Childhood Obesity and Dental Caries in Homeless Children
Childhood Obesity and Dental Caries in Homeless Children
A high percentage of children in this study were either overweight or obese. This result exceeds what was reported by Schwarz and colleagues (2007), who found that 43% of homeless children in Baltimore were overweight or obese. The two studies are similar in their study population—children who resided in an urban homeless shelter. Both studies provide support that children who reside in an urban homeless shelter have the same issue with their weight as do children in the United States.
Similar results with regard to dental caries were found in this vulnerable population. Slightly more than half of the children in this study were found to have dental caries. This result is higher than those reported in the literature (Clark, 1999; DiMarco, 2007; DiMarco et al., 2010; Vargas & Ronzio, 2006). For example, DiMarco and colleagues (2010). For example, DiMarco and colleagues (2010) reported that 39.4% of homeless children in their study had dental caries. In the United States, about one quarter of children ages 2 to 5 years have had caries, and about one fifth have untreated decay (as cited in Vargas & Ronzio, 2006). Nevertheless, this finding is consistent with other reports. One such report is by Marshall and colleagues (2007), who found that more dental caries were seen in children from lower family incomes.
One interesting finding that arose from this study was related to the relationship between obesity and dental caries when age is taken into consideration. This current study shows that as age increased, so did the rates of obesity and dental caries when examining these two factors separately with age. However, when examining the factors together and controlling for age, the positive increase between dental caries and BMI was diminished. These findings are consistent with the 2006 cross sectional study that observed dental caries rates in 3048 children ages 6 to 12 years in Mexico (Villalobos-Rodelo et al., 2006). These authors found that the overall significant caries index increased 0.34 (from 10.53 for 6-year-olds to 10.87 for 12-year-olds).
One limitation warrants discussion. This study did not examine other risk factors contributing to childhood obesity and dental caries in homeless children. These risk factors include access to nutritional foods, parental weight status, parental dental status, access to dental care, and physical activities. In addition, other inter-related factors contributing to dental caries and obesity include sex, age, socioeconomic status, dietary patterns, and oral hygiene habits (Moses, Rangeeth, & Gurunathan, 2011). Research findings from several studies have concluded that contemporary changes in beverage patterns, specifically increased soda pop intake and intake of powdered beverages, significantly increase dental caries and obesity rates in children (Majewski, 2001; Marshall et al., 2003). These researchers suggested that the combination of the consumption of highly sweetened drinks and the habitual usage of caffeine may significantly increase children's and adolescent's potential for developing dental caries and contribute to the increased risk of being overweight or obese. Future studies are needed to examine these factors in this particular (homeless) population.
Obesity and oral health disparities are complex issues with no easy solutions. These issues are especially difficult to discern when dealing with the homeless population. More research is needed to further explore the relationship between obesity and dental caries in this vulnerable population. Although a definitive conclusion between obesity and dental caries cannot be drawn from this study, childhood obesity and dental caries are important health issues for all U.S. children, especially homeless children. The American Academy of Pediatrics Committee on Community Health Services (2005) advocates for the expansion of health services in homeless shelters. Pediatric health care providers such as pediatric nurse practitioners (PNPs) have the ability to improve access to care for underserved children who experience barriers that limit access to appropriate dental services. One suggestion is to provide fluoride varnish to young children. PNPs from 38 state Medicaid programs are now being reimbursed for application of fluoride varnish (Smiles for Life, n.d.). Fluoride varnish is an effective way of reducing dental caries in low-income children (Weintraub et al., 2006). Furthermore, a model of shelter-based clinic also been shown to improve access to care in a group of homeless mothers and their children (DiMarco, 2007; DiMarco et al., 2010). During visits to shelter-based clinics, PNPs can utilize the Healthy Eating Activity Together guidelines (National Association of Pediatric Nurse Practitioners, 2009) to prevent obesity, as well as Bright Futures Oral Health Guidelines (Casamassimo & Holt, 2004) and fluoride varnishes to assist with the prevention of tooth decay in young children.
