Clinical Oral Investigations

, Volume 15, Issue 2, pp 177–184 | Cite as

Interrelation between obesity, oral health and life-style factors among Turkish school children

  • Ayse Basak Cinar
  • Heikki Murtomaa
Original Article


Obesity, dental caries and periodontal diseases are among major public health concerns which may affect children’s growth and development. This study seeks any clustering between obesity, oral health and life-style factors among school children in Istanbul, Turkey. A cross-sectional study of children, 10- to 12-year-olds, from a public and a private school was undertaken with questionnaires for children and their mothers and child oral health data, in Istanbul (n = 611). DMFS (number of decayed, missing and filled surfaces of permanent teeth), CPI (Community Periodontal Index), body mass index (BMI) and life-style factors (tooth-brushing frequency, milk consumption at breakfast and bedtimes on school nights) of children were examined. Data analysis included factor analysis, Student’s t test and Chi-square tests by cross-tabulation. Public school children were more dentally diseased but less obese than were those in private school (P < 0.001). They more frequently had calculus (62%) and reported non-recommended tooth-brushing (68%) than did those in private school (37%, 56%; P < 0.05). Principal component analysis revealed that DMFS, CPI and BMI shared the same cluster among all children. A need exists for addressing obesity, oral health and nutrition jointly in health promotion strategies to improve children’s well-being and empower good life-style factors.


