Influence of Obesity and Oral Health on Adolescent Self-Esteem: an Association Study

Objectives: It is not clear which factors hold more weight in predicting self-esteem-related oral health. Therefore, this study assessed the association of self-esteem with risk indicators such as obesity, gingivitis, dental plaque and toothache in adolescents.
Methods: Participants were randomly selected from public high schools and were attending CATO-USP in Brazil. The independent variables included the following: anthropometric measure (BMI), oral health-related factors (visible plaque index, bleeding on probing, gingivitis, and toothache), psychosocial factors (self-esteem and social support), and screen time. The Social Support Appraisals (SSA) and Rosenberg Self-Esteem Scale (RSES) questionnaires were applied. Frequencies and means or medians were used for data description. To adjust for confounding variables, the Poisson log-linear model with a robust estimator was used.
Results: A total of 205 adolescents participated in this study, with 116 (56.6%) being female. The median BMI (min-max) was 21.9 (13.3-52.8) kg/m2. 137 (66.8%) reported more than 3 hours of screen time per day. The average number of teeth with dental plaque was 25.7 (22.7). 84 (41%) had more than 10% of sites with bleeding, indicating the presence of gingivitis. 120 (58.5%) adolescents reported toothache. The average social support score was 118 (16.9) out of a total of 180, which was considered low. The average self-esteem score was 28 (5.13). Bivariate analysis showed the following associations with self-esteem: sedentary behavior (27.6±5.28; p=0.09); social support (RS=0.091, CI95% [-0.05, 0.22]; p=0.19); BMI (RS=-0.120, CI95% [-0.015, -0.282]; p=0.08); gingivitis (RS=-0.017; CI95% [-0.154, 0.120]; p=0.80); dental plaque (RS=0.028, CI95% [-0.109, 0.165]; p=0.63); and toothache (27.4±5.39; p=0.15). In the adjusted analysis, BMI was the variable that explained changes in self-esteem (RP=0.99, CI95% 0.990-0.999; p=0.025).
Conclusions: Our study indicates that BMI was responsible for changes in the self-esteem of adolescents, whereas gingivitis, dental plaque and toothache were not associated. Obesity in childhood and adolescence is a major public health challenge worldwide.