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Dental Caries or commonly known as tooth decay is one of the common health problem among child and adults, it is a chronic disease, having a gradual increase of prevalence in the world, study showed that, in USA among children aged from 5- 9 years old the prevalence of dental caries was 50% [1], Asian Countries also suffering from this problem, statistics from Pakistan reported day by day in different research journals, a study was conducted in sadder town school children of Karachi city, it gives the prevalence of dental carries among school going children was 51% [2], if we looked at international levels among Muslim countries, Iran, UAE and Saudi Arabian Childs also victim of this public health problem, a study conducted in Saudi Arab showed 68.9% tooth decayed among school going children’s [3].

Literature on dental caries throughout the world gives the evidence that, caries experience gives association with body mass index, diet habit and oral hygiene practices, samples having higher body mass index would give positive association with dental caries [1], caries risk also increases with more intake of sugar and sweets among [4].

A good diet plan can give the protection from caries, there are several studies that gives the evidence that, healthy nutrition practices can gives the protection from dental caries to the samples, a study reports a significant reduction in dental caries with usage of milk among samples [5], oral hygiene is one more important factor to overcome on this problem, a good and proper brushing practices can helps in reduction of caries, a study was conducted showed that a negative association of caries with oral hygiene practices [6].

Objective of the current study was to report the caries experience among Peshawar city and Larkana city of Pakistan and to find the association of dental caries experience with Body mass index, diet habits and oral hygiene.

Secondary baseline data on dental caries of a currently going project of Pakistani children, funded by Higher Education Commission, Islamabad, titled ‘Time and Sequence of Eruption Teeth of Pakistani Children [7] were used in the present study. The co-author of this study is the Principal Investigator of that Project.

Sampling technique

In project [8] Multistage Systematic Cluster Random sampling was performed to collect the data on study variables: age, gender, and type of school. The dentists also examined the children for dental caries and eruption of teeth.

Study population

Data were collected from school going children from Larkana, Sindh province and Peshawar, KPK province of Pakistan aged between 5 to 19 years.

Statistical analysis

Data were analyzed using STATA 12.0 MP version. Frequency and percentages were reported for baseline characteristics of 3358 samples. Body Mass index was categorized into Underweight, normal, overweight and obese classes using percentiles, samples with more than or equal to 95^th Percentile were considered as obsess, 85^th to 94^th percentiles were considered overweight, between the 5^th percentile to 85^th percentile were considered in the normal weight and below the 5^th percentile were considered underweight as per World Health Organization criteria. Pearson Chi Square test was done to see the association of different caries levels with Body Mass index, oral Hygiene and Diet habits. P-values less than 0.05 were considered significant.

Table 1 provides the baseline characteristics of samples populations, out of 3358 sampled children 35.1% were from Larkana city, 46.4% children were aged from 5- 8 years old, the mean age of sample children was 8.62±2.19 years with 95% confidence interval (8.42, 8.69). Less than 50% data were received from male gender. Results of the study showed that 49.3% of the children eat meat 3-5 times per week, 22.6% of the children consume vegetable 1-2 times per week and 40.1% children had same frequency for the rice intake per week, 49.6% children found with 1-2 times milk intake in a week.

Table 1: Baseline characteristics of studied sample (n=3358).

Table 2 illustrates the association of primary dental caries with body mass index, oral hygiene and diet habits of children using Pearson chi square test. Results showed that there was significant association between primary dental caries levels with body mass index. As the BMI level has increased from underweight to obese, the zero caries level has increased from 49.4% to 66.9% (Figure 1).

Table 2: Association of primary dental caries with BMI, oral hygiene and dietary habits.

Figure 1: A significant mean difference in dental caries was obtained between two cities samples using Mann-Whitney U test.

Meat, rice and milk intake were also significantly associated with primary dental caries (P<0.05). It was observed that levels of primary dental caries did not show any significant association with vegetable intake, (p=0.129).

Table 3 showed that permanent dental caries levels showed significant association with Body mass index. As the BMI level has increased from underweight to obese level, the percentage of zero level of caries experience decreased from 76.2% to 43.4%. This trend was opposite to the primary dmft discussed earlier. Meat, vegetable, rice and milk intake per week were also significantly associated with the level of dental caries (p<0.05). It was found that 2.4% sample children found with more than four permanent dental caries and fall in obese category of BMI, 25.6% children had low permanent dental caries and having meat intake from 3-5 times per week, 48.9% children found with low permanent dental caries and had used vegetables more than five times in a week, 2.3% children had higher permanent dental caries, used rice 1-2 times per week, 28.2% children found with milk intake 1- 2 times in a week and had low permanent dental caries (Figure 2).

Table 3: Association of permanent dental caries with BMI, oral hygiene and dietary habits.

Figure 2: Mean comparison of anthropometric measurements.

Table 4 reports the association of dietary habits between Larkana and Peshawar city children with body mass index, oral hygiene and dietary habits, a significant association obtained of body mass index and oral hygiene with Larakna and Peshawar city children, results also showed that 56.1% Larkana city children takes 1-2 times milk in a week in comparison of Peshawar children which was 45.9%, similarly 85.4% Larkana children found with rice intake more than five times in a week whereas in Peshawar it was found only 14.6%, Peshawar children found with more use of vegetables and these results were considered significant with p-value less than 0.05.

Table 4: Association of BMI, oral hygiene and dietary habits, between Larkana and Peshawar children (n=3358).

Results of this study showed, dental caries gives significant association with Body mass index, oral hygiene and diet habits, children with higher Body mass index would be expected to suffer more caries and these finding were also observed in the study [1], one more study results indicates, as weight increases, caries frequently got increased [9]. Diet and eating habits also played an important role for dental caries, in our study a significant association was obtained with milk and rice, usage of these two components gives the protection from caries, and several studies showed a negative association between more intake of milk and rice with and dental caries, a past study gives the evidence that, those non poor children who did not take breakfast daily or ate fewer than five serving of fruits and vegetables per day were found at higher risk of dental caries [6], in our study oral hygiene also gives significant association with dental caries, studies showed bad practice were observed among those children who were found with dental caries [3].

In the present study Primary dental caries levels gives significant association with body mass index, higher percentage of caries free children were observed among overweight and obese children. Contrary to this [10] showed that low geometric mean of caries among overweight children but it was not statistically significant, in our study intake of meat, rice and milk intake per week also gives significant association with carries. It was observed that a larger proportion of children found with low primary dental caries that were taken meat three to five times per week. Those children who take milk in a week were also found with low primary dental caries.

This study concludes that primary and permanent dental caries have significant association with body mass index, oral hygiene and dietary habits, and results of this study also gives the evidence that, dental caries gives association with different locations, (Larkana and Peshawar city).