The Open Dentistry Journal




ISSN: 1874-2106 ― Volume 14, 2020
RESEARCH ARTICLE

The Association between Reported Dental Pain Symptoms and Increased BMI in Indonesia: Evidence From The Indonesian Family Life Survey



Tantry Maulina1, *, Cut Novianti Rachmi2
1 Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
2 Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia

Abstract

Background:

Overweight/obesity remains one of the most important health issues. Not only due to the current health consequences but also because of its long-term effect. One of the most common health problems experienced by an individual with overweight/obesity is dental problem, which can be reflected from dental pain being complained.

Objective:

The objective of the current study was to evaluate the association of overweight/obesity to be the predictor of the occurrence of dental pain.

Methods:

Data from the Indonesian Family Life Survey (IFLS) from five consecutive survey waves (1993, 1997, 2000, 2007 and 2014) that involved more than 30.000 participants and their offsprings that were grouped into three different age categories (0-4.9 years old; 5-19.9 years old; and 20-49.9 years old) were gathered and analyzed for Odds Ratio (OR) and Confidence Interval (CI). Trends of childhood overweight/obesity, the occurrence of dental pain, as well as the likelihood of individuals with childhood overweight/obesity to develop dental pain were analyzed by using STATA Data Analysis and Statistical Software version 13.

Results:

The results of the current study revealed that all age groups exhibited an increase in numbers when it comes to the prevalence of overweight/obesity from the first wave (in 1993) up to the latest wave (in 2014). It was also revealed that those who were in the 0-4.9 years old age group, were those who were more likely to develop dental pain (OR:1.12; 95% CI: 0.84-1.5; p:0.44).

Conclusion:

Despite the wave to wave variation, overweight/obesity has the potential to be associated with future dental problems, with dental pain in particular.

Keywords: Toothache, Overweight, Obesity, Dental symptoms, Dental pain, IBMI.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 103
Last Page: 110
Publisher Id: TODENTJ-14-103
DOI: 10.2174/18742106020140103

Article History:

Received Date: 31/10/2019
Revision Received Date: 10/02/2020
Acceptance Date: 16/02/2020
Electronic publication date: 20/03/2020
Collection year: 2020

© 2020 Maulina and Rachmi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Oral Surgery Department, Faculty of Dentistry, UniversitasPadjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, 40132 Indonesia; Tel: +62 821 1551 3030; E-mail: tantry.maulina@ fkg.unpad.ac.id or tmau4292@ uni.sydney.edu.au





1. INTRODUCTION

Overweight/ obesity is an important health issue that needs to be managed comprehensively by all concerned parties due to its long term and detrimental effect [1Chan RSM, Woo J. Prevention of overweight and obesity: how effective is the current public health approach. Int J Environ Res Public Health 2010; 7(3): 765-83.
[http://dx.doi.org/10.3390/ijerph7030765] [PMID: 20617002]
, 2Pi-Sunyer X. The medical risks of obesity. Postgrad Med 2009; 121(6): 21-33.
[http://dx.doi.org/10.3810/pgm.2009.11.2074] [PMID: 19940414]
]. According to the World Health Organization (WHO), a raised body mass index (BMI) into the extent of overweight/obesity, is a major risk factor for non-communicable diseases such as cardiovascular disease (which was the leading cause of death in 2012), diabetes, musculoskeletal disorders, and certain types of cancer [3WHO. Obesity and overweight 2017.updated 7 June 2018. 18 October 2017 Available from: http://www.who.int/ news-room/fact-sheets/detail/obesity-and-overweight]. In 2016, more than 1.9 billion adults aged 18 years old and above were overweight, of which 650 million adults (out of the 1.9 billion) were obese [3WHO. Obesity and overweight 2017.updated 7 June 2018. 18 October 2017 Available from: http://www.who.int/ news-room/fact-sheets/detail/obesity-and-overweight]. As for some developing countries, the growing rate of obesity has now doubled in numbers [4Yang P, Zhou Y, Chen B, et al. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur J Cancer 2009; 45(16): 2867-73.
[http://dx.doi.org/10.1016/j.ejca.2009.04.019] [PMID: 19427197]
]. A recent epidemiological study about childhood obesity in the coastal province of China showed that the obesity rate has increased from 12.37% (in 2005) to 18.16% (in 2014) in boys, and from 4.30% (in 2005) to 6.58% (in 2014) in girls. The growing rate for childhood overweight was found to be higher [5Zhang Y, Zhao J, Chu Z, Zhou J. Increasing prevalence of childhood overweight and obesity in a coastal province in China. Pediatr Obes 2016; 11(6): e22-6.
[http://dx.doi.org/10.1111/ijpo.12070] [PMID: 26403644]
]. In Indonesia, the prevalence of obesity in all age groups was also reported to be rising in numbers [6Rachmi CN, Li M, Alison Baur L. Overweight and obesity in Indonesia: prevalence and risk factors-a literature review. Public Health 2017; 147: 20-9.
[http://dx.doi.org/10.1016/j.puhe.2017.02.002] [PMID: 28404492]
].

