Department of Health Sciences, Faculty of Sciences, University of York, Heslington, UK.
Research Department of Epidemiology and Public Health, University College London (UCL), London, UK.
Community Dent Oral Epidemiol. 2022 Dec;50(6):529-538. doi: 10.1111/cdoe.12707. Epub 2021 Nov 27.
To examine whether oral health-related quality of life (OHRQoL) explained the negative associations between dental caries and anthropometric measures of child growth among a sample of 5- to 9-year-old children in Dhaka, Bangladesh, while taking potential confounding factors (maternal education, family income, study setting, child's birth weight and childhood diseases) into account. In addition, to test whether specific oral impacts had a role in explaining these associations.
Data collection was conducted via a cross-sectional survey among children and their parents from both hospital and school settings in Dhaka. Dental caries and severe consequences of dental caries (defined here as dental sepsis) were the exposure variables, and age- and sex-adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ) were the outcome variables. OHRQoL was measured using the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). First, associations between oral impacts (prevalence of overall impacts and specific items of the SOHO-5) and outcome measures were assessed. Multiple linear regression was used to assess associations between caries and anthropometric measures, adjusted for potential confounders. Oral impacts were then added to test whether their inclusion attenuated the associations between exposures and outcomes. To further investigate potential mediating role of oral impacts, structural equation modelling (SEM) was used to test the hypothesis that dental caries and sepsis were associated with the outcomes directly and also indirectly via oral impacts in general. A similar approach was used to investigate mediation by specific SOHO-5 items.
The sample consisted of 715 children, 73.1% of whom had dental caries, 37.5% presented with sepsis, and 57.3% reported at least one oral impact (SOHO-5 score ≥1). Prevalence of overall oral impacts and also the impact on 'eating difficulty' (a specific item of SOHO-5) were negatively associated with all three outcomes. Dental caries and sepsis was associated with lower HAZ, WAZ and BAZ, and adjustment for overall oral impacts considerably attenuated the associations between 'severe dental caries' and outcomes, and dental sepsis and outcomes. Using SEM, we found significant indirect associations between caries and sepsis and anthropometric measures via oral impacts (except for dental caries and HAZ). Considering specific oral impacts, eating difficulties explained about 44% and 65% of the associations between caries and anthropometric outcomes, and dental sepsis and anthropometric outcomes, respectively.
Oral impacts, in particular eating difficulties, appear to mediate associations between caries and markers of child growth among this population.
在孟加拉国达卡的 5 至 9 岁儿童样本中，考虑到潜在的混杂因素（母亲教育、家庭收入、研究场所、儿童出生体重和儿童疾病），研究口腔健康相关生活质量（OHRQoL）是否解释了龋齿与儿童生长的人体测量指标之间的负相关关系，并检验特定的口腔影响是否在解释这些关联中发挥作用。
通过在达卡的医院和学校环境中对儿童及其父母进行横断面调查进行数据收集。龋齿和龋齿的严重后果（这里定义为牙周脓肿）是暴露变量，年龄和性别调整后的身高 Z 分数（HAZ）、体重 Z 分数（WAZ）和 BMI Z 分数（BAZ）是结果变量。使用孟加拉语版的 5 岁儿童口腔健康结局量表（SOHO-5）测量 OHRQoL。首先，评估口腔影响（整体影响的患病率和 SOHO-5 的特定项目）与结果测量之间的关联。使用多元线性回归评估龋齿和人体测量指标之间的关联，调整潜在混杂因素。然后添加口腔影响，以检验其纳入是否减弱了暴露与结果之间的关联。为了进一步研究口腔影响的潜在中介作用，使用结构方程模型（SEM）检验龋齿和牙周脓肿直接与一般口腔影响相关，以及通过口腔影响间接与结果相关的假设。采用类似的方法，调查了特定 SOHO-5 项目的中介作用。
该样本包括 715 名儿童，其中 73.1%患有龋齿，37.5%出现牙周脓肿，57.3%报告至少有一种口腔影响（SOHO-5 评分≥1）。整体口腔影响的患病率以及“进食困难”（SOHO-5 的一个特定项目）的影响与所有三个结果呈负相关。龋齿和牙周脓肿与较低的 HAZ、WAZ 和 BAZ 相关，而总体口腔影响的调整大大减弱了“严重龋齿”与结果之间的关联，以及牙周脓肿与结果之间的关联。使用 SEM，我们发现龋齿和牙周脓肿与人体测量指标之间存在显著的间接关联，通过口腔影响（龋齿与 HAZ 除外）。考虑到特定的口腔影响，进食困难解释了龋齿与人体测量结果之间约 44%和 65%的关联，以及牙周脓肿与人体测量结果之间的关联。
在该人群中，口腔影响，特别是进食困难，似乎在龋齿与儿童生长指标之间的关联中起中介作用。
