Original Article

Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10-12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach


Background: The aim of this study was to assess the associations between nutrition and dental caries in permanent dentition among schoolchildren.

Methods: A cross-sectional survey was undertaken on 698 schoolchildren aged 10 to 12 yr from a random sample of primary schools in Kermanshah, western Iran, in 2014. The study was based on the data obtained from the questionnaire containing information on nutritional habits and the outcome of decayed/missing/filled teeth (DMFT) index. The association between predictors and dental caries was modeled using the Zero Inflated Generalized Poisson (ZIGP) regression model.

Results: Fourteen percent of the children were caries free. The model was shown that in female children, the odds of being in a caries susceptible sub-group was 1.23(95% CI: 1.08-1.51) times more likely than boys (P=0.041). Additionally, mean caries count in children who consumed the fizzy soft beverages and sweet biscuits more than once daily was 1.41(95% CI: 1.19-1.63) and 1.27 (95% CI: 1.18-1.37) times more than children that were in category of less than 3 times a week or never, respectively.

Conclusions: Girls were at a higher risk of caries than boys were. Since our study showed that nutritional status may have significant effect on caries in permanent teeth, we recommend that health promotion activities in school should be emphasized on healthful eating practices; especially limiting beverages containing sugar to only occasionally between meals.



Benzian H, Monse B, Heinrich-Weltzien R, Hobdell M, Mulder J, van Palenstein Helderman W (2011). Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children. BMC Public Health, 11(1): 558.

Health UDo, Services H (2008). Oral health in America: A report of the Surgeon General, Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. NIH Publication no 00-4713.

Johansson I, Lif Holgerson P, Kressin N, Nunn M, Tanner A (2010). Snacking habits and caries in young children. CARIES RES,44(5): 421-30.

Vadiakas G (2008). Case definition, aetiology and risk assessment of early childhood caries (ECC): a revisited review. Eur Arch Paediatr Dent, 9(3): 114-25.

Kiwanuka S, Åstrøm A, Trovik T (2004). Dental caries experience and its relationship to social and behavioural factors among 3–5‐year‐old children in Uganda. Int J Paediatr Dent,14(5): 336-46.

Matee M, Hof M, Maselle S, Mikx F, Helderman WvP (1994). Nursing caries, linear hypoplasia, and nursing and weaning habits in Tanzanian infants. Community Dent Oral Epidemiol,22(5PT1): 289-93.

Hawkes C (2006). Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Global Health, 2(1): 4.

Kumarihamy SL, Subasinghe LD, Jayasekara P, Kularatna SM, Palipana PD (2011). The prevalence of Early Childhood Caries in 1-2 yrs olds in a semi-urban area of Sri Lanka. BMC Res Notes,4(1): 336.

Wamani H, Åstrøm AN, Peterson S, Tylleskär T, Tumwine JK (2005). Infant and young child feeding in western Uganda: knowledge, practices and socio-economic correlates. J Trop Pediatr, 51(6): 356-61.

Kemparaj U, Chavan S, Shetty NL (2014). Caries Risk Assessment Among School Children in Davangere City Using Cariogram. Int J Prev Med, 5(5): 664.

Chu C-H, Ho P-L, Lo EC (2012). Oral health status and behaviours of preschool children in Hong Kong. BMC Public Health, 12(1): 767.

Wolfe BL (1985). The influence of health on school outcomes: a multivariate approach. Med Care, 23(10): 1127-38.

Fowler M, Johnson M, Atkinson S (1985). School achievement and absence in children with chronic health conditions. J Pediatr, 106(4): 683-7.

Jackson SL, Vann Jr WF, Kotch JB, Pahel BT, Lee JY (2011). Impact of poor oral health on children's school attendance and performance. Am J Public Health, 101(10): 1900.

Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C (2005). The global burden of oral diseases and risks to oral health. Bull World Health Organ, 83(9): 661-9.

