Oral pathology and overweight among pupils in government primary schools in Cameroon: a cross-sectional study

**Background:** Tooth decay and periodontal diseases affect 60–90% of pupils worldwide, with prevalence of 43% and 75% respectively reported in Cameroon. Childhood overweight is increasing globally, with projections of 12.7% prevalence in Africa by 2020. Overweight children have altered saliva composition and higher consumption of refined carbohydrates and saturated fatty acids, which may increase risk of oral pathologies. This study aimed to assess the relationship between oral pathologies and overweight among primary school pupils in Cameroon.

**Methods:** A cross-sectional study was conducted from June to August 2020 in four government primary schools in Yaounde, selected through cluster sampling from 34 schools. A total of 650 pupils aged 6–11 years were enrolled. Exclusion criteria included chronic conditions affecting food intake or metabolism, signs of puberty, and parental withdrawal of consent. Data collection included anthropometric measurements (weight to 0.1 kg using OMRON BF 511 scale, height to 0.1 cm using SECA 206 stadiometer), oral cavity examination using the Australian Oral Health Assessment Tool and 2017 Chicago classification of periodontal diseases, and feeding habits assessed via multiple 24-hour dietary recall on three non-consecutive days. BMI z-scores were calculated using WHO growth references for children aged 5–19 years; overweight was defined as BMI z-score ≥ +1.0. Data were analyzed with SPSS 26.0 using binary logistic regression to determine risks of oral pathologies in overweight pupils, adjusting for confounders including age, carbohydrate consumption, fluoride intake, and oral hygiene. A p-value < 0.05 was considered statistically significant.

**Key Results:** The median age of pupils was 10.1 (IQR: 9.6–11.4) years; 54.2% were girls. The lower socio-economic class was most represented (42.9%). Overweight prevalence was 27% (95% CI: 23.5–30.5). Tooth decay was the most common oral pathology, affecting 60.3% of pupils (95% CI: 56.4–64.1). Periodontal diseases were found in 53.2% (95% CI: 49.3–57.1), comprising gingivitis (33.1%) and periodontitis (20.1%). Other oral pathologies included traumatic tooth lesions (10.3%), cheilitis and lip ulcerations (4.0%), hyposialia (2.6%), and glossitis (2.3%). Binary logistic regression revealed that overweight pupils were significantly 1.5 times more likely to develop tooth decay than non-overweight pupils after adjusting for age, carbohydrate consumption, and oral hygiene (adjusted OR: 1.5; 95% CI: 1.09–2.35; p=0.011). Poor oral hygiene was also significantly associated with tooth decay (adjusted OR: 2.41; 95% CI: 1.46–3.97; p=0.001). Daily fluoride consumption < 1 mg/day (p=0.03) and carbohydrate consumption < 130 g/day (p=0.045) were also significant in the model.

**Clinical Implications:** This study demonstrates a significant association between overweight and tooth decay among Cameroonian primary school pupils, with overweight children having 1.5 times higher odds of dental caries. The high prevalence of both conditions—27% overweight and 60.3% tooth decay—highlights the dual burden of nutritional and oral health problems in this population. The findings support the need for integrated school-based health promotion programs that address both oral hygiene and nutrition. Given that primary school enrollment in Cameroon was 84% in 2018, schools provide an effective platform for early intervention. The study is limited by its cross-sectional design, which cannot establish causality, and by its focus on government schools in one city, which may limit generalizability. Nonetheless, the results align with global evidence linking obesity and dental caries and underscore the importance of addressing nutritional transition and its oral health consequences in low- and middle-income countries.