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 Table of Contents  
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 52-57

Potency of dental permanent tooth eruption because of body mass index disturbance due to untreated teeth in elementary students

Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Date of Submission25-Oct-2018
Date of Decision30-Aug-2019
Date of Acceptance09-Sep-2019
Date of Web Publication25-Feb-2020

Correspondence Address:
Gilang R S Wening
Department of Dental Public Health, Faculty of Dentistry, Campus A Universitas Airlangga, Jl. Prof Dr. Moestopo No. 47, Surabaya 60132.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_278_18

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Aim: To analyze the correlation between body mass index (BMI) to the tooth eruption and the severity level of dental caries in elementary school-aged children. Materials and Methods: A descriptive cross-sectional observational study was conducted among the students of an elementary school. The population of this study comprised students aged 9–12 years. A total of 49 samples obtained in this study were selected by simple random sampling technique. In this study, PUFA (pulp, ulceration, fistula, abscess) index was performed in intraoral examination. BMI examination was conducted to measure the body mass of the respondents. The statistical analysis was carried out using SPSS software (Statistical Package for the Social Sciences), version 21. Analysis method used in this study was odds ratio with P < 0.05 (sig two-tailed) and confidence interval at 95%. Results: Approximately 48.1% children had right upper canine not fully erupted with poor BMI. A total of 63.6% children with good BMI had teeth (i.e., right upper canine) almost fully erupted. Children with teeth (i.e., left upper canine) that had erupted by 2/3 until completion were dominated by children with good BMI (72.7%). A total 86.4% children with good BMI had teeth (i.e., lower left canine) fully erupted. Whereas, children who had teeth (i.e., lower right canine) 2/3 to perfectly erupted were dominated by children with good BMI as much as 81.6%. (P > 0.05). Meanwhile, 53.6% respondents with normal BMI level had dental cares without pulp-involvement (P > 0.05). Conclusion: Tooth eruption and dental caries severity did not correlate with BMI.

Keywords: Body Mass Index, Caninus Growth, Dental Caries

How to cite this article:
Wening GR, Bramantoro T, Zamzam A, Kusumo AD, Ramadhani A. Potency of dental permanent tooth eruption because of body mass index disturbance due to untreated teeth in elementary students. J Int Oral Health 2020;12:52-7

How to cite this URL:
Wening GR, Bramantoro T, Zamzam A, Kusumo AD, Ramadhani A. Potency of dental permanent tooth eruption because of body mass index disturbance due to untreated teeth in elementary students. J Int Oral Health [serial online] 2020 [cited 2022 Oct 3];12:52-7. Available from:

  Introduction Top

Results of the Basic Health Research (RISKESDAS) in 2013 showed that the prevalence of dental caries in the last 12 months in Indonesia was 76.2%. Population with dental and oral problems who received care and treatment was 31.1% and the tendency of decay-missing-fillings (DMF-T) index was 4.5. The 2013 RISKESDAS data showed DMF-T for 12-year-old children <1. In line with the World Health Organization (WHO) plan, the Indonesian Ministry of Health in an integrated manner supports the realization of Indonesia Caries Free 2030 with the target of DMF-T children in the 12-year age group reaching 1.26.

Caries is a civilization disease, which means that the more a country develops, the higher the incidence of caries.[1] The health behavior of the parents’ dental and oral cavity is proven to affect the health of their children’s. Maternal behavior stimulates and increases microbial contamination in children’s oral cavity. It emphasizes that parents have an important role in maintaining the health of their children’s dental and oral cavity, such as the habit of brushing teeth. Knowledge, attitudes, and socioeconomic status of parents also affect children’s oral and dental health behaviors.[2]

Untreated caries can cause infection and pain and end in a gangrenous pulp state. Gangrenous pulp is one of the most common dental diseases in Gayungan Health Center, Indonesia. Caries that are not treated will affect the children’s quality of life because it can cause pain and discomfort in the oral cavity such that it will have an impact on diet and sleep patterns.[3] Research reveals that children with untreated caries can increase the risk of decreased body mass index (BMI) below normal.[4] The large number of teeth that are not treated, allowing a decrease in BMI due to decreased food consumption.

