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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 6  |  Page : 402-406  

Body Mass Index and Tooth Loss: An Epidemiological Study in a Sample of Suburban South Indian Population


1 Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
2 Department of Prosthodontics, International Medical University, Kuala Lumpur, Malaysia

Date of Web Publication28-May-2019

Correspondence Address:
Dr. Parthasarathy Natarajan
Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPBS.JPBS_48_19

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   Abstract 

Aim: This study evaluated the relationship between missing posterior teeth and body mass index with regard to age and socioeconomic state in a sample of the suburban south Indian population. Materials and Methods: The 500 individuals of both males and females aged 40 years and older with missing posterior teeth and not rehabilitated with any prosthesis were gone through a clinical history, intraoral examination, and anthropometric measurement to get information regarding age, sex, socioeconomic status, missing posterior teeth, and body mass index (BMI). Subjects were divided into five groups according to BMI (underweight > 18.5kg/m2, normal weight 18.5–23kg/m2, overweight 23–25kg/m2, obese without surgery 25–32.5kg/m2, obese with surgery < 32.5kg/m2). Multivariate logistic regression was used to adjust data according to age, sex, number of missing posterior teeth, and socioeconomic status. Results: People with a higher number of tooth loss were more obese. Females with high tooth loss were found to be more obese than male. Low socioeconomic group obese female had significantly higher tooth loss than any other group. No significant relation between age and obesity was found with regard to tooth loss. Conclusion: The BMI and tooth loss are interrelated. Management of obesity and tooth loss can help to maintain the overall health status.

Keywords: Body mass index, obesity, oral health, socioeconomic status, tooth loss


How to cite this article:
Natarajan P, Choudhury M, Seenivasan MK, Jeyapalan K, Natarajan S, Vaidhyanathan AK. Body Mass Index and Tooth Loss: An Epidemiological Study in a Sample of Suburban South Indian Population. J Pharm Bioall Sci 2019;11, Suppl S2:402-6

How to cite this URL:
Natarajan P, Choudhury M, Seenivasan MK, Jeyapalan K, Natarajan S, Vaidhyanathan AK. Body Mass Index and Tooth Loss: An Epidemiological Study in a Sample of Suburban South Indian Population. J Pharm Bioall Sci [serial online] 2019 [cited 2019 Jun 18];11, Suppl S2:402-6. Available from: http://www.jpbsonline.org/text.asp?2019/11/6/402/258877




   Introduction Top


The loss of teeth causes a considerable impact on mastication, digestion, phonation, and aesthetics.[1] The functional impairment depends on the location, distribution, and extension of the tooth loss, which might ultimately affect the quality of life.[2] Individuals having less number of teeth adapt to softer and processed food more than fibrous food such as fruits, raw vegetables, meat, and dry foods.[3],[4] The processed and softer food has a fairly high quantity of fat and cholesterol, and lacks in vitamins and minerals, which can lead to chronic illnesses such as stroke, hypertension, cardiovascular diseases, and physical disability.[4] Chauncey et al.[5] in their study concluded that “shifts in food selection patterns result from impairments in masticatory ability due to edentulism and appears to be dependent on the degree of impairment.”

The earlier studies showed an association between edentulousness and chewing problems to malnutrition in independent living, hospitalized, and institutionalized older people.[6],[7],[8],[9] Studies also showed that the presence of 20 or more teeth increases the chance of having an adequate body mass index (BMI) among independent living elderly people.[7],[10] However, these studies were carried out mainly in populations from well-developed countries, where the tooth loss is more frequently rehabilitated with dental prostheses. There is limited information in the literature on South Asian population like India where experiencing significant tooth losses were not replaced by dental prostheses due to various reasons and with the greater chance for obesity, underweight, or malnutrition. The aim of this study was to evaluate whether tooth loss is a potential contributor to changes in BMI or vice versa in south Indian suburban individuals.


