Open Access Highly Accessed Research article

Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children

Habib Benzian12*, Bella Monse3, Roswitha Heinrich-Weltzien4, Martin Hobdell5, Jan Mulder6 and Wim van Palenstein Helderman6

Author Affiliations

1 Fit for School Inc., Cor. V.A. Rufino/L.P. Leviste Street, Salcedo Village, Makati City, Manila, Philippines

2 The Health Bureau Ltd., The Barn, Haversham Manor, Haversham, MK19 7DZ, UK

3 Department of Education, Health and Nutrition Centre, P.O. Box 119, City of Division, 9000 Cagayan de Oro, Philippines

4 Department of Preventive Dentistry, Dental School of Erfurt Friedrich Schiller University of Jena, WHO Collaborating Centre for Prevention of Oral Diseases, Bachstrasse 18, 07740 Jena, Germany

5 Department of Epidemiology & Public Health, University College London, Gower Street, London WC1E 6BT, UK

6 Department Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands

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BMC Public Health 2011, 11:558  doi:10.1186/1471-2458-11-558

Published: 13 July 2011



Dental decay is the most common childhood disease worldwide and most of the decay remains untreated. In the Philippines caries levels are among the highest in the South East Asian region. Elementary school children suffer from high prevalence of stunting and underweight.

The present study aimed to investigate the association between untreated dental decay and Body Mass Index (BMI) among 12-year-old Filipino children.


Data collection was part of the National Oral Health Survey, a representative cross-sectional study of 1951 11-13-year-old school children using a modified, stratified cluster sampling design based on population classifications of the Philippine National Statistics Office. Caries was scored according to WHO criteria (1997) and odontogenic infections using the PUFA index. Anthropometric measures were performed by trained nurses. Some socio-economic determinants were included as potential confounding factors.


The overall prevalence of caries (DMFT + dmft > 0) was 82.3% (95%CI; 80.6%-84.0%). The overall prevalence of odontogenic infections due to caries (PUFA + pufa > 0) was 55.7% (95% CI; 53.5%-57.9%) The BMI of 27.1% (95%CI; 25.1%-29.1%) of children was below normal, 1% (95%CI; 0.5%-1.4%) had a BMI above normal. The regression coefficient between BMI and caries was highly significant (p < 0.001). Children with odontogenic infections (PUFA + pufa > 0) as compared to those without odontogenic infections had an increased risk of a below normal BMI (OR: 1.47; 95% CI: 1.19-1.80).


This is the first-ever representative survey showing a significant association between caries and BMI and particularly between odontogenic infections and below normal BMI. An expanded model of hypothesised associations is presented that includes progressed forms of dental decay as a significant, yet largely neglected determinant of poor child development.