Oral Health Status of Korean Students and Associated Fasting Plasma Glucose in Overweight/Obese Individuals

Hyeonjin Kim; Soyoun An

doi:10.5933/JKAPD.2024.51.4.369

J Korean Acad Pediatr Dent > Volume 51(4); 2024 > Article

Kim and An: Oral Health Status of Korean Students and Associated Fasting Plasma Glucose in Overweight/Obese Individuals

Original Article

J Korean Acad Pediatr Dent 2024;51(4): 369-379.

Published online: November 25, 2024

DOI: https://doi.org/10.5933/JKAPD.2024.51.4.369

Oral Health Status of Korean Students and Associated Fasting Plasma Glucose in Overweight/Obese Individuals

Hyeonjin Kim

, Soyoun An

Department of Pediatric Dentistry, Wonkwang University Daejeon Dental Hospital, Daejeon, Republic of Korea

Corresponding author: Soyoun An Department of Pediatric Dentistry, Daejeon Dental Hospital, Wonkwang University, 77, Dunsan-ro, Daejeon, 35233, Republic of Korea
Tel: +82-42-366-1197 / Fax: +82-42-366-1115 / E-mail: sue1111pedo@gmail.com

Received August 13, 2024 Revised September 10, 2024 Accepted September 11, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study aimed to evaluate the current oral health status of Korean children and adolescents and investigate the correlation between fasting plasma glucose levels and oral health in individuals with overweight and obesity. A total of 121,682 participants were selected from the Survey of School Health Examination data provided by the Ministry of Education over the last 5 years to assess recent oral health status and related factors. Among them, 18,105 students with overweight or obesity who had their fasting plasma glucose levels measured were assessed for blood glucose-related analysis. Based on fasting blood glucose levels, the participants were categorized into normal, impaired fasting glucose, and diabetes groups. The associations of these groups with dental caries, oral hygiene, and periodontal diseases were investigated. There were significant associations between demographic factors, health-related behaviors, and blood glucose levels with oral health. Increased fasting blood glucose levels were associated with poor oral health. These results suggest that glycemic management is important in enhancing the oral health of overweight and obese children and adolescents.

Keywords: Dental caries, Periodontal diseases, Oral hygiene, Blood glucose, Diabetes mellitus

Introduction

Consumption of low-sugar foods and drinks, such as Zero Coke, has surged, indicating a rising interest in blood glucose control. Replacing high-calorie fructose with artificial sweeteners, such as aspartame, aims to reduce calorie intake and prevent abrupt changes in blood glucose levels. With increasing clarity regarding the relationship between blood glucose control and weight management, it has been proposed as a potential solution for the escalating overweight and obesity epidemic[1-3].

The prevalence of overweight and obesity is increasing globally and becoming a major public health issue[4]. The increasing prevalence of obesity in Korea is evident, as highlighted in the 2023 Korean Obesity Status Report. Among adults, the prevalence of obesity was expected to increase from 30.2% in 2012 to 38.4% by 2021. The prevalence of obesity among Korean children and adolescents was expected to increase from 9.7% in 2012 to 19.3% in 2021. During the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of obesity increased from 13.7% in 2019 to 15.9% and 19.3% in 2020 and 2021, respectively[5].

Several factors increase the risk of obesity in children and adolescents, with dietary factors, such as overnutrition and excessive consumption of fast food and sugar-sweetened drinks, playing major roles; reduced physical activity also contributes to this. Childhood obesity is not a simple problem and frequently progresses into adulthood, leading to chronic comorbidities, such as metabolic diseases, musculoskeletal disorders, cardiovascular diseases, Alzheimer’s disease, obstructive sleep apnea, depression, and certain cancers[6-8].

Obesity significantly affects oral health. Obesity and oral health share several common risk factors, such as dietary, genetic, socioeconomic, and lifestyle elements. The association between obesity and oral health issues, such as caries and periodontal disease, in children and adolescents has been extensively documented. Although the association between obesity and dental caries varies across studies, its substantial association with periodontal disease is well-documented[9-12].

