showed no association. Six studies reported an association of severity of dental caries in the primary dentition and stunting, with all six showing a positive association

• Early childhood caries and wasting: six studies reported prevalence of early childhood caries (ECC) and risk of wasting. Four studies showed a positive association, and two studies showed a negative association. Seven studies reported severity of ECC and wasting with six studies reporting a positive association and one study a negative association

• Early childhood caries and stunting: two studies had data relating to prevalence of ECC and stunting with one study showing a positive association and one study no association. Two studies had data relating to severity of ECC and stunting with both showing a positive association

• Severe early childhood caries with wasting and stunting: two studies had data on the prevalence of severe ECC and risk of wasting with one study showing a positive association and one study a negative association. No studies had any data on prevalence of severe ECC and stunting.

Conclusions

The authors concluded: '…an association between severity of caries in the primary dentition and risk of undernutrition'.

The majority of publications reporting a positive association between prevalence and severity of dental caries with wasting or stunting in children.

Comments

This well-conducted systematic review mitigated against overall low quality publications through the quality assessment tool which removed 60% of publications from data analysis. The harvest plots showed the majority of publications reporting a positive association between prevalence and severity of dental caries with wasting or stunting in children. However, there is a need for well-designed prospective studies to contribute to the evidence. Dental professionals can make dietary recommendations to their patients by following the Delivering better oral health guidelines (Chapter 10: healthier eating).⁷

Author information

Dr Manas Dave qualified from the University of Manchester with degrees in pathology and dentistry. He undertook postgraduate training in Newcastle and Middlesbrough before returning to Manchester where he is an NIHR Academic Clinical Fellow in Oral and Maxillofacial Pathology and Honorary Lecturer in Dentistry. Manas has achieved postgraduate qualifications in Medical Education, Dental Public Health and Pathology Informatics. He has published extensively across numerous journals including the BMJ, Lancet and BDJ, has extensive teaching experience of both undergraduate and postgraduate students and is a recipient of numerous personal and research awards.