**1. Introduction**

378 Contemporary Approach to Dental Caries

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Abnormal growth/ weight gain in young children is a substantial public health problem which causes much concern among parents and health professionals.

Recent reports suggest that in many established market economies changes in dietary practices have resulted in a change in children and adolescents' body mass index. Among the reported dietary changes are alterations in the pattern of intake of carbohydrates. It would seem entirely consistent with current knowledge to assume that such changes may also impact upon dental caries in the child population.

Dental caries is a disease which attacks the dental hard tissues by demineralising the enamel. If oral conditions are favourable then this demineralisation can progress from the outer enamel layer of the tooth into the softer underlying dentine, resulting in decay. Dental decay is more common in individuals who have frequent intakes of dietary sugars (fermentable carbohydrates). Frequency of intake of carbohydrate is more predictive of the decay process than the absolute amount. Dental caries is also an extremely widespread childhood disease. It is particularly prevalent among deprived populations (Wright, 2000).

Dental caries is the most common reason for children undergoing general anaesthesia and thereby is therefore a major cause of exposure of small children to the medical risks associated with general anaesthesia (Whittle, 2000).

A number of nutritional factors, which may be factors in growth and development such as Vitamins A and D, water hardness and protein, have been hypothesised as potentially linked to dental caries (Mellanby & Pattison, 1928; East, 1941; Aptone-Merced & Navia, 1980). However, there is little evidence to substantiate that the systemic effects of poor nutrition increase the risk of dental decay, and it is generally accepted that while diet can have a profound local effect on erupted teeth, it has much less effect while the teeth are forming(Rugg-Gunn, 2000).

It has been demonstrated that low birth weight children more frequently have hypo plastic defects in the enamel of their teeth than normal weight babies, but that dental caries is also less frequent (Fearne et al, 1990).

Effect of Dental Caries on Children Growth 381

can occur at a number of stages, including in the setting up and calibration of equipment,

Growth monitoring may be done through height and weight measurements but a variety of other indices such as supine length, standing height, height velocity, weight velocity, weight for height, height for weight, Body Mass Index(BMI) and many more other measurements

In order to interpret biological variables such as height and weight, it is important to compare them with normal data for children of the same age and, where appropriate, sex. Accurate measurement and the use of standard growth charts are important tools for

Assessment of growth and nutrition is important, both in the diagnosis of primary nutritional and growth disorders and also in the diagnosis of chronic disorders. Because of some background disturbances, sometimes a child may be abnormally short or tall and light or heavy from infancy onwards, whereas in others initial normal growth is followed by

Food consumption has a tremendous influence on human lives and is essential to life itself. Eating appropriate amounts of a wide variety of foods helps to maintain optimal health. Prolonged periods of poor food choices may cause impaired health. People need approximately 50 nutrients for growth and maintenance of health. These nutrients are present in a wide variety of different types of foods. Carbohydrates, lipids and proteins are energy nutrients which give the human body the energy it needs for moving and doing work, as well as for such vital activity as breathing and pumping blood. Minerals, a category made up of more than 20 nutrients perform a variety of functions, although they are not sources of energy. Vitamins are regulatory substances needed in even smaller amounts than minerals. At present, 13 vitamins are recognized as essential nutrients. Every person, (whether a child or mature adult), needs good nutrition in order to maintain good health and this can be supplied by a well-balanced healthy diet taken in regular meals and in

The evidence in the World Health Organization (WHO) Global Database on Child Growth (De Onis et al, 2000) and Malnutrition gives a description of the magnitude and geographical distribution of childhood under- and over-nutrition worldwide. Analyses based on the database's information confirm that child under-nutrition remains a major public health problem in many countries, and can hamper children's physical growth and mental development. Indeed, it may even be a major threat to their survival. Despite an overall decrease in poor growth in developing countries, in some, poor growth is increasing in prevalence and in many others the incidence of growth faltering remains disturbingly high(De Onis et al, 2000, 1993 ). An important observation which has been made, is that the pattern of growth faltering in developing countries, not only within a region but also globally, are remarkably similar even though different instruments and measuring methods were used in the surveys. This suggests that interventions during the earliest periods of life

the measuring techniques used, and the recording of data.

are also considered relevant.

monitoring a child's growth.

growth failure or acceleration.

**5. Nutrition and growth** 

appropriate surroundings (Wright, 2000).

**4. Growth problems** 

An association between physical problems affecting the mouth, and childhood growth, has been hypothesized and it has been suggested that dentists may be ideally placed to recognize children at risk of poor growth and development (Boyd, 1998).

The concept that dental disease and child's body weight may be related was raised as early as 1982, when a retrospective case-note study examined the body weights of children attending for general anaesthetic tooth extractions, were compared to children attending for routine dental care (Miller et al 1982) and subsequent studies have suggested that treatment of caries may lead to improvement in weight gain (Acs et al, 1998, 1999; Malek Mohammadi et al, 2009) at least in children whose growth is below average.

This chapter presents evidence which strongly suggests that children's growth is affected by the state of their dental health. These relatively simple observations are very important, as they provides yet another reason for policy makers and Governments to invest time, resources and expertise in improving both children's diets, and their dental health. It is essential to remember that dental caries is one of only very few common childhood diseases which cause large numbers of the child population to undergo general anaesthesia. Children who are allowed to develop dental decay therefore suffer, not only in terms of potential effects on their growth and development, but also directly, as the treatment, if it is carried out using general anaesthesia poses a serious health risk to the children involved.