Several factors are considered to be the cause of obesity, including genetic, physical activity, as well as dietary intake [7Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4(2): 187-92.
[http://dx.doi.org/10.4103/2249-4863.154628] [PMID: 25949965]
, 8Xu S, Xue Y. Pediatric obesity: Causes, symptoms, prevention and treatment. Exp Ther Med 2016; 11(1): 15-20.
[http://dx.doi.org/10.3892/etm.2015.2853] [PMID: 26834850]
]. It is important to note that one of the risk factors for overweight/obesity such as diet and fat content of milk is also considered as risk factors for the prevalence of dental caries [9Olczak-Kowalczyk D, Mysiak-Dębska M, Dębska-Lasut K, Grzebieluch W, Kaczmarek U. Food and dental caries. Part 1. Milk and dairy products. Nowa Stomatol 2017; 1: 30-8.-11Jensen ME. Diet and dental caries. Dent Clin North Am 1999; 43(4): 615-33.
[PMID: 10553247]
] which is the most common dental problems amongst children [12Andegiorgish AK, Weldemariam BW, Kifle MM, et al. Prevalence of dental caries and associated factors among 12 years old students in Eritrea. BMC Oral Health 2017; 17(1): 169.
[http://dx.doi.org/10.1186/s12903-017-0465-3] [PMID: 29284471]
-14Mulu W, Demilie T, Yimer M, Meshesha K, Abera B. Dental caries and associated factors among primary school children in Bahir Dar city: a cross-sectional study. BMC Res Notes 2014; 7: 949-55.
[http://dx.doi.org/10.1186/1756-0500-7-949] [PMID: 25540044]
], adolescents [15Pontigo-Loyola AP, Medina-Solís CE, Borges-Yañez SA, Patiño-Marín N, Islas-Márquez A, Maupome G. Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations. J Public Health Dent 2007; 67(1): 8-13.
[http://dx.doi.org/10.1111/j.1752-7325.2007.00001.x] [PMID: 17436973]
], as well as adults [16Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent 2009; 22(1): 3-8.
[PMID: 19281105]
, 17García-Cortés JO, Medina-Solís CE, Loyola-Rodriguez JP, et al. Dental caries’ experience, prevalence and severity in Mexican adolescents and young adults. Rev Salud Publica (Bogota) 2009; 11(1): 82-91.
[http://dx.doi.org/10.1590/S0124-00642009000100009] [PMID: 19721982]
]. Dental caries with dental pain being the main complaint [18Maheswaran T, Ramesh V, Krishnan A, Joseph J. Common chief complaints of patients seeking treatment in the government dental institution of Puducherry, India. J Indian Acad Dent Specialist Res 2015; 2: 55-8.
[http://dx.doi.org/10.4103/2229-3019.177921]
, 19Al-Johani K, Lamfon H, Abed H, Beyari M. Common chief complaints of dental patients at Umm Al-Qura University, Makkah city, Saudi Arabia. Oral Health Dent Manag 2017; 16: 1-4.], has been associated with overweight/obesity in many previous studies [20Costacurta M, DiRenzo L, Sicuro L, Gratteri S, De Lorenzo A, Docimo R. Dental caries and childhood obesity: analysis of food intakes, lifestyle. Eur J Paediatr Dent 2014; 15(4): 343-8.
[PMID: 25517577]
-24Honne T, Pentapati K, Kumar N, Acharya S. Relationship between obesity/overweight status, sugar consumption and dental caries among adolescents in South India. Int J Dent Hyg 2012; 10(4): 240-4.
[http://dx.doi.org/10.1111/j.1601-5037.2011.00534.x] [PMID: 22081959]
]. Aside from dental caries, there are other oral conditions as well as diseases that have been positively associated with increased BMI, namely periodontal disease(s), teeth undergoing orthodontic treatment, and impacted teeth [25Bhardwaj VK, Sharma D, Jhingta P, Fotedar S, Sahore M, Manchanda K. Assessment of relationship between body mass index and periodontal status among state government employees in Shimla, Himachal Pradesh. J Int Soc Prev Community Dent 2013; 3(2): 77-80.
[http://dx.doi.org/10.4103/2231-0762.122439] [PMID: 24778984]
-27de Carvalho RW. Vanconcelos dEBC. Is overweight a risk factor for adverse events during removal of impacted lower third molars? ScientificWorldJournal 2014; 2014: 1-19.
[http://dx.doi.org/10.1155/2014/589856]
]. Interestingly, several studies revealed contradictory results from the above mentioned and stated that increased BMI was negatively correlated with a particular oral condition(s), including dental caries [28Khan MN, Russo J, Spivack J, et al. Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery. JAMA Otolaryngol Head Neck Surg 2017; 143(6): 574-9.
[http://dx.doi.org/10.1001/jamaoto.2016.4304] [PMID: 28301644]
, 29Liang JJ, Zhang ZQ, Chen YJ, et al. Dental caries is negatively correlated with body mass index among 7-9 years old children in Guangzhou, China. BMC Public Health 2016; 16: 638.
[http://dx.doi.org/10.1186/s12889-016-3295-3] [PMID: 27456686]
]. This has brought the association between oral diseases and BMI remains debatable.

Even though numerous studies have been conducted to investigate the association between BMI and a particular oral or dental condition, very few studies have evaluated the association between BMI and dental pain, which is the most common dental problem. Dental pain, like any other type of pain occurring in the human body, has an impact on a person’s quality of life [30Clementino MA, Gomes MC. Pinto-Sarmento TCdA, Martins CC, Granville-Garcia AF, Paiva SM. Perceived impact of dental pain on the quality of life of preschool children and their families. PLoS One 2015; 10: 1-13.
[http://dx.doi.org/10.1371/journal.pone.0130602]
, 31Masood M, Newton T, Bakri NN, Khalid T, Masood Y. The relationship between oral health and oral health related quality of life among elderly people in United Kingdom. J Dent 2017; 56: 78-83.
[http://dx.doi.org/10.1016/j.jdent.2016.11.002] [PMID: 27825838]
] as dental pain symptoms affect eating [32Shekhawat KS, Chauhan A, Nordstroem M. Dental pain and its impact on quality of life among indigenous adolescents of Himalayas (Ladakh), India. Indian J Dent Res 2016; 27(1): 22-6.
[http://dx.doi.org/10.4103/0970-9290.179809] [PMID: 27054856]
] and other jaw functional activities [33Cavalheiro CH, Abegg C, Fontanive VN, Davoglio RS. Dental pain, use of dental services and oral health-related quality of life in southern Brazil. Braz Oral Res 2016; 30(1)e39
[http://dx.doi.org/10.1590/1807-3107BOR-2016.vol30.0039] [PMID: 27556550]
, 34Mashoto KO, Astrøm AN, David J, Masalu JR. Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study. Health Qual Life Outcomes 2009; 7: 73-81.
[http://dx.doi.org/10.1186/1477-7525-7-73] [PMID: 19643004]
]. Considering the medical impact of overweight/obesity as well as dental pain symptoms, the first aim of the current study was to evaluate the current trend of overweight/obesity as well as dental pain symptoms, whilst the second aim was to evaluate the association between overweight/obesity and the occurrence of dental pain.

