The effect of dental treatment on weight gain in children in South Africa
Background: There is an increased interest in understanding the effects of severe tooth decay on the physical, anthropometric, psychosocial, functional, and oral health related quality of life (OHRQoL) among children. Children who have severe tooth decay are thought to have lower weight, height, Body Mass Index (BMI), Haemoglobin (Hb) levels and poorer OHRQoL compared to children who are caries free. Comprehensive dental treatment under general anaesthesia (GA) appears to significantly improve these variables to levels equivalent to healthy caries free children. However, there is a paucity of high quality evidence that has demonstrated these gains in the anthropometric (Height, Weight BMI), clinical and oral health related quality of life (OHRQoL) measures following extensive dental treatment under GA. This trial sought to determine the impact of the treatment of severe dental caries on weight, height, body mass index (BMI), Hb levels and oral health related quality of life (OHRQoL) among a group of young children who had access to immediate care compared to a control group of children who waited 6 months before treatment. Methodology: This was a Community based prospective, randomized controlled intervention trial conducted in the peri-urban town of Worcester in the Western Cape Region of South Africa. The study population consisted of crèche going children, aged 2-6 years old who had severe tooth decay with a pufa score ≥ 1and attended public dental facilitates in the town. Simple random sampling using an existing lottery draw system at the clinic was used to divide the children into an immediate treatment group and a delayed treatment group (6 months later). Baseline height, weight, BMI, Hb levels were compared between treatment and no treatment groups at 6 months. OHRQol was measured from both the child and parent/caregiver perspective at baseline, 6 months later (in delayed group) and 6 months post treatment in both groups. Anthropometric variables were reported as unadjusted means and z-scores which were determined by transforming the unadjusted means against a reference group to determine the weight-for-height (WAH), weight-for-age (WAZ) and BMI-for –age (BAZ) in both groups after treatment. OHRQoL scores were dichotomized and/or categorized into high, low and no impacts. Descriptive statistics (means), correlation analyses (by age, gender) and multilevel mixed regression model analysis was undertaken to determine the effect of the treatment on the outcome variables using SPSS version 23. Results: 126 children in the immediate group (mean age 4.4 years, SD 1.2) and 125 children (mean age 3.75 years, SD 1.3) completed this trial. Comparative baseline measures significantly favoured children in the immediate group for age, height, and weight. The average number of teeth extracted under GA was 7.4 (SD 3.53) in the immediate group and 8.55 (SD 3.94) in the delayed group. Unadjusted mean scores for height, weight, BMI and Hb showed significant improvements within the groups at 6 months follow-up. When the group were compared (treatment vs. no treatment) using unadjusted or z-scores, statistically significant gains were noted for height and weight but not for BMI or Hb. Multilevel Regression modelling confirmed these findings implying that the intervention alone was not a factor in the improved Hb or BMI levels. OHRQoL significantly improved from both the child and parent/caregivers' perspective after treatment was received. In the delayed group, there was no improvement in OHRQoL scores during the 6 month waiting period but these significantly improved to comparable levels seen in the immediate group 6 months after treatment. Conclusion: This randomised controlled trial found that children with severe tooth decay who received treatment under general anaesthesia had significantly better height and weight gains than those children who has no treatment. Although gains were also noted in the BMI and Hb levels, these gains were not statically significant and their improvements could not be explained by the intervention alone (dental treatment under general anaesthesia). OHRQoL outcomes showed significant improvement from both the child and parental/caregiver perspective when comparing children who received treatment against those who did not have treatment. Children who had to wait for treatment had similar negative impacts on OHRQoL at 6 months follow-up compared to baseline. However, once they received treatment (delayed group), similar significant improvements for OHRQoL as reported in the immediate group was also found in the delayed group.