In several studies, it was found that children’s BMI affects the eruption time of their permanent teeth. Low BMI can cause a permanent eruption delay compared to that in children who have BMI in the normal range. Permanent teeth that will erupt in elementary school children aged 8–12 years can be observed through eruption of canines. Normal eruption time of maxillary permanent canines is at 11–12 years and of permanent mandibular canines is at 9–10 years.[5]

The aim of this study was to analyze the correlation between BMI to the tooth eruption and the severity level of dental caries in elementary school-aged children.

  Materials and Methods Top

This was a descriptive observational study with a cross-sectional approach in elementary schools. The population in this study included students who attended elementary school with 177 students from grade 3 to 6 with age range of 9–12 years. We exclude the students in first and second grade class. This research was approved and ethically cleared by the board of Faculty of Dentistry, Universitas Airlangga ethics committee. The respondent has been signed the informed consent before filling out the questionaire.

In epidemiology research, the research subjects answered interview questions on the related child questionnaire form with caries risk factors, researchers observed the condition of the oral cavity with caries and its severity was measured using the PUFA (pulp, ulceration, fistula, abscess) index, then the questionnaire form for the subject’s parents (father or mother) was given and collected the next day. The researchers then took 49 students as a sample based on simple random sampling method.

The researchers performed PUFA examination to measure the severity of dental caries. In this study, the PUFA index examined was only pulp involvement. BMI measurements were used to evaluate overweight and obesity based on two parameters, height and weight. Weight is measured in kilograms, and height in meters. For examination of permanent tooth growth, a maxillary and mandibular canine is checked. The total number of canines examined was 4 teeth per person. We classified the tooth eruption into three groups: 1/3 erupted, 2/3 erupted, and fully erupted teeth.

Data processing had been collected, and then the results of data analysis were compiled in the form of research reports and conclusions and research suggestions.

The questionnaire used in this study had been tested for its validity. The validity test for the questionnaire was carried out by finding a correlation between the scores of each question (r result) with the r value in the table. The validity test was performed twice until all questions were considered valid. Each question was declared valid if r (results) had a positive value and r (results) > r (table), that is, at the significance level of 5% for n = x, then the value of r (table) = x. To be declared valid, all questions must have a positive r value and value > x. The results of the validity showed all valid questions.

Statistical analysis: Data collected were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 21 (Released 2012; IBM, Armonk, New York). Analysis method used in this study was odds ratio with P < 0.05 (sig two-tailed) and confidence interval at 95%.

  Results Top

From the results of respondent’s distributions as shown in [Table 1], it was found that 54.9% respondents had poor PUFA score. Approximately 62.7% of respondent’s parents were graduated from high school and had poor knowledge of dental caries (78.5%). As most of the respondents had poor knowledge of dental caries, they also had poor action and prevention toward dental caries. This was also affecting their children’s (respondent’s) action and knowledge toward caries. A total of 55% of the respondents had below average BMI score, and varied tooth eruption level [Table 1].
Table 1: Samples’ characteristics

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From the odds ratio analysis, it was found that dental caries severity (PUFA) had no significant relationship with all of the risk factors (children’s action, children’s knowledge, parent’s knowledge, parent’s prevention, parent’s action, and parent’s education levels) [Table 2] (P > 0.05). But most of the respondents that had poor PUFA score (high caries severity level) were relevant with the poor risk factors.
Table 2: Distribution of caries severity (pulp, ulceration, fistula, abscess [PUFA] index) based on risk factors

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[Table 3] shows that 66% of the respondents that had pulp involvement caries were having below average BMI, whereas, it was not a significant relationship (P > 0.05).
Table 3: Body mass index distribution of caries severity

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The result on data analysis between BMI score and canine eruption (growth) showed that there was no difference in poor and good BMI score [Table 4]. Respondents that had poor BMI score had their canine erupted early. We conducted odds ratio analysis and found that there was no significant correlation between BMI and canine eruption (P > 0.05).
Table 4: Distribution of body mass index to canine growth