2. MATERIALS AND METHODS

2.1. Indonesian Family Life Survey (IFLS)

2.1.1. Data Collection

IFLS is one of the nationally-representative surveys conducted in Indonesia. Starting in the year 1993 (wave 1), this survey sampled 13 out of the 27 provinces in Indonesia with more than 30.000 participants involved. The next waves (that involved two generations) were conducted in years 1997, 2000, 2007, and 2014, aiming to trace the same families/individuals and their off-springs from wave 1 (1993). More complete and detailed information regarding the sampling method and sample collection have been published in previous papers [35Frankenberg E, Karoly LA, Gertler P, Peterson CE, Wesley D. The 1993 Indonesian Family Life Survey: Overview and Field Report 1995.-38Rachmi CN, Agho KE, Li M, Baur LA. Stunting, underweight and overweight in children aged 2.0-4.9 years in Indonesia: prevalence trends and associated risk factors. PLoS One 2016; 11(5)e0154756
[http://dx.doi.org/10.1371/journal.pone.0154756] [PMID: 27167973]
]. In summary, the survey was conducted in 1993 using stratified random sampling to find the respondent. The survey itself comprised of questionnaires and followed by anthropometric measurements. The methods used in each following wave were similar to the one in 1993.

The data collected in the questionnaires were recorded in seven books which covered different ranges of information from individual-level information (age, sex, relationship with household head, anthropometric measures, etc.), household-level information (location of the house, economic and non-economic measures, etc.) as well as community-level information such as facilities in the area. In regards to dental pain questions (also known as toothache), this particular question was asked under the “Acute Morbidity” section. Participants were asked whether they have or had experienced toothache for the last four weeks (one question). All health-related measurements were performed by trained nurses. All of the data from the 5 waves have been publicly released. In this research, we combined all the related information from different books in each wave. One of the strengths of the IFLS is its high re-contact rate (the number of the same participants being re-contacted for the subsequent wave), as every subsequent wave can re-contact more than 90% of households and individuals from wave 1 [35Frankenberg E, Karoly LA, Gertler P, Peterson CE, Wesley D. The 1993 Indonesian Family Life Survey: Overview and Field Report 1995.-37Serrato C, Melnick G. The Indonesian family life survey overview and descriptive analysis. Santa Monica, California: RAND 1995. Contract No.: DRU-1191-AID].

2.1.2. Anthropometric Measurements

The height of participants was measured by trained nurses using Shorr measuring boards Model 420 and weight was measured using Seca Floor Model 770 scales (SECA, Los Angeles, CA, USA), with digital readout [35Frankenberg E, Karoly LA, Gertler P, Peterson CE, Wesley D. The 1993 Indonesian Family Life Survey: Overview and Field Report 1995.]. The age of children and adolescents was calculated based on dates of anthropometry examinations and birth dates. This is important for us to be able to express their body mass index (BMI; weight/ (height in m)2) as z scores using the LMS Growth program [38Rachmi CN, Agho KE, Li M, Baur LA. Stunting, underweight and overweight in children aged 2.0-4.9 years in Indonesia: prevalence trends and associated risk factors. PLoS One 2016; 11(5)e0154756
[http://dx.doi.org/10.1371/journal.pone.0154756] [PMID: 27167973]
,39LMS Growth Program. 2010.cited June 2014 Available from: http://www.healthforallchildren.com/?product=lmsgrowth]. For children under five, we calculated their BMI z scores against the WHO Child Growth Standard [40Organization WH. The WHO Child Growth Standards: World Health Organization 2006. Available from: http://www.who.int/childgrowth/standards/en/], and for children and adolescents aged 5 - 19 years, we used the WHO Growth Reference [41Organization WH. WHO Growth Reference for School-aged Children and Adolescents: WHO 2007. Available from: http://www.who.int/growthref/en/]. We further cleaned the dataset by identifying and discarding biologically implausible values (discard rate < 5%) using cutoff points from the WHO Anthro software as the following: weight-for-age z score (WAZ)<-6 and WAZ>5, height-for-age z score (HAZ)<-6 and HAZ>6, BMI z score (BMIZ)<- 5 and BMIZ>5 [42Organization WH. WHO Anthro version 3.2.2 and macros: World Health Organization 2011. Available from: http://www.who.int/childgrowth/software/en/]. Overweight/ obesity was defined as BMIZ>+1 according to the WHO definitions. In under-five children, we also included the ‘at-risk’ category as suggested by de Onis et al. which defined as BMIZ>+1 [43de Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92(5): 1257-64.
[http://dx.doi.org/10.3945/ajcn.2010.29786] [PMID: 20861173]
].

2.1.3. Statistical Analysis

All analyses were performed using STATA Data Analysis and Statistical Software version 13 [44Corp S. STATA statistical software: Release 13 2014.]. We conducted frequency tabulations to describe distributions. The results are presented as numbers and prevalence in percent. The odds ratio of overweight/ obese children having toothache within the last four weeks was computed by dividing the probability of having toothache symptoms in overweight/ obese children to the probability of non-overweight (healthy weight and underweight combined) children. Significance level (p-value) was set at < 0.05.

3. RESULTS

We reported an increasing number of participants in each wave (Table 1). In the 0 to 4.9 years age group, there were more male participants in every wave as compared to female participants. On the contrary, in the 20 to 49.9 years age group, there were more female participants in every wave as compared to their male counterparts. In the 5 to 19.9 years age group, we found similar numbers of female and male participants in the first three waves and more male participants in the latest two waves.

