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Salud(i)Ciencia

Print version ISSN 1667-8682On-line version ISSN 1667-8990

Salud(i)ciencia vol.23 no.1 Ciudad autonoma de Buenos Aires June 2018

 

Authors' chronicles

Childhood obesity: implications for pediatric dentists

Obesidad Infantil: importancia para los odontólogos pediatras

 

Rade Vukovic 1

1 Mother And Child Health Care Institute Of Serbia Dr. Vukan Cupic, Department Of Endocrinology, Belgrado, Serbia y Montenegro

Rade Vukovic describes for SIIC his article published in Journal of Cranio-Maxilary Diseases 3(2):73-74, July 2014

 

 

Belgrado, Serbia y Montenegro (special for SIIC)
Bearing in mind that every third child worldwide is overweight and every sixth child is obese, it is obvious why childhood obesity has become an important topic in the pediatric dental office. Inappropriate dietary habits and lifestyle changes have contributed to the increased prevalence of both obesity and oral diseases during the past few decades. Likewise, both of these conditions are considered alarming public health problems because their impact involves consequent general and oral health risks in childhood which further extend through adulthood. For example, the occurrence of early childhood caries or obesity is an important prognostic factor of dental caries incidence in permanent dentition or of obesity in adulthood.

Although the relationship between childhood obesity and dental caries is widely discussed in the literature, there is no consensus among professionals regarding this issue. Prolonged, frequent and between-meal consumption of snacks and drinks containing refined fermentable carbohydrates increases the intake of calories and increases body weight. Accordingly, it is considered a high risk behavior which increases the risk of caries occurrence. Some evidence suggests a significant link between body mass index and caries frequency since they share similar etiology. On the other hand, others reported high prevalence of caries in children with lower body mass index (BMI) or absence of correlation between BMI and occurrence of caries. Even negative association between obesity and dental caries has been reported. Considering all these contradictory results it may be concluded that obesity alone is not a good predictor of dental caries since it has been observed that obese patients who have good oral hygiene regime might not be affected. Also, when discussing the association between obesity and dental caries it is important to use statistical adjustment for confounders that are also related to caries development (social factors, behavioral factors, oral hygiene regime and dietary habits such as consumption of sweets, snacks, and soft drinks).

Adipose tissue is regarded as an endocrine organ which secretes inflammatory cytokines and adipokines. Accordingly, these mediators may be the cause of conditions such as chronic systemic inflammation, which could present a link between obesity and periodontal disease. Since periodontal disease is uncommon in children, studies regarding this matter are scarce. However, both pediatric dentists and pediatricians should be aware of the possibility that obese children might be prone to periodontal disease.

Hyperinsulinemia and lower levels of growth hormone cause alterations in craniofacial growth, development and morphology in obese children compared to children of the same age with normal BMI. Therefore, increased craniofacial growth is observed, especially in the area of the mandibluar condyles and alveolar processes. Hence, obesity is linked with bimaxillary prognathism and larger facial dimensions. These morphological differentiations should be considered during the process of orthodontic diagnosis or treatment planning because they might urge earlier initiation of the treatment.

Pediatric obesity also requires special considerations for those patients with dental fear and anxiety who need dental treatment under sedation. Since doses of sedatives are weight dependent, there is high risk of inadequate sedation –over-sedation when total body weight is used in calculation, or under-sedation when lean body mass is used. Also, inhalation sedation procedure might be compromised due to respiratory complications of childhood obesity such as fat-induced restrictive lung disease and obstructive sleep apnea. Emotional and psychological adverse outcomes of childhood obesity such as progressive withdrawal, depression and feelings of rejection may also influence the relationship and cooperation with pediatric dentist.

Childhood obesity widely impacts various aspects of both general and oral health. Pediatric dentists should be aware of the current pandemic of childhood obesity, and their participation in screening, prevention and early treatment is of high importance. Since diet consulting due to caries risk assessment is an unconditional part of dental examination, dental teams should be encouraged to measure height and weight and to calculate BMI. Also it is recommended that BMI of overweight children should be monitored and recorded on a dental chart during usual pediatric dental follow-ups. If unhealthy lifestyle, dietary habits and increasing body weight are observed in pediatric dental office, parents should be properly educated by the dentist and these patients should be referred to the pediatrician and nutritionist. Close collaboration of pediatric dentists, pediatricians and nutritionists is necessary in order to create a successful multidisciplinary team who will be able to provide the best possible health care for overweight and obese children and adolescents.

 

 

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