|Year : 2014 | Volume
| Issue : 1 | Page : 21-26
Correlation between PUFA/pufa scores and BMI-for age in rural Indian children
Rohini Dua, Ritu Jindal, Devinderjit Kaur, Neha Aggarwal
Department of Pedodontic and Preventive Dentistry, National Dental College and Hospital, Dera Bassi, Punjab, India
|Date of Submission||27-Jan-2013|
|Date of Acceptance||15-Feb-2014|
|Date of Web Publication||7-Apr-2014|
#92, Telephone Exchange Colony, Patiala Road, Zirakpur, Mohali, Punjab
Source of Support: None, Conflict of Interest: None
Context: Dental caries continues to be a major health problem in the developing nations like India. The unmet dental care needs pose an important risk factor for undernutrition prevalence in rural areas.
Aims: The present study aimed to investigate the effect of dental caries and its consequences using pulp involvement, ulceration, fistula, abscess (PUFA/pufa) indices on age-specific body mass index (BMI) for age, also considering socioeconomic status (SES) in 4-14 years old rural children.
Materials and Methods: A total of 100 children aged 4-14 years were included in the study that presented with any of the sequelae of untreated dental caries either in primary or permanent teeth. PUFA/pufa index was used according to the standard procedure to assess the consequence of untreated dental decay. The height and weight of the children were determined using standardized scales. The BMI percentile was computed using Centres for Disease Control and Prevention (CDC) growth charts. The children SES were also recorded.
Statistical Analysis Used: Kruskal-Wallis test and Mann-Whitney U-test were performed. Then, Spearman correlation coefficient was calculated. All calculations were performed using SPSS version 15 (Statistical Packages for the Social Sciences, Chicago, Illinois, USA).
Results: BMI for age and SES show a positive correlation ( P < 0.01). There exists statistically significant negative correlation of BMI for age with mean PUFA + pufa and SES. With increasing age, BMI for age shows positive correlation ( P < 0.01) with highly significant negative correlation with mean PUFA + pufa.
Conclusions: The younger children belonging to lower SES have higher mean PUFA + pufa scores and below normal BMI as compared with older children.
Keywords: Indian rural children, low socioeconomic status, undernutrition, untreated dental caries
|How to cite this article:|
Dua R, Jindal R, Kaur D, Aggarwal N. Correlation between PUFA/pufa scores and BMI-for age in rural Indian children. Indian J Oral Sci 2014;5:21-6
|How to cite this URL:|
Dua R, Jindal R, Kaur D, Aggarwal N. Correlation between PUFA/pufa scores and BMI-for age in rural Indian children. Indian J Oral Sci [serial online] 2014 [cited 2017 Mar 27];5:21-6. Available from: http://www.indjos.com/text.asp?2014/5/1/21/129945
| Introduction|| |
Oral health is an integral component of general health sharing same risk factors.  Despite medical advancements, over 40% of Indian children are afflicted with dental caries. , The unmet dental care needs of rural child, particularly of lower socioeconomic status (SES), pose an important risk factor for undernutrition prevalence which is the primary cause of illness and premature mortality. ,
The present study aimed to investigate the effect of dental caries and its consequences using pulp involvement, ulceration, fistula, abscess (PUFA/pufa) indices  on body mass index (BMI) for age, also considering SES in 4-14 years age group. The hypothesis tested was that there exist no association between them.
| Materials and Methods|| |
A total of 400 children were examined as a part of dental check up camp in nearby villages. 100 children aged 4-14 years were included in the study who presented with any of the sequelae of untreated dental caries either in primary or permanent teeth (PUFA/pufa score >1).
The demographic data were recorded on a recording form. Dental examination was carried out by a single examiner and data entered by a single assistant. Decayed, Missing and Filled (DMFT for permanent dentition and dmft for primary dentition) indices were recorded after drying the teeth with air and using a mirror and No 23 explorer.