Since childhood and adolescence are critical periods of growth and development, both obesity and dental diseases can have undesirable effects and lead to poor health-related behaviors[12]. With the rise of childhood obesity, diabetes is no longer solely an affliction in adults[13]. Diabetes, a metabolic disorder characterized by hyperglycemia resulting from abnormalities in insulin secretion and function, is one of the most prevalent consequences of obesity. Prolonged diabetes has systemic effects, including cardiovascular complications, and can lead to mortality[14,15]. It also has a profound impact on oral health, as well as general health, increasing the risk of periodontal disease, dental caries, and halitosis due to dry mouth[16,17].

In recent years, an increasing number of studies have investigated the relationship between oral health and diabetes in children; however, most reports still focus on adults with diabetes[18-21]. Several studies have reported a relationship between diabetes and oral health in children and adolescents. In addition, few studies have focused on differences in oral health conditions based on fasting plasma glucose levels, a common indicator for diabetes[22].

Diabetes negatively affects both oral and systemic health, reducing the quality of life and leading to sociopsychological issues. Recognizing these problems and developing effective prevention and treatment strategies is crucial[23,24].

This study aimed to assess the oral health status of Korean children and adolescents by focusing on dietary and health-related factors that influence oral health. We also examined the relationship between oral health and fasting blood glucose levels among children and adolescents with overweight and obesity using data from the Korean National Student Health Survey over the previous 5 years. Based on these findings, we aimed to provide a basis for oral health promotion through awareness and education of oral health among children and adolescents at risk of diabetes.

Materials and Methods

This study was approved by the Institutional Review Board of the Public Institution (P01-202404-01-023).

1. Study population

This study used raw data from the Survey of School Health Examinations provided by the Ministry of Education for the years 2017, 2018, 2019, 2021, and 2022. The survey was not conducted in 2020 owing to the COVID-19 pandemic. The School Health Examination Survey includes physical development assessments, health surveys, and health examinations. Health assessments were conducted in representative grades: the first, fourth, and sixth grades of elementary school and the first grade of middle and high school. Oral examinations were performed in all elementary school grades. In particular, children who were overweight or obese identified during physical development evaluations underwent additional pathological tests in representative grades: the fourth grade of elementary school and the first grade of middle and high school. There were no duplications in the sample; however, non-response data were included. From a total sample of 483,389 children over the course of 5 years, 121,682 children in whom caries, oral hygiene conditions, periodontal disease, general characteristics, and health habit variables were measured were selected for inclusion in the study (Table 1). For the analysis of glycemic factors, 18,105 individuals with overweight or obesity with non-missing fasting blood glucose data were additionally extracted (Fig. 1). Obesity was assessed by comparing body mass index (BMI) (kg/m²), calculated from each student’s height and weight, to sex- and age-specific percentile charts from the 2017 Child and Adolescent Growth Charts. A BMI below the 5th percentile indicated underweight, between the 85th and 95th percentiles indicated overweight, and above the 95th percentile indicated obesity. Starting in 2021, as a result of changes in the testing period caused by COVID-19, the cutoffs were adjusted for the exact month of age.

2. Study methods

To evaluate the oral health status of Korean children and adolescents, we calculated the dental caries prevalence (DCP), which represents the proportion of individuals with dental caries among those screened for this condition. We also calculated the required rate of improved oral hygiene (RRIOH), which indicated the proportion of individuals requiring enhanced oral hygiene among those screened for this condition. Additionally, the periodontal disease prevalence (PDP) was evaluated based on the proportion of those who had periodontal disease among those screened for the condition.

The following demographic data were collected from the study subjects: sex (male, female), city size (metropolitan/small city, town/village, rural/special area), school level (elementary, middle, and high school), health- and diet-related habits, and lifestyle habits. Data were collected through a subjective questionnaire health survey. Health-related behaviors included the frequency of beverage consumption, fast-food intake, meat consumption, milk and dairy product consumption, fruit and vegetable intake, breakfast frequency, and average daily frequency of tooth-brushing during the week.

Using oral health-related indicators, we aimed to observe changes in oral health over the years and identify differences in oral health according to demographic variables and health behaviors. Additionally, we used fasting blood glucose levels obtained through pathological tests as glycemic variables to examine the differences and associations between oral health and fasting blood glucose levels. Fasting blood glucose levels below 100 mg/dL were classified as normal, levels between 100 and 126 mg/dL were classified as impaired fasting blood glucose, and levels above 126 mg/dL were classified as diabetes.