Kazerouni K, Mohammadi N, Ansari G, Kamali Z (2005). The effects of socio-economic status on dental caries incidence in a group of primary school children, Tehran-2000. J Dent Sch, 22 (4): 51-9.

Motlagh MG, Khaniki GRJ, Adiban H (2007). Investigation of Dental Caries Prevalence among 6-12 year old Elementary School Children in Andimeshk, Iran. J Med Sci, 7(1): 116-20.

Momeni A, Mardi M, Pieper K (2005). Caries prevalence and treatment needs of 12-year-old children in the Islamic Republic of Iran. Med Princ Pract, 15(1): 24-8.

Sadeghi M, Lynch C, Arsalan A (2011). Is there a correlation between dental caries and body mass index-for-age among adolescents in Iran?. Community Dent Health, 28(2): 174-7.

Wake M, Nicholson JM, Hardy P, Smith K (2007). Preschooler obesity and parenting styles of mothers and fathers: Australian national population study. Pediatrics, 120(6): e1520-7.

Primosch RE (1982). Effect of Family Structure on the Dental Caries Experience of Children. J Public Health Dent, 42(2): 155-68.

Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N (2012). Body mass index and dental caries in children and adolescents: a systematic review of literature published 2004 to 2011. Syst Rev, 1:57.

Gerdin EW, Angbratt M, Aronsson K, Eriksson E, Johansson I (2008). Dental caries and body mass index by socio‐economic status in Swedish children. Community Dent Oral Epidemiol, 36(5): 459-65.

Reifsnider E, Mobley C, Mendez D (2004). Childhood obesity and early childhood caries in a WIC population. J Multicult Nurs Health, 10(2): 24-31.

Sadeghi M, Alizadeh F (2007). Association between dental caries and body mass index-for-age among 6-11-year-old children in Isfahan in 2007. J Dent Res Dent Clin Dent Prospects, 1(3): 119-24.

Dye BA, Shenkin JD, Ogden CL, Marshall TA, Levy SM, Kanellis MJ (2004). The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994. J Am Dent Assoc, 135(1): 55-66.

Sánchez-Pérez L, Irigoyen M, Zepeda M (2010). Dental caries, tooth eruption timing and obesity: a longitudinal study in a group of Mexican schoolchildren. Acta Odontol Scand, 68(1): 57-64.

Organization WH (1997). Oral health surveys: basic methods. World Health Organization. Geneva, Switzerland.

Livingstone M, Robson P (2000). Measurement of dietary intake in children. Proc Nutr Soc, 59(02): 279-93.

Nazik M, Malde M, Ahmed M, Trovik T (2013). Correlation between caries experience in Sudanese school children and dietary habits, according to a food frequency questionnaire and a modified 24-hr recall method. Afr J Food, Agri Nutr Develo,13(2).

Dean JA, Avery DR, McDonald RE (2010). McDonald and Avery dentistry for the child and adolescent. Elsevier Health Sciences.

Kristal AR, Abrams BF, Thornquist MD, Disogra L, Croyle RT, Shattuck AL, et al. (1990). Development and validation of a food use checklist for evaluation of community nutrition interventions. Am J Public Health, 80(11): 1318-22.

Hosseini M, Carpenter R, Mohammad K (1999). Body mass index reference curves for Iran. Ann Hum Biol, 26(6): 527-35.

Huew R, Waterhouse PJ, Moynihan PJ, Maguire A (2011). Prevalence and severity of dental caries in Libyan schoolchildren. Int Dent J, 61(4): 217-23.

Gatou T, Koletsi Kounari H, Mamai‐Homata E (2011). Dental caries prevalence and treatment needs of 5‐to 12‐year‐old children in relation to area‐based income and immigrant background in Greece. Int Dent J, 61(3): 144-51.