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  Discussion Top

In this study, a sample of 49 children was taken in an elementary school in Surabaya to measure BMI and condition of the oral cavity due to untreated caries. The number of children who experienced caries was found to involve the pulp by 48%. In Iran, it is known that the prevalence of primary school students who have caries with pulp-involevment reaches 30%.[6] This study showed that 66.7% of children with caries involving the pulp had BMI below average, whereas only 33.3% had BMI above average. The grouping of BMI was then divided into two categories in poor BMI, which were the BMI values below average (≤18.4kg/m2) and the ones above average (≥18.5kg/m2). The severity of dental caries may reduce a person’s ability to eat, which results in weight loss. BMI can also be a predisposing factor in caries severity. Protein or energy deficiency in food results in decreased protein intake decreased salivary flow, tartar formation, high caries rate, and decreased growth. Chronic malnutrition, especially in childhood, is associated with a person’s susceptibility to primary dental caries, for example, due to enamel hypoplasia and decreased salivary function. However, this can also be influenced by other variables such as socioeconomic status.[6]

Further research was conducted to assess the severity of dental and oral diseases due to caries that were not treated at elementary school, measured using PUFA index. The results of the study showed the prevalence of primary dental caries involving the pulp, which was 58.1%. This result was more than that in the research conducted in Iran, which mentions the number of children who had caries that involved the pulp in primary school-aged children by 30%.[7]

Most of the children in elementary schools in Surabaya had large caries with pulp involvement. This indicated that most children had poor dental and oral health status that can affect public health. The severity of caries can be influenced by many things, both from the internal aspect and the external environment. The distribution results of the severity of child caries based on parental education showed that the results of parental education with the last education level of high school/vocational high school had higher PUFA index of 67.7%. Caries severity decreased if the level of parents’ education was higher. This study was in line with the results of a study, which stated that the level of parents’ education has an influence on children’s oral health.[8] The quality of parents’ education levels was thought to be one of the predisposing factors for poor oral and dental health of children.

Furthermore, the level of parents’ education will affect the socioeconomic status of the family. Unhealthy lifestyles tend to be owned by parents with low levels of education and low socioeconomic status.[9] Education can influence health behavior in several ways. Someone with higher education level obtains more information about health, knows, and realizes the consequences of carrying out an action that is not in accordance with the health rules. Someone with low education tends to have poor health behavior. They tend to have poor perceptions about their personal health and the surrounding environment, they do not maintain good health, and they have a lack of health needs, which result in a lack of concern with health status and low utilization of health facilities.

Parents’ knowledge data were cross-tabulated with children’s PUFA index, and the results showed that parents with bad knowledge about caries had children with bad PUFA index value of 82.8%. This study is in line with the theory that parental knowledge of oral health affects the level of caries in children. Parents’ knowledge is very important in underlying the formation of behavior that supports or does not support children’s oral and dental hygiene.[10] This knowledge can be obtained naturally or in a planned manner through the education process. Parents with low knowledge of dental and oral health are predisposing factors for behavior that does not support children’s oral and dental health.[11]

Parents with good levels of oral hygiene tend to have children with a bad plaque index than parents who have poor levels of oral hygiene. It can be concluded that mothers with good education will have extensive knowledge about health behaviors so that they can channel good health behaviors to their children.[12]

The results showed that children with poor dental health had poor caries severity (PUFA), which was 65.6%. The most adverse action that affected the severity of the subjects’ caries was that they did not clean their teeth after eating sweet and sticky foods, even if only gargling. When dental caries were severe, they preferred to leave them as such or buy drugs at the pharmacy rather than visit the dentist, and most of them did not visit the dentist every six months. The act of maintaining dental and oral health improperly causes high caries severity. Dental and oral health handling is one of the health behavioral factors that affect the severity of dental caries in children.[13] The action in maintaining proper oral and dental health is by brushing teeth twice a day in the morning after breakfast and at night before bed.[14] In this study, there are still many children who did not brush their teeth twice a day, especially before going to bed. Many children did not rinse their mouths after eating sweet or sticky foods, and there was a lack of dental visits every six months.

After eating sweet and sticky food, at least children have to rinse with water to help remove the remaining food so that it does not stick to the surface of the tooth for a long time.[15] In this study, most children did not gargle after eating sweet and sticky food they often buy at school breaks. This behavior was influenced by their knowledge of the causes of cavities that were considered to be lacking, and also the knowledge of parents to instruct their children to do so was still low. This showed that the child subjects with poor dental health knowledge had poor caries severity (PUFA), which was 65.6%.