3. Statistical analysis

To assess the variations in DCP, RRIOH, and PDP over the years, a Rao-Scott χ2 test was performed using the weighted composite sample χ2 test as suggested for the raw data. A χ2 test was performed to investigate differences in DCP, RRIOH, and PDP based on demographic characteristics, health-related habits, and blood glucose levels. Additionally, logistic regression analysis was performed to examine the impact of blood glucose levels on the probability of DCP, RRIOH, and PDP. Using normal blood glucose as a reference, odds ratios (OR) were calculated for impaired fasting glucose and diabetes. All demographic characteristics and health-related habits were considered control variables to correct for their effects.

All statistical analyses were performed using SPSS 26.0 (SPSS Inc., Chicago, IL, USA) with a significance level of α = 0.05.

Results

1. DCP, RRIOH, and PDP according to the year

Herein, we assessed changes in DCP, RRIOH, and PDP over the previous 5 years; all three indicators showed statistically significant differences across the years (p < 0.0001).

The DCPs were 23.5% in 2017, 23.5% in 2018, 23.8% in 2019, 20.2% in 2021, and 19.1% in 2022, indicating a decrease in the prevalence of caries post-COVID-19. The RRIOHs were 14.7% in 2017, 14.6% in 2018, 13.3% in 2019, 14.3% in 2021, and 13.9% in 2022, showing a slight decrease in 2019 and a subsequent increase post-COVID-19. PDPs were 10.6% in 2017, 9.8% in 2018, 8.7% in 2019, 8.1% in 2021, and 9.5% in 2022, showing a decrease until 2021 and an increase in 2022 (Fig. 2).

2. DCP, RRIOH, and PDP according to demographic characteristics

We analyzed the impact of demographic characteristics on DCP, RRIOH, and PDP; all indicators differed significantly according to sex, city size, and school level (p < 0.0001).

DCP was higher among females, whereas RRIOH and PDP were higher among males. Regarding city size, DCP and RRIOH were notably lower in large and medium-sized cities, whereas PDP was relatively consistent throughout city levels, with a slight increase in towns. Regarding school levels, DCP was the highest among elementary students and the lowest among middle-school students; RRIOH showed an inverse trend. PDP increased with school level (Table 2).

3. DCP, RRIOH, and PDP according to health-related habits

We examined the relationships of DCP, RRIOH, and PDP with health-related habits; significant differences in all indicators were observed across all health behaviors (p < 0.0001).

Higher levels of DCP, RRIOH, and PDP were associated with more frequent consumption of beverages and fast food. In contrast, consumption of milk or dairy, vegetables, and regular breakfast was associated with a lower DCP, RRIOH, and PDP. Additionally, DCP, RRIOH, and PDP tended to be higher among individuals who brushed their teeth less than once a day on average (Table 3).

4. DCP, RRIOH, and PDP according to blood glucose levels

We examined differences in DCP, RRIOH, and PDP based on blood glucose levels. Significant differences in DCP (p= 0.004), RRIOH (p < 0.0001), and PDP (p= 0.004) were observed across blood glucose levels.

DCP increased from 21.6% in individuals with normal blood glucose levels to 23.4% in those with impaired fasting glucose and further to 28.1% in individuals with diabetes, suggesting a positive association between higher blood glucose levels and increased DCP. Similarly, RRIOH was 15.8% in those with normal blood glucose, 18.9% in those with impaired fasting blood glucose, and 18.5% in those with diabetes, indicating relatively better oral hygiene among those with normal blood glucose levels (p < 0.0001). PDP followed a similar trend, with rates of 13.6% in those with normal blood glucose, 15.4% in those with impaired fasting blood glucose, and 18.5% in those with diabetes, implying a positive correlation between higher blood glucose levels and increased PDP (Table 4).

5. Effect of blood glucose level on DCP, RRIOH, and PDP

Compared with those with normal blood glucose levels, those with impaired fasting blood glucose levels were significantly more likely to have caries (OR = 1.15, p= 0.002); similarly, those with diabetes were significantly more likely to have caries (OR = 1.42, p= 0.015). Individuals with impaired fasting blood glucose levels were significantly more likely to require improved oral hygiene (OR = 1.19, p < 0.0001) compared with those with normal blood glucose levels. Although people with diabetes also showed a higher likelihood of needing improved oral hygiene compared to those with normal blood glucose levels, this difference was not statistically significant, likely because of the small sample size. Additionally, individuals with impaired fasting glucose were significantly more predisposed to periodontal disease (OR = 1.16, p= 0.004); similarly, those with diabetes had significantly greater predisposition to periodontal disease (OR = 1.42, p= 0.036).