In children aged 0 to 4.9 years, there was a decrease in height between the years 1993 to 2000 (7 years range), followed by an increase in the year 2007 and 2014. There was a relatively stable mean weight between years 1993, 1997, and 2000, followed by an increase in the year 2007 and 2014. The mean BMI is increasing from wave 1 (1993) to wave 5 (2014). In the 5 to 19.9 years age group, there was a relatively similar mean height from wave 1 to wave 4, followed by an increase in mean height in wave 5. The mean weight and BMI are quite similar in the first three waves and an increase in waves 4 and 5. In adults aged 20 to 49.9 years, we have an increase in height, weight, and BMI from the year 1993 to 2014.

The current study analyzed the data based on three different age groups and five waves. The first analysis revealed that there was an increase in trends when it comes to being overweight (Table 2). For example, for the 0 to 4.9 years old (children) age group, despite the growing number of those who considered being healthily weighted, yet, there was a growing percentage (18.10%, 2014) of those who were in the overweight category. When all three categories were compared, the highest growth percentage for the overweight category occurred in the 20 to 49.9 years old (adults) age group, whereas the percentage increased as much as 18.59% (15.93% in 1993 up to 34.52% in 2014).

Table 1
Characteristics of participants.


Table 2
Trends of the prevalence of underweight, healthy weight, and overweight/ obesity (number, percentage).


The next analysis performed was on those in every age group that complained about dental pain in the last four weeks of the survey period (Table 3). In line with the increasing trend of being overweight, this part of the analysis showed that, as the year progressed, more people complained about experiencing dental pain. There was a decrease in percentage in all age groups in the fourth wave (2007), but the percentage went right back up for all age categories in 2014, with the highest percentage exhibited by those in the children and adolescents (5 to 19.9 years old) age group.

When the two variables were associated (Table 4), it showed that the 5 to 19.9 years old (children adolescent) age group had the highest percentage of individuals complaining of dental pain as compared to those who did not by the fifth wave of the survey period (the year 2014). In regard to the complaint of dental pain, it is interesting to note that in 2007, every age category showed a decrease as compared to the previous wave (the year 2000), and has an increase in percentage in the fifth wave (the year 2014).

The next analysis of the current study evaluated the odds ratio for overweight children to experience dental pain as compared to non-overweight children in 0 - 4.9 years old (Children) age group (Fig. 1). Despite the inconsistency of the odds ratios throughout the five survey periods, the latest survey (wave 5, the year 2014) revealed that children with the overweight problem had 1.12 times the odds of having dental pain as compared to non-overweight children (95% CI: 0.84-15, p = 0.44). It was also revealed that the lowest odds ratio exhibited by the participants was the one in the year 2000, whereas participants “only” had 0.39 times the odds of having dental pain (95% CI=0.23 - 0.69, p = 0.001).

Table 3
Percentage of children, adolescents, and adults with toothache symptoms within the last 4 weeks (number, percentage).


Table 4
Number of children, adolescents, and adults with toothache symptoms within the last 4 weeks based on weight status (number, percentage).


Fig. (2) exhibited the odds ratio of individuals who were overweight and belonged to the 5 to 19.9 years old (Children and adolescents) age group from experiencing dental pain as compared to their non-overweight counterparts. In this particular group, the odds ratio of having dental pain is getting smaller as time progressed (from 1.17; 95% CI: 0.46-2.98; p = 0.75 to 0.59; 95% CI: 0.50 - 0.70; p < 0.001). There was an increase in the odds between wave 2 and wave 3, yet the overall trends in this particular group were to decrease.

The last analysis of the current study was the odds ratio for those who were in 20 to 49.9 years old (Adult) age group and overweight, having dental pain as compared to individuals who were in this age group without being overweight (Fig. 3). In contrast with the previous group, this particular group showed an increase in its overall trends. If the odds ratio for individuals in this category was 0.84 (95% CI: 0.69-1.02; p = 0.08) in the first wave, it increased up to 1.03 (95% CI: 0.95-1.11; p = 0.50) in the last wave, showing an increase as much as 0.19 in odds ratio.

Fig. (1)
Are overweight children aged 0 - 4.9 years more likely to have toothache as compared to their non-overweight counterparts?


Fig. (2)
Are overweight children and adolescents aged 5 - 19.9 years more likely to have toothache as compared to their non-overweight counterparts?


Fig. (3)
Are overweight adults aged 20 - 49.9 years more likely to have toothache as compared to their non-overweight counterparts?


4. DISCUSSION

In regard to the results obtained in the current study, previous studies that evaluated the correlation between dental problems and nutritional status usually exhibited the correlation between dental caries and underweight conditions [45Mishu MP, Hobdell M, Khan MH, Hubbard RM, Sabbah W. W S. Relationship between untreated dental cariesand weight and height of 6 to 12 year old primary school chidlren in Bangladesh. Int J Dent 2013; 2013629675
[http://dx.doi.org/10.1155/2013/629675] [PMID: 23690777]
-47Heinrich-Weltzien R, Monse B, Benzian H, Heinrich J, Kromeyer-Hauschild K. Association of dental caries and weight status in 6- to 7-year-old Filipino children. Clin Oral Investig 2013; 17(6): 1515-23.
[http://dx.doi.org/10.1007/s00784-012-0849-3] [PMID: 23053701]
]. There is a lack of attention on the correlation between the most complained dental problem, which is dental pain [18Maheswaran T, Ramesh V, Krishnan A, Joseph J. Common chief complaints of patients seeking treatment in the government dental institution of Puducherry, India. J Indian Acad Dent Specialist Res 2015; 2: 55-8.
[http://dx.doi.org/10.4103/2229-3019.177921]
, 19Al-Johani K, Lamfon H, Abed H, Beyari M. Common chief complaints of dental patients at Umm Al-Qura University, Makkah city, Saudi Arabia. Oral Health Dent Manag 2017; 16: 1-4., 48Hasan-Ansari S, Al-Saffan A, Al-Dhubaiban D, Yaser-Turkistani O, Al-Khalaf R, Al-Assaf D. Prevalence of chief complaints among pediatric dental patients in saudi population; study done in Riyadh Colleges of Dentistry and Pharmacy, Saudi Arabia. Res Rev: J Dent Sci 2016; 4: 58-62., 49Shqair AQ, Gomes GB, Oliveira A, et al. Dental emergencies in a university pediatric dentistry clinic: a retrospective study. Braz Oral Res 2012; 26(1): 50-6.
[http://dx.doi.org/10.1590/S1806-83242012000100009] [PMID: 22344338]
], and nutritional status. The current study evaluated the association between dental pain and overweight/obesity status in the Indonesian sample to analyze whether this particular nutritional condition can be used as a predictor for future dental problems. To do this, the first analysis performed aimed at observing the trend of overweight/obesity in the Indonesian sample. The analysis revealed how overweight/obesity seemed to increase as time progressed. This particular result is in line with a review study conducted by Reilly et al. (2012), stating that the prevalence of obesity in all age categories tends to increase as time progresses [50Reilly D, Boyle CA, Craig DC. Obesity and dentistry: a growing problem. Br Dent J 2009; 207(4): 171-5.
[http://dx.doi.org/10.1038/sj.bdj.2009.717] [PMID: 19696833]
]. Another study conducted by Wang et al. (2008) in the United States also revealed the increasing trend of obesity amongst the population [51Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese? estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) 2008; 16(10): 2323-30.
[http://dx.doi.org/10.1038/oby.2008.351] [PMID: 18719634]
].

