Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region

Abstract

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the “Alli Kiru” program (2011–2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02–1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58–0.97). This relationship was most pronounced among 3–6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children’s risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal

“…Across both age groups, severe caries by pufa+PUFA-an indication of deep dental infection, cavitation, and likelihood of dental pain-was associated with lower WAZ and BAZ, suggesting a risk for acute malnutrition, and in older children, severe caries by SiC was associated with lower HAZ, suggesting a risk for chronic malnutrition. This study adds to the growing literature from developing countries, demonstrating that severe dental caries may exacerbate the risk for childhood malnutrition, especially in early childhood [29,32,33,36]. The pathophysiologic mechanisms by which severe caries may contribute to malnutrition include chronic infection/inflammation and dental pain suppressing children's appetite and growth, loss of tooth structure inhibiting children's ability to chew nutritious foods, and increasing use of non-nutritious sweets to pacify children's chronic pain [32].…”

“…There have been mixed findings on the association between severe caries and nutritional status. Studies have demonstrated an association between severe caries and malnutrition in some low-income contexts, with caries contributing to mouth pain and chronic inflammation which disrupt normal eating, sleep, and growth [29][30][31][32][33]; associations with obesity in high-income contexts due to shared dietary risk factors [34,35]; and no associations in other studies [36]. There is limited research on these relationships in Nepali populations.…”

Prevalence and factors associated with dental caries in patients attending an HIV care clinic in Uganda: a cross sectional study

“…PLHIV are also at a higher risk for malnutrition [9], which may be exacerbated by dental caries. Studies suggest that caries of the primary and permanent dentitions is associated with early childhood malnutrition [12, 14] and increased likelihood of malnutrition [15] in the elderly respectively. PLHIV are now living longer due to ART, which means that chronic health issues like dental caries and oral health are increasingly important to manage well in HIV patients to prevent complications such as malnutrition.…”

Early Childhood Oral Health and Nutrition in Urban and Rural Nepal

“…Globally, limited access to dental care leaves most ECC untreated, which can lead to widespread loss of tooth structure, chronic infection and inflammation, mouth pain, decreased appetite, disrupted sleep, and poor functioning and confidence in school, all of which interfere with children’s quality of life, growth, and development [9,10]. In low- and middle-income countries, studies have documented a significant association between ECC and malnutrition; a bidirectional relationship is postulated, where undernutrition predisposes a child to caries and caries predispose a child to undernutrition [11,12,13].…”