In summary, higher blood glucose levels were associated with increased odds of caries and periodontal disease among adolescents, whereas impaired fasting levels were associated with a higher likelihood of requiring improved oral hygiene (Table 5).

Discussion

This study was conducted using data from the Survey of School Health Examination to evaluate the current oral health status of Korean children and adolescents and investigate the association between fasting blood glucose levels and oral health in overweight and obese students.

Our findings showed higher DCP in females, consistent with previous findings that, compared with males, females experience more dental caries due to earlier tooth development and first molar eruption[25,26]. DCP and RRIOH were lower in large- and medium-sized cities, likely due to better access to dental treatment and checkups. The variation in DCP across school levels, with the highest prevalence in elementary students and the lowest in middle-school students, may be due to the timing of permanent tooth eruption, leading to less advanced caries in the permanent teeth. Additionally, higher RRIOH in middle-school students and higher PDP in high-school students may be related to hormonal changes during adolescence[27].

The significant associations between oral health indicators and dietary habits align with previous findings that a lower intake of fruits and vegetables leads to lower fiber intake and that an unhealthy diet is related to increased caries and periodontal disease[12]. Toothbrushing frequency, an indicator of self-care, was significantly correlated with DCP, RRIOH, and PDP. This contrasts with previous studies that found no significant association between brushing frequency and caries prevalence[28,29]. This discrepancy may be due to the inclusion of middle- and high-school students who have developed tooth-brushing skills. Poor oral health can stem from various factors, such as inadequate oral hygiene habits and poor dietary choices, which necessitate greater awareness and habit improvement. Comprehensive strategies to promote overall well-being are required to enhance oral health outcomes.

The findings of this study highlight the impact of fasting blood glucose levels on oral health, showing that individuals with high fasting blood glucose levels (hyperglycemia) have a higher prevalence of caries, periodontal disease, and poorer oral hygiene than those with normal blood glucose levels. Although studies investigating oral health based on blood glucose levels are limited, our results are consistent with those of previous studies. A study on the association of BMI and metabolic risk factors with early childhood caries in preschool children found that while BMI was not significantly associated with dental caries, elevated fasting glucose levels were significantly associated with decayed or filled teeth, and mean fasting glucose levels were significantly associated with the presence of dental caries[30]. Similar associations between hyperglycemia and dental caries have been reported in adults. Studies using data from the Korean National Health Examination Survey have shown an association between elevated fasting blood glucose levels with periodontitis and tooth loss in nondiabetic Koreans aged ≥ 40 years[31]. Hyperglycemia induces macrophage hyperthermia and cellular senescence, accelerates gingival inflammation, and produces more advanced glycation end products that interact with receptors and mediate oxidative stress pathways, leading to periodontitis through an excessive systemic immune response[32,33]. These findings underscore the multifaceted impact of hyperglycemia on oral health and the need for comprehensive oral health management strategies, especially in individuals with elevated fasting blood glucose levels.

Although more studies on the association between fasting blood glucose levels and oral health are being conducted, they largely focus on adults and preschool children, with little attention paid to school-aged children and adolescents. This study addresses this gap by investigating this association in this population. Our findings highlight the importance of understanding the relationship between blood glucose levels and oral health in children and adolescents. Increasing awareness of this connection may improve the management of blood glucose levels and lifestyle habits, ultimately enhancing oral health in this age group.

This study has some limitations. First, the national data lacked remeasurements for students with fasting blood glucose levels over 100 mg/dL, limiting the precision in diagnosing impaired fasting glucose and diabetes[34]. Second, the sample size was restricted to overweight or obese students, excluding those of normal weight or underweight. This exclusion likely led to an underrepresentation of insulin-dependent type 1 diabetes, which is more common among children, whereas type 2 diabetes, associated with obesity, was more likely included[35,36]. Lastly, the cross-sectional nature of the study limits the ability to establish causal relationships, and the findings may not be generalizable beyond Korean students who are overweight and obese. Long-term cohort or experimental studies are necessary to better understand the causal relationship between blood glucose levels and oral health.