Several reasons might act as the cause of this phenomenon, such as environmental factors, lifestyle, cultural environment, eating habits, and genetics [7Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4(2): 187-92.
[http://dx.doi.org/10.4103/2249-4863.154628] [PMID: 25949965]
, 8Xu S, Xue Y. Pediatric obesity: Causes, symptoms, prevention and treatment. Exp Ther Med 2016; 11(1): 15-20.
[http://dx.doi.org/10.3892/etm.2015.2853] [PMID: 26834850]
]. An analysis of the prevalence of dental pain also showed an increasing trend as time progressed. Our literature study found no record of a cohort study that recorded the prevalence of dental pain over time. Yet, our literature study recorded several previous studies that recorded the high prevalence of dental pain as well as related factors. Most of these studies correlated the high prevalence of dental pain to low socio-economic status [52Guskuma RC, Lages VA, Hafner MB, et al. Factors associated with the prevalence and intensity of dental pain in children in the municipalities of the Campinas region, São Paulo. Rev Paul Pediatr 2017; 35(3): 322-30.
[http://dx.doi.org/10.1590/1984-0462/;2017;35;3;00001] [PMID: 28977286]
-54Saheer A, Kousalya PS, Raju R, Gubbihal R. Dental pain among 10-15 year old children attending oral health promoting schools: A cross-sectional study. J Int Soc Prev Community Dent 2015; 5(Suppl. 2): S101-6.
[PMID: 26942112]
], yet, a study by Escoffié-Ramirez et al. (2017) provided a rather interesting result, whereas their study correlated high prevalence of dental pain with higher economic status [55Escoffié-Ramirez M, Ávila-Burgos L, Baena-Santillan ES, et al. Factors associated with dental pain in Mexican Schoolchildren aged 6 to 12 years old. BioMed Res Int 2017; 20177431301
[http://dx.doi.org/10.1155/2017/7431301] [PMID: 28685149]
]. This particular result fits the first part of the result of our study, of which the increasing trend of overweight/obesity was correlated with higher monthly family income [56Collins AE, Pakiz B, Rock CL. Factors associated with obesity in Indonesian adolescents. Int J Pediatr Obes 2008; 3(1): 58-64.
[http://dx.doi.org/10.1080/17477160701520132] [PMID: 17852550]
].

Our study also revealed the association between overweight/obesity and the occurrence of dental pain, whereas overweight/obese children (aged 0 to 4.9 years old) had 1.12 the odds of experiencing dental pain as compared to their counterparts. A study by Lemes et al. (2015) that was conducted on the 2 to the 4-year-old group of children revealed that one of the factors that were significantly related to the occurrence of dental pain was the consumption level of artificial powder juice containing sugar [57Lemes MGC, Peixoto MdoR, Meneses IH, Freire MdoC. Dental pain and associated factors in 2 to 4-year-old children in Goiânia. Rev Bras Epidemiol 2015; 18(3): 630-41.
[http://dx.doi.org/10.1590/1980-5497201500030009] [PMID: 26247187]
]. Even though the type of diet was not evaluated in the current study, yet, the result revealed by Lemes et al. (2015) in their study might have provided us with the evidence of how this particular type of childhood diet might be one of the reasons that children who are overweight/obese have bigger odds on having dental pain symptoms. As previous studies have indicated how sugary beverages were significantly associated with overweight/obesity [58Papandreou D, Andreou E, Heraclides A, Rousso I. Is beverage intake related to overweight and obesity in school children? Hippokratia 2013; 17(1): 42-6.
[PMID: 23935343]
-60Luger M, Lafontan M, Bes-Rastrollo M, Winzer E, Yumuk V, Farpour-Lambert N. Sugar-sweetened beverages and weight gain in children and adults: A systematic review from 2013 to 2015 and a comparison with previous studies. Obes Facts 2017; 10(6): 674-93.
[http://dx.doi.org/10.1159/000484566] [PMID: 29237159]
] and the increased prevalence of dental caries [61Skinner J, Byun R, Blinkhorn A, Johnson G. Sugary drink consumption and dental caries in New South Wales teenagers. Aust Dent J 2015; 60(2): 169-75.
[http://dx.doi.org/10.1111/adj.12310] [PMID: 25988969]
-63Wilder JR, Kaste LM, Handler A, Chapple-McGruder T, Rankin KM. The association between sugar-sweetened beverages and dental caries among third-grade students in Georgia. J Public Health Dent 2016; 76(1): 76-84.
[http://dx.doi.org/10.1111/jphd.12116] [PMID: 26339945]
], which is the main cause of dental pain [64Boeira GF, Correa MB, Peres KG, et al. Caries is the main cause for dental pain in childhood: findings from a birth cohort. Caries Res 2012; 46(5): 488-95.
[http://dx.doi.org/10.1159/000339491] [PMID: 22813889]
, 65Renton T. Dental (odontogenic) pain. Rev Pain 2011; 5(1): 2-7.
[http://dx.doi.org/10.1177/204946371100500102] [PMID: 26527224]
].