Oral health Obesity Life-style factors School children Socio-economic status 



We express our deepest thanks to Professor Nuket Sandalli for her support during the research process and to Turkish colleague Dr. Sule Kavaloglu for her help during the clinical examinations in Turkey.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Petersen PE (2003) The World Oral Health Report 2003: continuous improvement of oral health in the 21st century—the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 31(Suppl 1):3–23PubMedCrossRefGoogle Scholar
  2. 2.
    Sheiham A, Watt RG (2000) The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 28:399–406PubMedCrossRefGoogle Scholar
  3. 3.
    Larson NI, Story M (2007) The pandemic of obesity among children and adolescents: what actions are needed to reverse current trends? J Adolesc Health 41:521–522PubMedCrossRefGoogle Scholar
  4. 4.
    Kwan S, Petersen PE (2003) Oral health promotion: an essential element of a health-promoting school. Geneva, WHO. Available via WHO. Accessed 2 Sept 2009
  5. 5.
    Ayhan H, Suskan E, Yildirim S (1996) The effect of nursing or rampant caries on height, body weight and head circumference. J Clin Pediatr Dent 20:209–212PubMedGoogle Scholar
  6. 6.
    Cinar BA, Murtomaa HA (2007) Comparison of psychosocial factors related to dental anxiety among turkish and finnish pre-adolescents. Oral Health Prev Dent 5:173–179PubMedGoogle Scholar
  7. 7.
    WHO (1997) Oral health survey: basic methods, 4th edn. WHO, GenevaGoogle Scholar
  8. 8.
    Löe H (2000) Oral hygiene in the prevention of caries and periodontal disease. Int Dent J 50:129–139PubMedGoogle Scholar
  9. 9.
    Pine CM, McGoldrick PM, Burnside G, Curnov MM, Chesters RK, Nicholsen J et al (2000) An intervention programme to establish regular toothbrushing: understanding parents' beliefs and motivating children. Int Dent J 50:312–323Google Scholar
  10. 10.
    WHO (2007) BMI-for-age (5-19 years). Available via WHO. Accessed 2 Feb 2009
  11. 11.
    Macek MD, Mitola DJ (2006) Exploring the association between overweight and dental caries among US children. Pediatr Dent 28:375–380PubMedGoogle Scholar
  12. 12.
    WHO (1995) Physical status: the use and interpretation of anthropometry: Report of a WHO Expert Committee. WHO, GenevaGoogle Scholar
  13. 13.
    Pinto A, Kim S, Wadenya R, Rosenberg H (2007) Is there an association between weight and dental caries among pediatric patients in an urban dental school? A correlation study. J Dent Educ 71:1435–1440PubMedGoogle Scholar
  14. 14.
    Garson DG (2008). Factor Analysis. Available via Accessed 2 Sept 2009
  15. 15.
    WHO.WHO Child Growth Standards.Backgrounder4. Available via WHO. Accessed 2 Sep 2009
  16. 16.
    Harnack L, Stang J, Story M (1999) Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc 9:436–441CrossRefGoogle Scholar
  17. 17.
    Merrit J, Qi F, Shi W (2006) Milk help building strong teeth and promotes oral health. Calif Dent Assoc J 34:361–366Google Scholar
  18. 18.
    Willerhausen B, Blettner M, Kasaj A, Hohenfellner K (2007) Association between body mass index and dental health in 1,290 children of elementary schools in a German city. Clin Oral Investig 11:195–200PubMedCrossRefGoogle Scholar
  19. 19.
    Alm A, Fahraeus C, Wendt LK, Koch G, Andersson-Gäre B, Birkhed D (2008) Body adiposity status in teenagers and snacking habits in early childhood in relation to approximal caries at 15 years of age. Int J Paediatr Dent 18:189–196PubMedCrossRefGoogle Scholar
  20. 20.
    Cinar AB, Murtomaa H (2008) Clustering of obesity and dental health with life-style factors among Turkish and Finnish pre-adolescents. Obesity Facts 1:196–202PubMedCrossRefGoogle Scholar
  21. 21.
    Güven A, Odaci H, Ozgen IT, Bek Y (2008) Effects of individual factors on adolescent obesity: study in Turkey. Pediatr Int 50:356–362PubMedCrossRefGoogle Scholar
  22. 22.
    Al-Zahrani MS, Borawski EA, Bissada NF (2004) Poor overall diet quality as a possible contributor to calculus formation. Oral Health Prev Dent 4:345–349Google Scholar
  23. 23.
    Psoter WJ, Reid BC, Katz RV (2005) Malnutrition and dental caries: a review of the literature. Caries Res 39:441–447PubMedCrossRefGoogle Scholar
  24. 24.
    Johansson I, Saellström AK, Rajan BP, Parameswaran A (1992) Salivary flow and dental caries in Indian children suffering from chronic malnutrition. Caries Res 26:38–43PubMedCrossRefGoogle Scholar
  25. 25.