In addition to data collection for DMFT/dmft, the PUFA/pufa index was used according to the standard procedure.  PUFA/pufa is an index used to assess the presence of oral conditions and infections resulting from untreated caries in the primary (pufa) and permanent (PUFA) dentition. The index is recorded separately from the DMFT/dmft and scores the presence of either a visible pulp (P/p), ulceration of the oral mucosa due to root fragments (U/u), a fistula (F/f), or an abscess (A/a). The PUFA/pufa index per child is calculated in the same cumulative way as the DMFT/dmft index and represents the number of teeth meeting the PUFA/pufa diagnostic criteria.
After the dental examination, the height and weight of the children with positive PUFA/pufa scores were determined using standardized scales. No adjustments were made for clothing, but children were only lightly dressed. The BMI  was calculated using the formula BMI = Kg/m 2 using height and weight measures;  then, BMI percentile was computed using CDC Growth charts  [Figure 1] and [Figure 2]. Based on percentiles,  children were grouped into categories as given by Macek and Mitola, as shown in [Table 1]. SES was assessed according to annual parental income,  from the information given by parents as given in [Table 2].
The data for mean PUFA + pufa are presented as mean ± standard deviation and median with interquartile range, Kruskal-Wallis test followed by Mann-Whitney U-test was used for statistical analysis of Mean PUFA + pufa on the basis of SES and categories of BMI. To see the relationship between continuous variables, Spearman correlation coefficient was calculated. A P < 0.05 was considered to indicate statistical significance. All calculations were performed using SPSS version 15 (Statistical Packages for the Social Sciences, Chicago, Illinois, USA).
| Results|| |
Of 100 children aged 4-14 years, 56 were boys and 44 were girls. [Table 3] shows mean values of PUFA, pufa and mean PUFA + pufa in various BMI categories. [Table 4] shows mean values of PUFA, pufa and mean PUFA + pufa in various SES categories. When computed the correlation between them, it was seen:
- BMI for age and SES shows a positive correlation (P = 0.347). The below normal BMI is seen more in the children belonging to lower SES
- As shown in [Table 5], there exists statistically highly significant (P < 0.01) negative correlation between BMI and mean PUFA + pufa. The higher PUFA + pufa scores are seen more in case of lower SES children. The negative correlation between SES and mean PUFA + pufa is also statistically significant (P < 0.05) The lower the SES, more the mean PUFA + pufa scores
- With increasing age, BMI for age shows positive correlation (P < 0.01) with highly significant negative correlation with mean PUFA + pufa [Table 6]. The younger children showed more PUFA + pufa scores with more below normal BMI for age.
|Table 3: Mean (standard deviation) experience of odontogenic infections due to caries in children with differing body mass index|
Click here to view
|Table 4: Mean (standard deviation) experience of odontogenic infections due to caries with differing socioeconomic status|
Click here to view
|Table 5: Nonparametric correlation between body mass index for age, socioeconomic status, and mean PUFA, mean pulp involvement, ulceration, fistula, abscess, mean pulp involvement, ulceration, fistula, abscess|
Click here to view
|Table 6: Nonparametric correlation between body mass index for age, mean pulp involvement, ulceration, fistula, abscess, mean pulp involvement, ulceration, fistula, abscess, and mean pulp involvement, ulceration, fistula, abscess with increasing age (years)|
Click here to view
| Discussion|| |
In the present study, 100 children from rural area having PUFA/pufa ≥1 belonging to different SES were included. The result shows that children with low SES had more progression of caries into the pulp (odontogenic infections) and an increased risk of below normal BMI.
Thus, the association between untreated dental caries and low BMI in 4-14 years old Indian rural children of low SES exists. A survey conducted among 12-year-old Filipino children showed a significant association between odontogenic infections and below normal BMI  similar to present study results. This association has not been studied over wide age group range. Virtually, there is no study comparing this significant association in different Socioeconomic strata which is one of the principal predictor of BMI  and dental health.  So keeping this in mind, in this study an attempt was made to test this association over wide age group range, that is, 4-14 years old children, also taking into account their SES.