   Materials and Methods Top


The study was a randomized cross-sectional study for evaluating the association between oral health and obesity (BMI). The sample was composed of 500 free-living individuals including both males and females aged 40 years and older. The selection criteria include the persons should not have any acute infection recently (not less than 6-month period) or any chronic systemic illness such as diabetes, hypertension, hyperthyroidism, hypothyroidism, and tumors. The period of edentulousness should not be less than 6 months and the person should have at least one missing posterior occluding unit and without any prosthesis replacement. The physically and mentally challenged individuals were excluded. The ethical clearance for the study was obtained and informed consent was taken from all the participants before starting the study. All the subjects underwent a recording of clinical history, oral clinical examination, and anthropometric measurement. Clinical history: The age, gender, socioeconomic status, marital status, and smoking status of the individuals were recorded. Oral clinical examination: The subjects were seated in a dental chair and oral examination was performed with help of two trained dental surgeons. The number of missing teeth and posterior missing occluding unit in all the four quadrants of the maxillary and mandibular arch were assessed and noted. Anthropometric measurements: Height and weight of each subject were measured. Height was measured with the help of wall-mountable Bio Plus Stature Meter (Bharat Enterprises [Bio Plus], Delhi, India) and weight was measured using platform weighing scale (Sansui Electronics, Pune, India). After recording the weight and height of each subject, BMI was calculated using the metric-imperial formula BMI (kg/m2) = weight in kilograms/(height in meters)2. Subjects were divided into five groups according to BMI cutoffs set by Health Ministry of India in 2008 in the consensus guidelines for prevention and management of obesity and metabolic syndrome for the country (underweight >18.5kg/m2, normal weight 18.5–23kg/m2, overweight 23-25kg/m2, obese without surgery 25–32.5kg/m2, obese with surgery <32.5kg/m2).[11],[12] Data were adjusted according to age (<50 years, 50–60 years, 61–70 years, >70 years), sex, missing posterior teeth (low <4 teeth, medium 5–10 teeth, high >10 teeth), and socioeconomic status. Multivariable analysis was performed using logistic regression.


   Results Top


Of 500 individuals, 260 were females and 240 were males. Obesity was found to be increased in people with a higher number of teeth loss (>10). Of the 500 total subjects, 32.8% had a higher number of tooth loss and 50% of that were obese. Overall data show the prevalence of higher tooth loss was 31.8% in male and 33.6% female and the prevalence of obesity was 51.2% in females and 30.6% in male, which is a significant difference [Table 1]. Females with high tooth loss group were found to be more obese than their male counterpart. Of the females, 59.5% were obese with high tooth loss as compared to 35.7% males [Figure 1]. Of the females with obesity, 70% belonged to a low socioeconomic group, which is significantly higher than any other group [Figure 2]. There was no significant relationship between age groups and obesity with regard to tooth loss.
Table 1: Demographic data presenting male and female subjects according to body mass index (BMI) and number of tooth loss

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Figure 1: A bar graph showing the relationship between tooth loss and body mass index with regard to sex

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Figure 2: A bar graph showing the relationship between tooth loss and body mass index with regard to socioeconomic status

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   Discussion Top


Obesity or overweight is a cause for a number of disorders including life-threatening ones as found in the literature.[13],[14] The risk stratification is based on the Quetelet’s Index (or BMI), which is commonly a surrogate measure of fatness.[15] In Indian population, the diagnostic cutoff for BMI is lowered to 23kg/m2 as opposed to 25kg/m2 globally because studies have shown that Indian body composition and genetics are different from their western counterparts and are more prone for abdominal obesity.[11],[12] The results of this cross-sectional study suggest that a poor oral status represented by partial or complete tooth loss is associated with obesity in independent living persons from the suburban south India. In this study, 59.5% of females had high tooth loss and were found to be obese whereas only 35.7% of males were obese with high tooth loss. This shows a significant number of female populations in suburban India are obese, which agrees with the previous reports.[11] It is seen in recent studies that females are more prone to high tooth loss than males.[16] Overall data suggested obesity was associated with higher number of tooth loss. Marcenes et al.[10] found that the people with less than 20 teeth were at a risk to be obese three times greater than the ones with 31–32 teeth.

There is no known mechanism that explains the exact relationship between obesity, tooth loss, and gender differences related to these factors. It has been speculated that these changes are mediated by eating behavior of the individual.[17] An impaired dental status can lead to altered food patterns.[18],[19] Edentulism has been shown to increase the chance for both underweight as well as obesity depending on the population characteristics.[20] A few studies have been carried out in a population experiencing extensive tooth loss whether the oral health status was associated with body composition.