Moghimbeigi A, Eshraghian MR, Mohammad K, Mcardle B (2008). Multilevel zero-inflated negative binomial regression modeling for over-dispersed count data with extra zeros. J Appl Stat, 35(10): 1193-202.

Saied-Moallemi Z, Virtanen J, Tehranchi A, Murtomaa H (2006). Disparities in oral health of children in Tehran, Iran. Eur Arch Paediatr Dent, 7(4): 262-4.

Al-Darwish M, El Ansari W, Bener A (2014). Prevalence of dental caries among 12–14year old children in Qatar. Saudi Dent J, 26(3): 115-25.

Krzywiec E, Zalewska M, Wójcicka A, Jabłoński R, Olejnik B, Grabowska S, et al. (2012). Selected eating habits and caries occurrence in adolescents. Przegl Epidemiol, 66(4): 713-21.

Parner ET, Heidmann JM, Væth M, Poulsen S (2001). A longitudinal study of time trends in the eruption of permanent teeth in Danish children. Arch Oral Biol, 46(5): 425-31.

Wedl J, Danias S, Schmelzle R, Friedrich R (2005). Eruption times of permanent teeth in children and young adolescents in Athens (Greece). Clin Oral Investig, 9(2): 131-4.

Levy S, Warren J, Broffitt B, Hillis S, Kanellis M (2003). Fluoride, beverages and dental caries in the primary dentition. Caries Res, 37(3): 157-65.

Sohn W, Burt B, Sowers M (2006). Carbonated soft drinks and dental caries in the primary dentition. J Dent Res, 85(3): 262-6.

Stevens A, Hamel C, Singh K, Ansari MT, Myers E, Ziegler P, et al. (2014). Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol. Syst Rev, 3(1): 96.

Tahmassebi J, Duggal M, Malik-Kotru G, Curzon M (2006). Soft drinks and dental health: a review of the current literature. J Dent, 34(1): 2-11.

Meurman J, Rytömaa I, Kari K, Laakso T, Murtomaa H (1987). Salivary pH and glucose after consuming various beverages, including sugar-containing drinks. Caries Res, 21(4): 353-9.

Ismail AI, Burt BA, Eklund SA (1984). The cariogenicity of soft drinks in the United States. J Am Dent Assoc, 109(2): 241-5.

Marshall S, Burrows T, Collins C (2014). Systematic review of diet quality indices and their associations with health‐related outcomes in children and adolescents. J Hum Nutr Diet, 27(6):577-98.

Hayden C, Bowler JO, Chambers S, Freeman R, Humphris G, Richards D, et al. (2013). Obesity and dental caries in children: a systematic review and meta‐analysis. Community Dent Oral Epidemiol, 41(4): 289-308.

Chiu S-H, DiMarco MA, Prokop JL (2013). Childhood obesity and dental caries in homeless children. J Pediatr Health Care, 27(4): 278-83.

Markovic D, Ristic‐Medic D, Vucic V, Mitrovic G, Nikolic Ivosevic J, Peric T, et al. (2014). Association between being overweight and oral health in Serbian schoolchildren. Int J Paediatr Dent, 25(6): 409-17.

McDowell I (2006). Measuring health: a guide to rating scales and questionnaires. Oxford University Press.

Rugg-Gunn AJ (1993). Nutrition, diet and dental public health. Community Dent Health, 10 Suppl 2: 47-56.

Balay JL (2007). Nutrition for dental health. Diabetes Self Manag, 24(2): 6-8.

IssueVol 45 No 3 (2016) QRcode
SectionOriginal Article(s)
Nutritional habits Dental caries Zero Inflated Generalized Poisson regression model Schoolchildren

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
ALMASI A, RAHIMIFOROUSHANI A, ESHRAGHIAN MR, MOHAMMAD K, PASDAR Y, TAR­RAHIMJ, MOGHIMBEIGI A, AHMADI JOUYBARI T. Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10-12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach. Iran J Public Health. 2016;45(3):353-361.