This study raises awareness of the importance of glycemic control and its connection to oral health in individuals with overweight and obesity. With rising rates of childhood obesity and diabetes, pediatric dentists can play a vital role in recognizing this association, educating both parents and patients about oral health risks, and providing guidance on diet, lifestyle, and weight management[37]. Furthermore, these findings emphasize the necessity for multifaceted strategies to enhance oral health. Programs focusing on glycemic and oral health management and education may be effective in preventing metabolic diseases among children and adolescents with diabetes and improving oral health in young individuals with overweight and obesity. Achieving this requires a comprehensive multidisciplinary approach involving medical, dental, and nutritional professionals. This comprehensive approach can enhance not only oral health but also the systemic health and quality of life of children and adolescents, leading to substantial benefits[38-40].

Conclusion

Our results show that the prevalence of dental caries has declined over the previous 5 years, whereas the rates of improved oral hygiene and prevalence of periodontal disease, which had been declining before COVID-19, have increased since the pandemic. Factors that affect oral health include dietary habits, tooth-brushing frequency, and demographic factors. We found a significant association between oral health status and blood glucose levels, with higher blood glucose levels being associated with poorer oral health, suggesting that glycemic control is an important factor in improving oral health in children and adolescents with overweight and obesity.

ACKNOWLEDGMENTS

This paper was supported by Wonkwang University in 2023.

NOTES

Conflicts of Interest

The authors have no potential conflicts of interest to disclose.

Funding information

This paper was supported by Wonkwang University in 2023.

Fig 1.

Flow chart of subjects through the study, adapted from the CONSORT flowchart.

Source: https://www.consort-statement.org/.

Fig 2.

Changes in oral health status over the previous 5 years.

DCP: Dental Caries Prevalence; RRIOH: Required Rates of Improved Oral Hygiene; PDP: Periodontal Disease Prevalence.

Table 1.

Demographic characteristics of subjects

Classification	n (%)
Region
Metropolitan/City	96,325 (79.2)
Town	14,929 (12.3)
Rural/Special area	10,428 (8.6)
Sex
Boys	62,000 (51.0)
Girls	59,682 (49.0)
School
Elementary school	26,618 (21.9)
Middle school	43,800 (36.0)
High school	51,264 (42.1)
Total	121,682 (100)

Table 2.

Oral health status by demographic characteristics (n = 121,682)

Variables	DCP [n (%)]	p value	RRIOH [n (%)]	p value	PDP [n (%)]	p value
Region
Metropolitan/City	19,409 (20.1)	< 0.0001	12,718 (13.2)	< 0.0001	9,499 (9.9)	< 0.0001
Town	3,675 (24.6)		2,148 (14.4)		1,620 (10.9)
Rural/Special area	2,604 (25.0)		1,448 (13.9)		1,025 (9.8)
Sex
Boys	12,642 (20.4)	< 0.0001	9,501 (15.3)	< 0.0001	7,044 (11.4)	< 0.0001
Girls	13,046 (21.9)	< 0.0001	6,813 (11.4)	< 0.0001	5,100 (8.5)	< 0.0001
School
Elementary school	6,289 (23.6)	< 0.0001	3,007 (11.3)	< 0.0001	418 (1.6)	< 0.0001
Middle school	7,956 (18.2)		6,479 (14.8)		4,620 (10.5)
High school	11,443 (22.3)		6,828 (13.3)		7,106 (13.9)

p value from the chi-square test.

DCP: Dental Caries Prevalence; RRIOH: Required Rates of Improved Oral Hygiene; PDP: Periodontal Disease Prevalence.

Table 3.

Oral health status by health-related habits (n = 121,682)

