An occasionally irregular blog about orthodontics

Does Body Mass Index influence orthodontic related oral health?

Does Body Mass Index influence orthodontic related oral health?

Does Body Mass Index influence orthodontic related oral health?

I am now returning to the blog by posting some shorter posts over the next few weeks. I am also not 100% after my surgery, so please ignore any typos etc!  I came across this paper that has recently been published in the advance access section of the European Journal of orthodontics. The title of the paper caught my eye as it raised an interesting question.

images-13Impact of body mass index on oral health during orthodontic treatment: an explorative pilot study

Julia Von Bremen, Nathalie Lorenz, Sabine Ruf

European Journal of Orthodontics: Advance access: DOI: 10.1093/ejo/cjv074

This paper is particularly relevant as there is presently a large amount of concern on the effects of childhood obesity. In many countries this is regarded as a major health problem and a serious public health challenge. At first, I was not sure whether this was an issue for orthodontic treatment. However, in the literature review they pointed out that previous orthodontic studies have shown that children who were overweight do not appear to cooperate as well as normal weight peers. As a result, they carried out this explorative study to provide information on whether body-mass index was related to oral health and cooperation during orthodontic treatment.

What did they do?

The study was based in their university clinic.  They obtained their sample of patients by screening all the patients who had been treated with fixed appliances between March 2007 and May 2012. The main inclusion criteria were

  • the patients were under 18 years old,
  • they had completed their treatment and
  • pre-and post treatment records were available.

They identified 181 patients. They calculated their BMI based on their weight and height data. They then evaluated white spot lesions and gingivitis from photographs that were taken at the start and finish of treatment. They also collected data on appliance breakages, poor oral hygiene and the overall process of treatment from the patient record. It is important to point out that this was a retrospective investigation.

What did they find?

Of the 181 patients 138 (79%) had normal BMI, 22 (12.5%) were overweight and 15 (8.5%) were obese.

They found that after treatment 44% of the patients had at least one new white spot lesion on their incisors. They also found that the higher the pretreatment BMI the higher the prevalence of white spot lesions. For example, 41% of the normal BMI patients had a white spot lesion, 50% of the overweight and 66% of the obese had additional white spot lesions.

They found similar effects on gingivitis. Finally, they suggested that children with normal BMI greater levels of cooperation than those who were overweight or obese.

In their discussion they pointed out that because this was an exploratory study and they wanted to minimise bias they did not formulate a hypothesis or carry out a sample size calculation. They also stated that their data  was not robust and their findings should only be considered as an indicator that there may be a relationship between BMI and cooperation. This concept should then be evaluated further in a  prospective study.

What did I think?

I think that it us useful to consider why children who had high BMI did not have good levels of co-operation.  The authors have suggested that this may because of potential socio economic effects, in that high BMI is related to lower socio-economic status.  They also suggested that this could be due to difference in metabolism.  But this is simply conjecture and need further investigation.

Overall, I felt that this was an interesting study and I do agree totally with their comments about the study not being sufficiently robust to draw conclusions. I was then surprised that they concluded

“An increased BMI appears to be associated with more all health-related problems during orthodontic treatment and a longer treatment duration”.

I do not feel that we can draw this conclusion from their data and we need to remember that this study is a pilot study and we should be very careful about  implementing these findings into our practice. This is particularly relevant when we consider the potential negative stereotyping of overweight people. Nevertheless, their findings to point towards some useful prospective studies, which may result in clinically relevant data that could help us treat children who are obese. But until this work is done, I will not be changing my practice.

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  1. Clínica Alexandre Câmara | October 27, 2015
  1. Roy Dookun says:

    perhaps the relationship between BMI and paediatric OSA and paediatric sleep disordered breathing in orthodontic treatment planning is of more relevance?

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