Several studies have shown that dental caries and periodontal diseases are the main causative factors for tooth loss.[21],[22] Recent research by Forsyth Institute found a link between the obesity and a particular periodontal-disease-causing bacterium named Tannerella forsythia, which is found in the oral flora in an otherwise healthy mouth.[23] The 40 bacterial species were studied and the only species found in different proportion in obese individuals than others was T. forsythia. This may suggest that the metabolic changes that occur due to obesity might change the microbial colonization patterns altering the progression the periodontal diseases leading to tooth loss.[24] A study by Chitsazi et al. showed that obesity, weight circumference, and overweight are also associated with C-reactive protein (CRP) in both male and female gender but it is more prominent in females.[25] It is well-known that CRP is an acute phase inflammatory mediator produced by liver.[26] It is also elevated in periodontitis caused by gram-negative pathogens such as Porphyromonas gingivalis and T. forsythia.[23],[27],[28] This suggests that in obese females, the risk of periodontitis is higher than male leading to more tooth loss. But all the local factors also have to be taken into consideration.

The findings suggest that individuals living partially edentulous without any replacement with the prosthesis are at risk for both malnutrition as well as obesity. Obesity and tooth loss seem to be interrelated in a more complex way. The effects of the oral health status on body composition indicate the maintenance of a healthy and functional dentition into old age may have an important additional effect in maintaining a healthy BMI. The limitations of this study are self-reported measures of the medical diseases and no assessment of physical activity, food preferences of the individuals, and level of education was performed. A case–control study with more samples may give us better conclusive evidence.


   Conclusion Top


The BMI and tooth loss are interrelated. Compared to males, females with high tooth loss are found to be more obese. Females belonging to a low socioeconomic group and having high tooth loss are more obese, which is significantly higher than any other group. There is no significant relationship between age groups and obesity with regard to tooth loss.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Liedberg B, Norlén P, Owall B. Teeth, tooth spaces, and prosthetic appliances in elderly men in Malmö, Sweden. Community Dent Oral Epidemiol 1991;19:164-8.  Back to cited text no. 1
    
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Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.  Back to cited text no. 2
    
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Kagawa R, Ikebe K, Inomata C, Okada T, Takeshita H, Kurushima Y, et al. Effect of dental status and masticatory ability on decreased frequency of fruit and vegetable intake in elderly Japanese subjects. Int J Prosthodont 2012;25:368-75.  Back to cited text no. 3
    
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Sheiham A, Steele JG, Marcenes W, Finch S, Walls AW. The relationship between oral health status and body mass index among older people: A national survey of older people in Great Britain. Br Dent J 2002;192:703-6.  Back to cited text no. 7
    
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Sahyoun NR, Lin CL, Krall E. Nutritional status of the older adult is associated with dentition status. J Am Diet Assoc 2003;103:61-6.  Back to cited text no. 8
    
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Dormenval V, Mojon P, Budtz-Jørgensen E. Associations between self-assessed masticatory ability, nutritional status, prosthetic status and salivary flow rate in hospitalized elders. Oral Dis 1999;5:32-8.  Back to cited text no. 9
    
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Marcenes W, Steele JG, Sheiham A, Walls AW. The relationship between dental status, food selection, nutrient intake, nutritional status, and body mass index in older people. Cad Saude Publica 2003;19:809-16.  Back to cited text no. 10
    
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O’Neill BV, Bullmore ET, Miller S, McHugh S, Simons D, Dodds CM, et al. The relationship between fat mass, eating behaviour and obesity-related psychological traits in overweight and obese individuals. Appetite 2012;59:656-61.  Back to cited text no. 17
    
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Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a mediator in the relation between oral and systemic disease: Associations between specific measures of adult oral health and nutrition outcomes. Crit Rev Oral Biol Med 2002;13:291-300.  Back to cited text no. 18
    
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Haffajee AD, Socransky SS. Relation of body mass index, periodontitis and Tannerella forsythia. J Clin Periodontol 2009;36:89-99.  Back to cited text no. 23
    
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Suresh S, Mahendra J. Multifactorial relationship of obesity and periodontal disease. J Clin Diagn Res 2014;8:ZE01-3.  Back to cited text no. 24
    
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Chitsazi MT, Pourabbas R, Shirmohammadi A, Ahmadi Zenouz G, Vatankhah AH. Association of periodontal diseases with elevation of serum C-reactive protein and body mass index. J Dent Res Dent Clin Dent Prospects 2008;2:9-14.  Back to cited text no. 25
    
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