Variables	Categories	DCP [n (%)]	p value	RRIOH [n (%)]	p value	PDP [n (%)]	p value
Drinks (1 wk)	None	2,752 (19.1)	< 0.0001	1,737 (12.0)	< 0.0001	1,215 (8.4)	< 0.0001
	1-2 times	13,465 (20.9)		8,339 (13.0)		6,009 (9.3)
	3-5 times	7,856 (21.7)		5,141 (14.2)		4,052 (11.2)
	Daily	1,615 (23.6)		1,097 (16.1)		868 (12.7)
Fast food (1 wk)	None	5,409 (20.4)	< 0.0001	3,327 (12.5)	< 0.0001	2,431 (9.1)	< 0.0001
	1-2 times	18,273 (21.2)		11,755 (13.6)		8,708 (10.1)
	3-5 times	1,851 (22.3)		1,129 (13.6)		936 (11.3)
	Daily	155 (27.1)		103 (18.0)		69 (12.0)
Meat (1 wk)	None	573 (25.5)	< 0.0001	342 (15.2)	< 0.0001	248 (11.0)	0.021
	1-2 times	10,048 (22.6)		6,331 (14.2)		4,446 (10.0)
	3-5 times	11,890 (20.4)		7,592 (13.0)		5,707 (9.8)
	Daily	3,177 (19.1)		2,049 (12.3)		1,743 (10.5)
Milk (1 wk)	None	2,042 (22.6)	< 0.0001	1,312 (14.5)	< 0.0001	1,020 (11.3)	< 0.0001
	1-2 times	8,173 (21.8)		5,045 (13.5)		4,154 (11.1)
	3-5 times	8,283 (20.7)		5,316 (13.3)		3,896 (9.8)
	Daily	7,190 (20.4)		4,641 (13.2)		3,074 (8.7)
Fruits (1 wk)	None	1,167 (21.9)	< 0.0001	844 (15.9)	< 0.0001	680 (12.8)	< 0.0001
	1-2 times	8,805 (22.2)		5,670 (14.3)		4,445 (11.2)
	3-5 times	9,787 (21.0)		6,160 (13.2)		4,537 (9.7)
	Daily	5,929 (19.7)		3,640 (12.1)		2,482 (8.3)
Vegetables (1 wk)	None	1,491 (22.9)	< 0.0001	985 (15.1)	< 0.0001	714 (11.0)	< 0.0001
	1-2 times	8,930 (21.9)		5,711 (14.0)		4,166 (10.2)
	3-5 times	9,236 (21.0)		5,774 (13.1)		4,394 (10.0)
	Daily	6,031 (19.8)		3,844 (12.6)		2,870 (9.4)
Breakfast	Almost	12,143 (19.4)	< 0.0001	7,715 (12.3)	< 0.0001	5,483 (8.7)	< 0.0001
	Usually	5,674 (21.5)		3,588 (13.6)		2,662 (10.1)
	Sometimes	3,390 (23.8)		2,196 (15.4)		1,661 (11.7)
	Rarely	4,481 (24.5)		2,815 (15.4)		2,338 (12.8)
Tooth brushing (1 day)	≥ 2	23,444 (20.8)	< 0.0001	14,631 (13.0)	< 0.0001	10,973 (9.8)	< 0.0001
Tooth brushing (1 day)	< 2	2,244 (24.4)	< 0.0001	1,683 (18.3)	< 0.0001	1,171 (12.7)	< 0.0001

p value from the chi-square test.

DCP: Dental Caries Prevalence; RRIOH: Required Rates of Improved Oral Hygiene; PDP: Periodontal Disease Prevalence; wk: week.

Table 4.

Dental caries, oral hygiene, and periodontal disease by fasting glucose level (n = 18,105)

Variables	Fasting glucose level [n (%)]			p value
Variables	Normal (< 100 mg/dL)	Impaired fasting glucose (100 - 126 mg/dL)	Diabetes (≥ 126 mg/dL)	p value
Dental caries
Yes	3,090 (21.6)	832 (23.4)	70 (28.1)	0.004
No	11,217 (78.4)	2,717 (76.6)	179 (71.9)	0.004
Oral hygiene
Poor	2,267 (15.8)	672 (18.9)	46 (18.5)	< 0.0001
Fair	8,126 (56.8)	1,853 (52.2)	133 (53.4)
Good	3,914 (27.4)	1,024 (28.9)	70 (28.1)
Periodontal disease
Yes	1,950 (13.6)	545 (15.4)	46 (18.5)	0.004
No	12,357 (86.4)	3,004 (84.6)	203 (81.5)	0.004

p value from the chi-square test.

Table 5.

Effect of fasting glucose level on oral health status (n = 18,105)

Variables		Fasting glucose level [n (%)]
Variables		normal (< 100 mg/dL)	Impaired fasting glucose (100 - 126 mg/dL)	Diabetes (≥ 126 mg/dL)
DCP	OR (95% CI)	1	1.15 (1.05 - 1.25)	1.42 (1.07 - 1.88)
DCP	p value		0.002	0.015
RRIOH	OR (95% CI)	1	1.19 (1.08 - 1.31)	1.22 (0.88 - 1.69)
RRIOH	p value		< 0.0001	0.225
PDP	OR (95% CI)	1	1.16 (1.05 - 1.29)	1.42 (1.02 - 1.96)
PDP	p value		0.004	0.036

Adjusted for general characteristics and health behavior.

p value from logistic regression.