    Psoter WJ, Spielman AL, Gebrian B, St Jean R, Katz RV (2008) Effect of childhood malnutrition on salivary flow and pH. Arch Oral Biol 53:231–237PubMedCrossRefGoogle Scholar
  26. 26.
    Shibasaki T (1989) Relationship of nutrition and dietary habits to gingivitis, dental calculus deposit and dental plaque adhesion in high school students (abstract in English). Shoni Shikagaku Zasshi; 27:415–426PubMedGoogle Scholar
  27. 27.
    Alvarez JO (1995) Nutrition, tooth development, and dental caries. Am J Clin Nutr 61:410S–416SPubMedGoogle Scholar
  28. 28.
    Gherunpong S, Tsakos G, Sheiham A (2004) The prevalence and severity of oral impacts on daily performances in Thai primary school children. Health Qual Life Outcomes. doi: 10.1186/1477-7525-2-57 PubMedGoogle Scholar
  29. 29.
    Acs G, Lodolini G, Kaminsky S, Cisneros GJ (1992) Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 14:302–305PubMedGoogle Scholar
  30. 30.
    Acs G, Shulman R, Ng MW, Chussid S (1999) The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatr Dent 21:109–113PubMedGoogle Scholar
  31. 31.
    Armstrong J, Dorosty AR, Reilly JJ, Child Health Information Team, Emmett PM (2003) Coexistence of social inequalities in undernutrition and obesity in preschool children: population based cross sectional study. Arch Dis Child 88:671–675PubMedCrossRefGoogle Scholar
  32. 32.
    United Nations (2006) 33rd session of the standing committee of nutrition participant’s statement. United Nations, GenevaGoogle Scholar
  33. 33.
    Cinar AB (2008) Preadolescents and Their Mothers as Oral Health-Promoting Actors: Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents. Dissertation, University of HelsinkiGoogle Scholar
  34. 34.
    Kanli A, Kanbur NO, Dural S, Derman O (2008) Effects of oral health behaviors and socioeconomic factors on a group of Turkish adolescents. Quintessence Int 39:26–32Google Scholar
  35. 35.
    Poverty DHF (2008) The double burden of malnutrition in mothers and the intergenerational impact. Ann N Y Acad Sci 1136:172–184CrossRefGoogle Scholar
  36. 36.
    Pekcan G, Karaagaoglu N (2000) State of nutrition in Turkey. Nutr Health 14:41–52PubMedGoogle Scholar
  37. 37.
    Gür E, Can G, Akkus S, Ercan G, Arvas A, Güzelöz S, Cifçili S (2006) Is undernutrition a problem among Turkish school children?: Which factors have an influence on it? J Trop Pediatr 52:421–426PubMedCrossRefGoogle Scholar
  38. 38.
    Carruth BR, Skinner JD (2001) The role of dietary calcium and other nutrients in moderating body fat in preschool children. Int J Obes Relat Metab Disord 25:559–566PubMedCrossRefGoogle Scholar
  39. 39.
    Mirmiran P, Esmaillzadeh A, Azizi F (2005) Dairy consumption and body mass index: an inverse relationship. Int J Obes 29:115–121CrossRefGoogle Scholar
  40. 40.
    Das UN (2001) Is obesity an inflammatory condition? Nutrition 17:953–966PubMedCrossRefGoogle Scholar
  41. 41.
    Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y (2005) A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 76(11 Suppl):2075–2084PubMedCrossRefGoogle Scholar
  42. 42.
    Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ (2000) Calcium and the risk for periodontal disease. J Periodontol 71:1057–1066PubMedCrossRefGoogle Scholar
  43. 43.
    Reeves AF, Rees JM, Schiff M, Hujoel P (2006) Total body weight and waist circumference associated with chronic periodontitis among adolescents in the United States. Arch Pediatr Adolesc Med 160:894–899PubMedCrossRefGoogle Scholar
  44. 44.
    Khader YS, Bawadi HA, Haroun TF, Alomari M, Tayyem RF (2008) The association between periodontal disease and obesity among adults in Jordan. J Clin Periodontol 1:18–24Google Scholar
  45. 45.
    Sarlati F, Akhondi N, Ettehad T, Neyestani T, Kamali Z (2008) Relationship between obesity and periodontal status in a sample of young Iranian adults. Int Dent J 58:36–40PubMedGoogle Scholar
  46. 46.
    Kinane FD (2000) Periodontal disease in children and adolescents: introduction and classification. Periodontol 2001(26):7–15Google Scholar
  47. 47.
    Aaro LE, Laberg JC, Wold B (1995) Health behaviors among adolescents: towards a hypothesis of two dimensions. Health Educ Res 10:83–93CrossRefGoogle Scholar
  48. 48.
    Petersen PE, Jiang H, Peng B, Tai BJ, Bian Z (2008) Oral and general health behaviours among Chinese urban adolescents. Community Dent Oral Epidemiol 36:76–84PubMedGoogle Scholar
  49. 49.