CONCLUSION

To conclude, despite the age-related variation, overweight/obesity has the potential to be the predictor for the occurrence of dental problems with dental pain symptoms in particular.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Not applicable.

HUMAN AND ANIMAL RIGHTS

No animals/humans were used for studies that are the basis of this research.

CONSENT FOR PUBLICATION

Not applicable.

AVAILABILITY OF DATA AND MATERIALS

The data supporting the findings of the article are available at the RAND Corporation website and can be downloaded through the following link: http://www.rand.org/ labor/FLS/IFLS.html.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

None stated.

REFERENCES

[1] Chan RSM, Woo J. Prevention of overweight and obesity: how effective is the current public health approach. Int J Environ Res Public Health 2010; 7(3): 765-83.
[http://dx.doi.org/10.3390/ijerph7030765] [PMID: 20617002]
[2] Pi-Sunyer X. The medical risks of obesity. Postgrad Med 2009; 121(6): 21-33.
[http://dx.doi.org/10.3810/pgm.2009.11.2074] [PMID: 19940414]
[3] WHO. Obesity and overweight 2017.updated 7 June 2018. 18 October 2017 Available from: http://www.who.int/ news-room/fact-sheets/detail/obesity-and-overweight
[4] Yang P, Zhou Y, Chen B, et al. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur J Cancer 2009; 45(16): 2867-73.
[http://dx.doi.org/10.1016/j.ejca.2009.04.019] [PMID: 19427197]
[5] Zhang Y, Zhao J, Chu Z, Zhou J. Increasing prevalence of childhood overweight and obesity in a coastal province in China. Pediatr Obes 2016; 11(6): e22-6.
[http://dx.doi.org/10.1111/ijpo.12070] [PMID: 26403644]
[6] Rachmi CN, Li M, Alison Baur L. Overweight and obesity in Indonesia: prevalence and risk factors-a literature review. Public Health 2017; 147: 20-9.
[http://dx.doi.org/10.1016/j.puhe.2017.02.002] [PMID: 28404492]
[7] Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4(2): 187-92.
[http://dx.doi.org/10.4103/2249-4863.154628] [PMID: 25949965]
[8] Xu S, Xue Y. Pediatric obesity: Causes, symptoms, prevention and treatment. Exp Ther Med 2016; 11(1): 15-20.
[http://dx.doi.org/10.3892/etm.2015.2853] [PMID: 26834850]
[9] Olczak-Kowalczyk D, Mysiak-Dębska M, Dębska-Lasut K, Grzebieluch W, Kaczmarek U. Food and dental caries. Part 1. Milk and dairy products. Nowa Stomatol 2017; 1: 30-8.
[10] Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003; 78(4): 881S-92S.
[http://dx.doi.org/10.1093/ajcn/78.4.881S] [PMID: 14522753]
[11] Jensen ME. Diet and dental caries. Dent Clin North Am 1999; 43(4): 615-33.
[PMID: 10553247]
[12] Andegiorgish AK, Weldemariam BW, Kifle MM, et al. Prevalence of dental caries and associated factors among 12 years old students in Eritrea. BMC Oral Health 2017; 17(1): 169.
[http://dx.doi.org/10.1186/s12903-017-0465-3] [PMID: 29284471]
[13] Zou J, Meng M, Law CS, Rao Y, Zhou X. Common dental diseases in children and malocclusion. Int J Oral Sci 2018; 10(1): 7.
[http://dx.doi.org/10.1038/s41368-018-0012-3] [PMID: 29540669]
[14] Mulu W, Demilie T, Yimer M, Meshesha K, Abera B. Dental caries and associated factors among primary school children in Bahir Dar city: a cross-sectional study. BMC Res Notes 2014; 7: 949-55.
[http://dx.doi.org/10.1186/1756-0500-7-949] [PMID: 25540044]
[15] Pontigo-Loyola AP, Medina-Solís CE, Borges-Yañez SA, Patiño-Marín N, Islas-Márquez A, Maupome G. Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations. J Public Health Dent 2007; 67(1): 8-13.
[http://dx.doi.org/10.1111/j.1752-7325.2007.00001.x] [PMID: 17436973]
[16] Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent 2009; 22(1): 3-8.
[PMID: 19281105]
[17] García-Cortés JO, Medina-Solís CE, Loyola-Rodriguez JP, et al. Dental caries’ experience, prevalence and severity in Mexican adolescents and young adults. Rev Salud Publica (Bogota) 2009; 11(1): 82-91.
[http://dx.doi.org/10.1590/S0124-00642009000100009] [PMID: 19721982]
[18] Maheswaran T, Ramesh V, Krishnan A, Joseph J. Common chief complaints of patients seeking treatment in the government dental institution of Puducherry, India. J Indian Acad Dent Specialist Res 2015; 2: 55-8.
[http://dx.doi.org/10.4103/2229-3019.177921]
[19] Al-Johani K, Lamfon H, Abed H, Beyari M. Common chief complaints of dental patients at Umm Al-Qura University, Makkah city, Saudi Arabia. Oral Health Dent Manag 2017; 16: 1-4.
[20] Costacurta M, DiRenzo L, Sicuro L, Gratteri S, De Lorenzo A, Docimo R. Dental caries and childhood obesity: analysis of food intakes, lifestyle. Eur J Paediatr Dent 2014; 15(4): 343-8.
[PMID: 25517577]
[21] Marshall TA, Eichenberger-Gilmore JM, Broffitt BA, Warren JJ, Levy SM. Dental caries and childhood obesity: roles of diet and socioeconomic status. Community Dent Oral Epidemiol 2007; 35(6): 449-58.
[http://dx.doi.org/10.1111/j.1600-0528.2006.00353.x] [PMID: 18039286]
[22] Hayden C, Bowler JO, Chambers S, et al. Obesity and dental caries in children: a systematic review and meta-analysis. Community Dent Oral Epidemiol 2013; 41(4): 289-308.
[http://dx.doi.org/10.1111/cdoe.12014] [PMID: 23157709]