Despite the pandemic character of dental decay, particularly in children, there are only a few studies that have examined the relationship between the severity of dental decay and child weight. Previous research concluded that children with early childhood caries who needed treatment for tooth extraction had lower mean weights than those without treatment need.  The relationship between caries and underweight remained inconclusive. , The population groups that suffer the worst oral health status are mostly of low SES,  thus more chances of untreated dental caries. There are indications from several longitudinal studies that treatment of severe caries resulted in weight gain. ,
If untreated caries progresses into the dental pulp there are possibly three main pathways for this association: 1) pain and discomfort result in reduced food intake; 2) reduced quality of life affects children's growth and development through restricted activity, reduced sleep, concentration deficits, and so on; and 3) odontogenic infections may result in cytokine release which might impact on growth. The study results support an expanded model of hypothesized relations purposed by Benzian, 2011 of untreated dental decay leading to poor child development. Thus, the absence of odontogenic infections (PUFA + pufa = 0) can be considered as an important outcome indicator for Indian (oral) health program planning, monitoring, and evaluation.
| Conclusion|| |
The following conclusions can be drawn from this study:
- The below normal BMI for age is seen more in the children belonging to lower SES
- The higher PUFA + pufa scores are seen more in case of lower SES children
- The children belonging to lower SES have higher mean PUFA + pufa scores
- The younger children have higher mean PUFA + pufa scores and below normal BMI for age as compared with older children.
So, the lack of awareness and unmet dental care needs of younger children belonging to lower SES in rural India may account for higher chances of odontogenic infections (mean PUFA + pufa), thus below normal BMI for age.
| References|| |
|1.||Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21 st century-the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31:3-23. |
|2.||Goyal A, Gauba K, Chawla HS, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. J Indian Soc Pedod Prev Dent 2007;25:115-8. |
|3.||Meghashyam B, Nagesh L, Ankola A. Dental caries status and treatment needs of children of fisher folk communities, residing in the coastal areas of Karnataka region, South India. West Indian Med J 2007;56:96-8. |
|4.||Patil SN, Wasnik VR. Nutritional and health status of rural school children in Ratnagiri district of Maharashtra. [serial online] J Clin Diagn Res 2009; 3:1611-4. Available from: http://www.jcdr.net/back_issues.asp?issn=0973-709x and year=2009 and month=June and volume=3 and issue=3 and page=1611-1614 and id=439 [Last cited on 2009 Jun 1]. |
|5.||Gaur S, Nayak R. Underweight in low socioeconomic status preschool children with severe early caries. J Indian Soc Pedod Prev Dent 2011;29:305-9. |
|6.||Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W. PUFA--An index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol 2010;38:77-82. |
|7.||Frier BM, Truswell AS, Shepherd J, De Looy A, Jung R. Diabetes mellitus, and nutritional and metabolic disorders. In: Haslett C, Chilvers E, John AA, Boon N, editors. Davidson′s Principles and Practice of Medicine. 18 th ed. Churchill Livingstone press; 1999. p. 526. |
|8.||Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC Growth Charts for the United States: Methods and development. Vital Health Stat 2002:1-190. |
|9.||Macek MD, Mitola DJ. Exploring the association between overweight and dental caries among US children. Pediatr Dent 2006;28:375-80. |
|10.||Park JE. Social sciences and medicine. In: Park K, editor. Textbook of Preventive and Social Medicine. 18 th ed. Jabalpur: Banarsidas Bhanot Publishers; 2005. p. 517. |
|11.||Benzian H, Monse B, Heinrich-Weltzien R, Hobdell M, Mulder J, van Palenstein Helderman W. Untreated severe dental decay: A neglected determinant of low Body Mass Index in 12-year-old Filipino children. BMC Public Health 2011;11:558. |
|12.||O′Dea JA, Wilson R. Socio-cognitive and nutritional factors associated with body mass index in children and adolescents: Possibilities for childhood obesity prevention. Health Educ Res 2006;21:796-805. |
|13.||Gillcrist JA, Brumley DE, Blackford JU. Community socioeconomic status and children′s dental health. J Am Dent Assoc 2001;132:216-22. |
|14.||Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992;14:302-5. |
|15.||Gokhale N, Sivakumar N, Nirmala SV, Abinash M. Dental caries and body mass index in children of nellore. J Orofac Sci 2010;2:4-6. |
|16.||Chandra Shekar BR, Reddy C. Oral health status in relation to socioeconomic factors among the municipal employees of Mysore city. Indian J Dent Res 2011;22:410-8. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]