    Macgregor ID, Balding J, Regis D (1996) Toothbrushing schedule, motivation and 'lifestyle' behaviours in 7, 770 young adolescents. Community Dent Health 13:232–237PubMedGoogle Scholar
  50. 50.
    Macgregor ID, Balding JW (1987) Toothbrushing frequency in relation to family size and bedtimes in English schoolchildren. Community Dent Oral Epidemiol 15:181–183PubMedCrossRefGoogle Scholar
  51. 51.
    Bruno-Ambrosius K, Swanholm G, Twetman S (2005) Eating habits, smoking and toothbrushing in relation to dental caries: a 3-year study in Swedish female teenagers. Int J Paediatr Dent 15:190–196PubMedCrossRefGoogle Scholar
  52. 52.
    Amin TT, Al-Sultan AI, Ali A (2008) Overweight and obesity and their relation to dietary habits and socio-demographic characteristics among male primary school children in Al-Hassa, Kingdom of Saudi Arabia. Eur J Nutr 47:310–318PubMedCrossRefGoogle Scholar
  53. 53.
    Padez C, Mourao I, Moreira P, Rosado V (2009) Long sleep duration and childhood overweight/obesity and body fat. Am J Hum Biol 21:371–376PubMedCrossRefGoogle Scholar
  54. 54.
    Eley BM, Manson JD (2004) Periodontics. WRIGHT, Elsevier, LondonGoogle Scholar
  55. 55.
    Grossi SG, Collier DN, Perkin RM (2008) Integrating oral health to the care of overweight children: a model of care whose time has come. J Pediatr 152:451–452PubMedCrossRefGoogle Scholar
  56. 56.
    Sekine M, Yamagami T, Hamanishi S, Kagamimori S (2002) Accuracy of the estimated prevalence of childhood obesity from height and weight values reported by parents: results of the Toyama Birth Cohort study. J Epidemiol 12:9–13PubMedGoogle Scholar
  57. 57.
    Manios Y, Dimitriou M, Moschonis G, Kocaoglu B, Sur H, Keskin Y, Hayran O (2004) Cardiovascular disease risk factors among children of different socioeconomic status in Istanbul. Turkey: directions for public health and nutrition policy. Lipids Health Dis. doi: 10.1186/1476-511X-3-11 PubMedGoogle Scholar
  58. 58.
    Discigil G, Tekin N, Soylemez A (2009) Obesity in Turkish children and adolescents: prevalence and non-nutritional correlates in an urban sample. Child Care Health Dev 35:153–158PubMedCrossRefGoogle Scholar
  59. 59.
    Kocoglu G, Ozdemir L, Sümer H, Demir DA, Cetinkaya S (2003) Prevalence of obesity among 11–14 years old students in Sivas-Turkey. Pakistan Journal of Nutrition 2:292–295CrossRefGoogle Scholar
  60. 60.
    WHO (1998) Health behavior in school-aged children: a WHO Cross-National Study (HBSC) research protocol for the 1997/98 Survey. University of Edinburgh, EdinburghGoogle Scholar
  61. 61.
    Gökalp S, Doğan GB, Tekcicek M, Berbereoglu A, Ünlüer S (2007) Oral health profile among the adults and elderly—Turkey-2004 (Abstract in English). Hacettepe Dis Hekimligi Dergisi 31:11–18Google Scholar
  62. 62.
    Lee JM, Appugliese D, Kaciroti N, Corwyn RF, Bradley RH, Lumeng JC (2007) Weight status in young girls and the onset of puberty. Pediatrics 119:624–630CrossRefGoogle Scholar
  63. 63.
    Rogol AD, Roemmich JN, Clark PA (2002) Growth at puberty. J Adolesc Health 31(6 Suppl):192–200PubMedCrossRefGoogle Scholar
  64. 64.
    Bruno-Ambrosius K, Yucel-Lindberg T, Twetman S (2004) Salivary buffer capacity in relation to menarche and progesterone levels in saliva from adolescent girls: a longitudinal study. Acta Odontol Scand 62:269–272PubMedCrossRefGoogle Scholar
  65. 65.
    Jenkins WM, Papapanou PN (2000) Epidemiology of periodontal disease in children and adolescents. Periodontol 26:16–32CrossRefGoogle Scholar
  66. 66.
    David J, Raadal M, Wang NJ, Strand GV (2006) Caries increment and prediction from 12 to 18 years of age: a follow-up study. Eur Arch Paediatr Dent 7:31–37PubMedGoogle Scholar
  67. 67.
    Shumei SG, William CC (1999) Tracking of body mass index in children in relation to overweight in adulthood. Am J Clin Nutr 70:145S–148SGoogle Scholar
  68. 68.
    Hunter ML, Newcombe R, Richmond S, Owens J, Addy M (2007) The Cardiff dental survey: oral hygiene and gingival health between the ages of 11–12 and 30–31 years. Br Dent J. doi: 10.1038/bdj.2007.964 Google Scholar
  69. 69.
    Kelder SH, Perry CL, Klepp KI, Lyttle LL (1994) Longitudinal tracking of adolescent smoking, physical activity, and food choice behavior. Am J Public Health 84:1121–1126PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Community Dentistry, Institute of OdontologyUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Oral Public HealthInstitute of Dentistry, University of HelsinkiHelsinkiFinland

Personalised recommendations