[23] Alswat K, Mohamed WS, Wahab MA, Aboelil AA. The association between body mass index and dental caries: cross-sectional study. J Clin Med Res 2016; 8(2): 147-52.
[http://dx.doi.org/10.14740/jocmr2433w] [PMID: 26767084]
[24] Honne T, Pentapati K, Kumar N, Acharya S. Relationship between obesity/overweight status, sugar consumption and dental caries among adolescents in South India. Int J Dent Hyg 2012; 10(4): 240-4.
[http://dx.doi.org/10.1111/j.1601-5037.2011.00534.x] [PMID: 22081959]
[25] Bhardwaj VK, Sharma D, Jhingta P, Fotedar S, Sahore M, Manchanda K. Assessment of relationship between body mass index and periodontal status among state government employees in Shimla, Himachal Pradesh. J Int Soc Prev Community Dent 2013; 3(2): 77-80.
[http://dx.doi.org/10.4103/2231-0762.122439] [PMID: 24778984]
[26] Michelogiannakis D, Rossouw PE, Khan J, Akram Z, Menenakos E, Javed F. Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies. J Orthod 2019; 46(4): 323-34.
[http://dx.doi.org/10.1177/1465312519873669] [PMID: 31522589]
[27] de Carvalho RW. Vanconcelos dEBC. Is overweight a risk factor for adverse events during removal of impacted lower third molars? ScientificWorldJournal 2014; 2014: 1-19.
[http://dx.doi.org/10.1155/2014/589856]
[28] Khan MN, Russo J, Spivack J, et al. Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery. JAMA Otolaryngol Head Neck Surg 2017; 143(6): 574-9.
[http://dx.doi.org/10.1001/jamaoto.2016.4304] [PMID: 28301644]
[29] Liang JJ, Zhang ZQ, Chen YJ, et al. Dental caries is negatively correlated with body mass index among 7-9 years old children in Guangzhou, China. BMC Public Health 2016; 16: 638.
[http://dx.doi.org/10.1186/s12889-016-3295-3] [PMID: 27456686]
[30] Clementino MA, Gomes MC. Pinto-Sarmento TCdA, Martins CC, Granville-Garcia AF, Paiva SM. Perceived impact of dental pain on the quality of life of preschool children and their families. PLoS One 2015; 10: 1-13.
[http://dx.doi.org/10.1371/journal.pone.0130602]
[31] Masood M, Newton T, Bakri NN, Khalid T, Masood Y. The relationship between oral health and oral health related quality of life among elderly people in United Kingdom. J Dent 2017; 56: 78-83.
[http://dx.doi.org/10.1016/j.jdent.2016.11.002] [PMID: 27825838]
[32] Shekhawat KS, Chauhan A, Nordstroem M. Dental pain and its impact on quality of life among indigenous adolescents of Himalayas (Ladakh), India. Indian J Dent Res 2016; 27(1): 22-6.
[http://dx.doi.org/10.4103/0970-9290.179809] [PMID: 27054856]
[33] Cavalheiro CH, Abegg C, Fontanive VN, Davoglio RS. Dental pain, use of dental services and oral health-related quality of life in southern Brazil. Braz Oral Res 2016; 30(1)e39
[http://dx.doi.org/10.1590/1807-3107BOR-2016.vol30.0039] [PMID: 27556550]
[34] Mashoto KO, Astrøm AN, David J, Masalu JR. Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study. Health Qual Life Outcomes 2009; 7: 73-81.
[http://dx.doi.org/10.1186/1477-7525-7-73] [PMID: 19643004]
[35] Frankenberg E, Karoly LA, Gertler P, Peterson CE, Wesley D. The 1993 Indonesian Family Life Survey: Overview and Field Report 1995.
[36] Frankenberg E, Thomas D. The Indonesia family life survey (IFLS): Study design and results from waves 1 and 2 Santa Monica, California: RAND 2000. Contract No.: DRU-2238/1-NIA/NICHD
[37] Serrato C, Melnick G. The Indonesian family life survey overview and descriptive analysis. Santa Monica, California: RAND 1995. Contract No.: DRU-1191-AID
[38] Rachmi CN, Agho KE, Li M, Baur LA. Stunting, underweight and overweight in children aged 2.0-4.9 years in Indonesia: prevalence trends and associated risk factors. PLoS One 2016; 11(5)e0154756
[http://dx.doi.org/10.1371/journal.pone.0154756] [PMID: 27167973]
[39] LMS Growth Program. 2010.cited June 2014 Available from: http://www.healthforallchildren.com/?product=lmsgrowth
[40] Organization WH. The WHO Child Growth Standards: World Health Organization 2006. Available from: http://www.who.int/childgrowth/standards/en/
[41] Organization WH. WHO Growth Reference for School-aged Children and Adolescents: WHO 2007. Available from: http://www.who.int/growthref/en/
[42] Organization WH. WHO Anthro version 3.2.2 and macros: World Health Organization 2011. Available from: http://www.who.int/childgrowth/software/en/
[43] de Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92(5): 1257-64.
[http://dx.doi.org/10.3945/ajcn.2010.29786] [PMID: 20861173]
[44] Corp S. STATA statistical software: Release 13 2014.
[45] Mishu MP, Hobdell M, Khan MH, Hubbard RM, Sabbah W. W S. Relationship between untreated dental cariesand weight and height of 6 to 12 year old primary school chidlren in Bangladesh. Int J Dent 2013; 2013629675
[http://dx.doi.org/10.1155/2013/629675] [PMID: 23690777]
[46] Parkar SM, Chokshi M. Exploring association between dental caries and body mass index in public school children of Ahmedabad city, Gujarat. J Res Dent Sci 2013; 4: 101-5.
[http://dx.doi.org/10.4103/0976-433X.121633]
[47] Heinrich-Weltzien R, Monse B, Benzian H, Heinrich J, Kromeyer-Hauschild K. Association of dental caries and weight status in 6- to 7-year-old Filipino children. Clin Oral Investig 2013; 17(6): 1515-23.
[http://dx.doi.org/10.1007/s00784-012-0849-3] [PMID: 23053701]