OR: odds ratio; CI: confidence interval; DCP: Dental Caries Prevalence; RRIOH: Required Rates of Improved Oral Hygiene; PDP: Periodontal Disease Prevalence.

References

1. Gallagher AM, Ashwell M, Halford JCG, Hardman CA, Maloney NG, Raben A : Low-calorie sweeteners in the human diet: scientific evidence, recommendations, challenges and future needs. J Nutr Sci, 10:E7, 2021.

2. Daher M, Fahd C, Nour AA, Sacre Y : Trends and amounts of consumption of low-calorie sweeteners: A cross-sectional study. Clin Nutr ESPEN, 48:427-433, 2022.

3. Papakonstantinou E, Oikonomou C, Nychas G, Dimitriadis GD : Effects of Diet, Lifestyle, Chrononutrition and Alternative Dietary Interventions on Postprandial Glycemia and Insulin Resistance. Nutrients, 14:823, 2022.

4. Arroyo-Johnson C, Mincey KD : Obesity Epidemiology Worldwide. Gastroenterol Clin North Am, 45:571-579, 2016.

5. Jeong SM, Jung JH, Yang YS, Kim WS, Cho IY, Lee YB, Park KY, Nam GE, Han KD : 2023 Obesity Fact Sheet: Prevalence of Obesity and Abdominal Obesity in Adults, Adolescents, and Children in Korea from 2012 to 2021. J Obes Metab Syndr, 33:27-35, 2024.

6. Jebeile H, Kelly AS, O’Malley G, Baur LA : Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol, 10:351-365, 2022.

7. Güngör NK : Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol, 6:129-143, 2014.

8. Blüher M : Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol, 15:288-298, 2019.

9. Panagiotou E, Agouropoulos A, Vadiakas G, Pervanidou P, Chouliaras G, Kanaka-Gantenbein C : Oral health of overweight and obese children and adolescents: a comparative study with a multivariate analysis of risk indicators. Eur Arch Paediatr Dent, 22:861-868, 2021.

10. Silveira MG, Schneider BC, Tillmann TF, Silva AE : Excess Weight and Dental Caries throughout Childhood and Adolescence: Systematic Review of Longitudinal Studies. Int J Clin Pediatr Dent, 15:691-698, 2022.

11. Martens L, De Smet S, Yusof MY, Rajasekharan S : Association between overweight/obesity and periodontal disease in children and adolescents: a systematic review and meta-analysis. Eur Arch Paediatr Dent, 18:69-82, 2017.

12. Halder S, Kaul R, Angrish P, Saha S, Bhattacharya B, Mitra M : Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India. Int J Clin Pediatr Dent, 11:233-237, 2018.

13. Kao KT, Sabin MA : Type 2 diabetes mellitus in children and adolescents. Aust Fam Physician, 45:401-406, 2016.

14. American Diabetes Association : Diagnosis and classification of diabetes mellitus. Diabetes Care, 34(Suppl 1):S62-S69, 2011.

15. Schmidt AM : Highlighting Diabetes Mellitus: The Epidemic Continues. Arterioscler Thromb Vasc Biol, 38:E1-E8, 2018.

16. Lamster IB, Lalla E, Borgnakke WS, Taylor GW : The relationship between oral health and diabetes mellitus. J Am Dent Assoc, 139(Suppl):S19-S24, 2008.

17. Ship JA : Diabetes and oral health: an overview. J Am Dent Assoc, 134(Spec):S4-S10, 2003.

18. Wang Y, Xing L, Yu H, Zhao L : Prevalence of dental caries in children and adolescents with type 1 diabetes: a systematic review and meta-analysis. BMC Oral Health, 19:213, 2019.

19. Zainal Abidin Z, Zainuren ZA, Noor E, Mohd Nor NS, Mohd Saffian S, Abdul Halim R : Periodontal health status of children and adolescents with diabetes mellitus: a systematic review and meta-analysis. Aust Dent J, 66(Suppl 1):S15-S26, 2021.