Knowledge is the basis of health behavior and is very important in shaping a correct health behavior. Several studies have shown that there is a correlation between good knowledge about dental and oral health and good dental health status. Dental health behavior can be performed optimally if the subject knows well the knowledge of dental disease that they can experience and the cause of the diseases that can occur.[16]

The lack of children’s knowledge about dental and oral health can be influenced by the lack of parents’ knowledge about it, the lack of dental health education taught in schools, wherein schools are the primary learning place for children other than home, as well as the lack of role of dental health workers to improve children’s knowledge in their environment. The low knowledge of children can be intervened from schools by including dental health material as a school curriculum. The educational program must involve the school, dental health workers, and parents.

Dental caries that are not treated will cause the severity of dental infections and cause discomfort and pain in children, so that it can reduce appetite due to pain experienced when eating. The second is that dental caries that are not treated can reduce the quality of life due to pain, irritation, and sleep disturbance. Sleep disorders affect glucocorticoid production and child growth. Although not all untreated caries have an influence on public health, but several studies say there is a significant relationship between the quality of life of children and food intake. A third mechanism that explains how caries can affect child growth is chronic inflammation that occurs when pulpitis and periapical abscess stimulates the production of cytokines such as interleukin-1, which results in the inhibition of erythropoiesis. These obstacles will inhibit the formation of hemoglobin and in the long run will lead to anemia and low weight in children.[17]

The relationship between BMI and eruption of permanent teeth showed that children who had tooth 13, which was not erupted until 1/3 erupted, were dominated by children with poor BMI of 48.1%. Whereas, 63.6% of children with good BMI had teeth 13, which were 2/3 until completely erupted. In children with poor BMI, 55.6% of them had teeth 23 which were 2/3 until completely erupted, whereas in children with good BMI, 72.7% had teeth 23 that were 2/3 until completely erupted. As many as 86.4% of children with good BMI had teeth 33, which were 2/3 until completely erupted. Children who had teeth 43, which were 2/3 until completely erupted, were dominated by children with good BMI of 81.8%.

The study showed that children with good BMI had teeth 13, 23, 33, and 43, which erupted more than children with poor BMI. This was related to adipose tissue of children with good BMI. Adipose tissue has a complex function, which plays a role in organ endocrine function, which is part of the metabolic process and hormonal response. Adipose tissue expansion results in hormonal changes with increased secretion of insulin-like growth factor-1 and changes in mineral metabolism that can increase the acceleration of tooth eruption.[18] Impaired tooth eruption can affect treatment time. Failure for early treatment measures can increase the risk of dental and oral problems such as malocclusion, crowded teeth, and poor oral hygiene. Failure of early therapy can also add to the need for therapy that must be carried out next.[19]

Although the results of statistical analysis showed no significant correlation for all variables, the data collected showed the relevant score. For future research direction, the researcher can use more variables to determine the impact of untreated caries due to children’s BMI. For example, it is associated with child’s nutritional intake, activities carried out, and physiology of the child itself. With the existence of this research, the results are expected to help the Public Health Center to create a health program to address existing problems. The close relationship between teeth that are not handled by BMI can also be a start of making health policies in Indonesia. We can conclude that there is no significant correlation between BMI and canine eruptions.

The limitation in this study was that the result was not related to the theory used in this research, this might be something limited to the research population, samples, data analysis technique, and measurement variables. The time for conducting this research was limited too, so the variables checked were not optimal. We can also classify the age of the respondents, the nutritional foods they consumed, dental habit, and radiographic photo of tooth eruption.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Ethical policy and institutional review board statement

Ethic approval for performing this study has been obtained from the Research Ethics Committee of Faculty of Dentistry, Universitas Airlangga, Surabaya, Indonesia, with the number of ethic clearance as 27/KKEPK.FKG/VI/2014.


We would like to thank all the staff at the Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia, for supporting this research, and also the Gayungan PKL students who made this research come true.

Financial support and sponsorship

This work was self-funded by the authors.

Conflicts of interest


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  [Table 1], [Table 2], [Table 3], [Table 4]


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