[48] Hasan-Ansari S, Al-Saffan A, Al-Dhubaiban D, Yaser-Turkistani O, Al-Khalaf R, Al-Assaf D. Prevalence of chief complaints among pediatric dental patients in saudi population; study done in Riyadh Colleges of Dentistry and Pharmacy, Saudi Arabia. Res Rev: J Dent Sci 2016; 4: 58-62.
[49] Shqair AQ, Gomes GB, Oliveira A, et al. Dental emergencies in a university pediatric dentistry clinic: a retrospective study. Braz Oral Res 2012; 26(1): 50-6.
[http://dx.doi.org/10.1590/S1806-83242012000100009] [PMID: 22344338]
[50] Reilly D, Boyle CA, Craig DC. Obesity and dentistry: a growing problem. Br Dent J 2009; 207(4): 171-5.
[http://dx.doi.org/10.1038/sj.bdj.2009.717] [PMID: 19696833]
[51] Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese? estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) 2008; 16(10): 2323-30.
[http://dx.doi.org/10.1038/oby.2008.351] [PMID: 18719634]
[52] Guskuma RC, Lages VA, Hafner MB, et al. Factors associated with the prevalence and intensity of dental pain in children in the municipalities of the Campinas region, São Paulo. Rev Paul Pediatr 2017; 35(3): 322-30.
[http://dx.doi.org/10.1590/1984-0462/;2017;35;3;00001] [PMID: 28977286]
[53] Slade GD. Epidemiology of dental pain and dental caries among children and adolescents. Community Dent Health 2001; 18(4): 219-27.
[PMID: 11789699]
[54] Saheer A, Kousalya PS, Raju R, Gubbihal R. Dental pain among 10-15 year old children attending oral health promoting schools: A cross-sectional study. J Int Soc Prev Community Dent 2015; 5(Suppl. 2): S101-6.
[PMID: 26942112]
[55] Escoffié-Ramirez M, Ávila-Burgos L, Baena-Santillan ES, et al. Factors associated with dental pain in Mexican Schoolchildren aged 6 to 12 years old. BioMed Res Int 2017; 20177431301
[http://dx.doi.org/10.1155/2017/7431301] [PMID: 28685149]
[56] Collins AE, Pakiz B, Rock CL. Factors associated with obesity in Indonesian adolescents. Int J Pediatr Obes 2008; 3(1): 58-64.
[http://dx.doi.org/10.1080/17477160701520132] [PMID: 17852550]
[57] Lemes MGC, Peixoto MdoR, Meneses IH, Freire MdoC. Dental pain and associated factors in 2 to 4-year-old children in Goiânia. Rev Bras Epidemiol 2015; 18(3): 630-41.
[http://dx.doi.org/10.1590/1980-5497201500030009] [PMID: 26247187]
[58] Papandreou D, Andreou E, Heraclides A, Rousso I. Is beverage intake related to overweight and obesity in school children? Hippokratia 2013; 17(1): 42-6.
[PMID: 23935343]
[59] Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006; 84(2): 274-88.
[http://dx.doi.org/10.1093/ajcn/84.2.274] [PMID: 16895873]
[60] Luger M, Lafontan M, Bes-Rastrollo M, Winzer E, Yumuk V, Farpour-Lambert N. Sugar-sweetened beverages and weight gain in children and adults: A systematic review from 2013 to 2015 and a comparison with previous studies. Obes Facts 2017; 10(6): 674-93.
[http://dx.doi.org/10.1159/000484566] [PMID: 29237159]
[61] Skinner J, Byun R, Blinkhorn A, Johnson G. Sugary drink consumption and dental caries in New South Wales teenagers. Aust Dent J 2015; 60(2): 169-75.
[http://dx.doi.org/10.1111/adj.12310] [PMID: 25988969]
[62] Zahara AM Jr, Fashihah MH, Nurul AY. Relationship between frequency of sugary food and drink cinsumption with occurence of dental caries among preschool children in Titiwangsa, Kuala Lumpur. Malays J Nutr 2010; 16(1): 83-90.
[PMID: 22691855]
[63] Wilder JR, Kaste LM, Handler A, Chapple-McGruder T, Rankin KM. The association between sugar-sweetened beverages and dental caries among third-grade students in Georgia. J Public Health Dent 2016; 76(1): 76-84.
[http://dx.doi.org/10.1111/jphd.12116] [PMID: 26339945]
[64] Boeira GF, Correa MB, Peres KG, et al. Caries is the main cause for dental pain in childhood: findings from a birth cohort. Caries Res 2012; 46(5): 488-95.
[http://dx.doi.org/10.1159/000339491] [PMID: 22813889]
[65] Renton T. Dental (odontogenic) pain. Rev Pain 2011; 5(1): 2-7.
[http://dx.doi.org/10.1177/204946371100500102] [PMID: 26527224]
Track Your Manuscript:


Endorsements



"Thank you for your magnificent and marvelous support throughout the publication stages. I would like to endorse my experience with you as a Junior Researcher and a recent graduate of the Dental school. Once again Thank you for your Great Help and Guidance throughout the stages of Publication. You guys are a great team and I am proud to be a Young Bentham author."


Asra Sabir Hussain
The University of Edinburgh Business School, UK

"My experience with Bentham Open was a valuable one because the quality of the services and analysis of my paper contributed in improving what we intended to convey to the readers."


José Ricardo Kina
Department of Surgery and Integrated Clinic,
Araçatuba School of Dentistry, São Paulo State University
Brazil

"The Publication Manager was very cooperative and replied my mails and guided me without any delays; however the reviewing process was too long."


Mahtab Memarpour
Prevention of Oral and Dental Disease Research Center,
Department of Pediatric Dentistry, School of Dentistry,
Shiraz University of Medical Sciences, Shiraz,
Iran


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open