20. Pachoński M, Jarosz-Chobot P, Koczor-Rozmus A, Łanowy P, Mocny-Pachońska K : Dental caries and periodontal status in children with type 1 diabetes mellitus. Pediatr Endocrinol Diabetes Metab, 26:39-44, 2020.

21. Beheshti M, Badner V, Shah P, Margulis KS, Yeroshalmi F : Association of Diabetes and Dental Caries Among U.S. Adolescents in the NHANES Dataset. Pediatr Dent, 43:123-128, 2021.

22. Mandura RA, Meligy OAE, Attar MH, Alamoudi RA : Diabetes Mellitus and Dental Health in Children: A Review of Literature. Int J Clin Pediatr Dent, 14:719-725, 2021.

23. Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S : Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol, 6:69-80, 2018.

24. Mohseni Homagarani Y, Adlparvar K, Teimuri S, Tarrahi MJ, Nilchian F : The effect of diabetes mellitus on oral health-related quality of life: A systematic review and meta-analysis study. Front Public Health, 11:1112008, 2023.

25. Bashirian S, Shirahmadi S, Seyedzadeh-Sabounchi S, Soltanian AR, Karimi-Shahanjarini A, Vahdatinia F : Association of caries experience and dental plaque with sociodemographic characteristics in elementary school-aged children: a cross-sectional study. BMC Oral Health, 18:7, 2018.

26. Zemaitiene M, Grigalauskiene R, Andruskeviciene V, Matulaitiene ZK, Zubiene J, Narbutaite J, Slabsinskiene E : Dental caries risk indicators in early childhood and their association with caries polarization in adolescence: a cross-sectional study. BMC Oral Health, 17:2, 2016.

27. Kinane DF, Podmore M, Murray MC, Hodge PJ, Ebersole J : Etiopathogenesis of periodontitis in children and adolescents. Periodontol, 26:54-91, 2001.

28. T S, Kumar BS, Datta M, V TH, Nisha VA : Prevalence, severity and associated factors of dental caries in 3-6 year old children. J Clin Diagn Res, 7:1789-1792, 2013.

29. Kim AH, Han SY, Kim HG, Kwon HK, Kim BI : The characteristics of high caries risk group for 12-year old children in Korea. J Korean Acad Oral Health, 34:302-309, 2010.

30. Boustedt K, Roswall J, Kjellberg E, Twetman S, Dahlgren J : A prospective study of perinatal and metabolic risk factors for early childhood caries. Acta Paediatr, 109:2356-2361, 2020.

31. Song TJ, Chang YK, Jeon JM, Kim JK : Oral health and longitudinal changes in fasting glucose levels: A nationwide cohort study. PLoS One, 16:E0253769, 2021.

32. Zhao P, Yue Z, Nie L, Zhao Z, Wang Q, Chen J, Wang Q : Hyperglycaemia-associated macrophage pyroptosis accelerates periodontal inflamm-aging. J Clin Periodontol, 48:1379-1392, 2021.

33. Kocher T, König J, Borgnakke WS, Pink C, Meisel P : Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol, 78:59-97, 2018.

34. Libman I, Haynes A, Lyons S, Pradeep P, Rwagasor E, Tung JY, Jefferies CA, Oram RA, Dabelea D, Craig ME : ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes, 23:1160-1174, 2022.

35. Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ : Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am, 39:481-497, 2010.

36. Streisand R, Monaghan M : Young children with type 1 diabetes: challenges, research, and future directions. Curr Diab Rep, 14:520, 2014.

37. Bimstein E, Katz J : Obesity in children: a challenge that pediatric dentistry should not ignore - review of the literature. J Clin Pediatr Dent, 34:103-106, 2009.

38. Rafatjou R, Razavi Z, Tayebi S, Khalili M, Farhadian M : Dental Health Status and Hygiene in Children and Adolescents with Type 1 Diabetes Mellitus. J Res Health Sci, 16:122-126, 2016.

39. Triebl Z, Bencze B, Bányai D, Rózsa N, Hermann P, Végh D : Poor glycemic control impairs oral health in children with type 1 diabetes mellitus - a systematic review and meta-analysis. BMC Oral Health, 24:748, 2024.

40. Elheeny AAH : Oral health status and impact on the oral health-related quality of life of Egyptian children and early adolescents with type-1 diabetes: a case-control study. Clin Oral Investig, 24:4033-4042, 2020.