Discussion
A high percentage of children in this study were either overweight or obese. This result exceeds what was reported by Schwarz and colleagues (2007), who found that 43% of homeless children in Baltimore were overweight or obese. The two studies are similar in their study population—children who resided in an urban homeless shelter. Both studies provide support that children who reside in an urban homeless shelter have the same issue with their weight as do children in the United States.
Similar results with regard to dental caries were found in this vulnerable population. Slightly more than half of the children in this study were found to have dental caries. This result is higher than those reported in the literature (Clark, 1999; DiMarco, 2007; DiMarco et al., 2010; Vargas & Ronzio, 2006). For example, DiMarco and colleagues (2010). For example, DiMarco and colleagues (2010) reported that 39.4% of homeless children in their study had dental caries. In the United States, about one quarter of children ages 2 to 5 years have had caries, and about one fifth have untreated decay (as cited in Vargas & Ronzio, 2006). Nevertheless, this finding is consistent with other reports. One such report is by Marshall and colleagues (2007), who found that more dental caries were seen in children from lower family incomes.
One interesting finding that arose from this study was related to the relationship between obesity and dental caries when age is taken into consideration. This current study shows that as age increased, so did the rates of obesity and dental caries when examining these two factors separately with age. However, when examining the factors together and controlling for age, the positive increase between dental caries and BMI was diminished. These findings are consistent with the 2006 cross sectional study that observed dental caries rates in 3048 children ages 6 to 12 years in Mexico (Villalobos-Rodelo et al., 2006). These authors found that the overall significant caries index increased 0.34 (from 10.53 for 6-year-olds to 10.87 for 12-year-olds).
One limitation warrants discussion. This study did not examine other risk factors contributing to childhood obesity and dental caries in homeless children. These risk factors include access to nutritional foods, parental weight status, parental dental status, access to dental care, and physical activities. In addition, other inter-related factors contributing to dental caries and obesity include sex, age, socioeconomic status, dietary patterns, and oral hygiene habits (Moses, Rangeeth, & Gurunathan, 2011). Research findings from several studies have concluded that contemporary changes in beverage patterns, specifically increased soda pop intake and intake of powdered beverages, significantly increase dental caries and obesity rates in children (Majewski, 2001; Marshall et al., 2003). These researchers suggested that the combination of the consumption of highly sweetened drinks and the habitual usage of caffeine may significantly increase children's and adolescent's potential for developing dental caries and contribute to the increased risk of being overweight or obese. Future studies are needed to examine these factors in this particular (homeless) population.
Obesity and oral health disparities are complex issues with no easy solutions. These issues are especially difficult to discern when dealing with the homeless population. More research is needed to further explore the relationship between obesity and dental caries in this vulnerable population. Although a definitive conclusion between obesity and dental caries cannot be drawn from this study, childhood obesity and dental caries are important health issues for all U.S. children, especially homeless children. The American Academy of Pediatrics Committee on Community Health Services (2005) advocates for the expansion of health services in homeless shelters. Pediatric health care providers such as pediatric nurse practitioners (PNPs) have the ability to improve access to care for underserved children who experience barriers that limit access to appropriate dental services. One suggestion is to provide fluoride varnish to young children. PNPs from 38 state Medicaid programs are now being reimbursed for application of fluoride varnish (Smiles for Life, n.d.). Fluoride varnish is an effective way of reducing dental caries in low-income children (Weintraub et al., 2006). Furthermore, a model of shelter-based clinic also been shown to improve access to care in a group of homeless mothers and their children (DiMarco, 2007; DiMarco et al., 2010). During visits to shelter-based clinics, PNPs can utilize the Healthy Eating Activity Together guidelines (National Association of Pediatric Nurse Practitioners, 2009) to prevent obesity, as well as Bright Futures Oral Health Guidelines (Casamassimo & Holt, 2004) and fluoride varnishes to assist with the prevention of tooth decay in young children.
