{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:04:43Z","timestamp":1790600683836,"version":"4.1.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background &amp; aim<\/jats:title>\n<jats:p>Understanding the impact of food exposures outside the home environment is pivotal for helping children establish healthy eating patterns, for the prevention and delay of dental caries and other non-communicable diseases. This study sought to assesses the dietary habits and oral health experiences of primary school children in Johannesburg.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a cross-sectional analytical study of grade three learners, aged 9\u201311 years old. The measurement tools used included an observational checklist, a questionnaire, an oral health examination and anthropometric measures for assessing the Body Mass Index (BMI). Correlation and regression analysis were undertaken to determine relationships between sugar intake, calories intake, dmft, DMFT and gingival index.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 107 eligible children participating, 68% were from a school with a feeding scheme and 31.8% with no feeding scheme. The mean (SD) of BMI, dmft, and DMFT were 18.19 (3.59), 3.14 (3.39), and 1.49 (2.10), respectively. The mean sugar content of meals served in schools with a feeding scheme was lower [11.65g (SD 9.6)] than the mean sugar content of food consumed at a schools with no feeding scheme [35.84g (29.9)]. The regression analysis in this population indicated that the low gingival score was associated with high BMI and sugar intake.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Although the sugar content of meals served at National School Nutrition Programme (NSNP) schools was less that the sugar content accessed by children at Non-NSNP schools, both the schools had poor controls over sugar consumption and purchasing behaviour of the learners. The low gingival score was attributed to socio-economic status and access to toothbrushes and pastes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323522","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T18:14:32Z","timestamp":1748456072000},"page":"e0323522","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["School dietary habits &amp; oral health experiences of primary school children in Johannesburg"],"prefix":"10.1371","volume":"20","author":[{"given":"Octavia Refiloe","family":"Lebele","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veerasamy","family":"Yengopal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peedi","family":"Mathobela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9227-3927","authenticated-orcid":true,"given":"Mpho Matlakale","family":"Molete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"issue":"1","key":"pone.0323522.ref001","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/jphd.12116","article-title":"The association between sugar-sweetened beverages and dental caries among third-grade students in Georgia","volume":"76","author":"JR Wilder","year":"2016","journal-title":"J Public Health Dent"},{"issue":"3","key":"pone.0323522.ref002","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1590\/1677-3225v13n3a09","article-title":"Body mass index, dental caries and sugar intake in 2-5 year-old preschoolers","volume":"13","author":"RJ Martins","year":"2014","journal-title":"Braz J Oral Sci"},{"issue":"2","key":"pone.0323522.ref003","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4103\/0970-9290.66652","article-title":"Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12- to 13-year-old school children","volume":"21","author":"RP Shenoy","year":"2010","journal-title":"Indian J Dent Res"},{"issue":"3","key":"pone.0323522.ref004","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1467-3010.2011.01910.x","article-title":"Nutrition, health and schoolchildren","volume":"36","author":"E Weichselbaum","year":"2011","journal-title":"Nutrition Bulletin"},{"issue":"2","key":"pone.0323522.ref005","doi-asserted-by":"crossref","first-page":"424","DOI":"10.4269\/ajtmh.20-0779","article-title":"The role of health in education and human capital: why an integrated approach to school health could make a difference in the futures of schoolchildren in low-income countries","volume":"104","author":"LM Cohee","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pone.0323522.ref006","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/1403494814558150","article-title":"Effect of national recommendation on sweet selling as an intervention for a healthier school environment","volume":"43","author":"J Anttila","year":"2015","journal-title":"Scand J Public Health"},{"issue":"14","key":"pone.0323522.ref007","doi-asserted-by":"crossref","first-page":"2626","DOI":"10.1017\/S1368980020000506","article-title":"Effectiveness of school-based nutrition interventions in sub-Saharan Africa: a systematic review","volume":"23","author":"P Kyere","year":"2020","journal-title":"Public Health Nutr"},{"key":"pone.0323522.ref008","unstructured":"Sanousi M. The expected effects of the national school nutrition programme: evidence from a case study in Cape Town, Western Cape. 2019."},{"key":"pone.0323522.ref009","first-page":"5522575","article-title":"Salt Used for the National School Nutrition Program (NSNP) in rural schools of Limpopo Province, South Africa, has adequate levels of iodine","author":"M Ramugondo","year":"2021","journal-title":"Biochem Res Int"},{"issue":"7","key":"pone.0323522.ref010","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1038\/sj.bdj.4814072","article-title":"The effect of social demographic factors snack consumption and vending machine use on oral health of children living in London","volume":"201","author":"M Maliderou","year":"2006","journal-title":"Br Dent J"},{"key":"pone.0323522.ref011","volume-title":"School feeding in South Africa: what we know, what we don\u2019t know","author":"S Devereux","year":"2018"},{"issue":"1","key":"pone.0323522.ref012","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/16070658.2015.11734518","article-title":"The school food environment: shaping the future health of the nation","volume":"28","author":"MF Anniza de Villiers","year":"2015","journal-title":"South African Journal of Clinical Nutrition"},{"issue":"6","key":"pone.0323522.ref013","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.3390\/nu13062043","article-title":"The food environment of primary school learners in a low-to-middle-income area in Cape Town, South Africa","volume":"13","author":"SA O\u2019Halloran","year":"2021","journal-title":"Nutrients"},{"issue":"12","key":"pone.0323522.ref014","doi-asserted-by":"crossref","first-page":"891","DOI":"10.2471\/BLT.11.089243","article-title":"Food security in South Africa: a review of national surveys","volume":"89","author":"D Labadarios","year":"2011","journal-title":"Bull World Health Organ"},{"key":"pone.0323522.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-015-2282-4","article-title":"Did healthkick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?","volume":"15","author":"NP Steyn","year":"2015","journal-title":"BMC Public Health"},{"key":"pone.0323522.ref016","doi-asserted-by":"crossref","first-page":"533","DOI":"10.3109\/00016356309011240","article-title":"Periodontal disease in pregnancy. I. prevalence and severity","volume":"21","author":"H Loe","year":"1963","journal-title":"Acta Odontol Scand"},{"key":"pone.0323522.ref017","volume-title":"Oral health surveys: basic methods","author":"Organization WH","year":"2013"},{"issue":"1","key":"pone.0323522.ref018","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/20786204.2007.10873497","article-title":"The use of the road to health card in monitoring child health","volume":"49","author":"C Tarwa","year":"2007","journal-title":"South African Family Practice"},{"issue":"1","key":"pone.0323522.ref019","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1186\/s12913-020-05122-8","article-title":"The policy implementation gap of school oral health programmes in Tshwane, South Africa: a qualitative case study","volume":"20","author":"M Molete","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"12","key":"pone.0323522.ref020","doi-asserted-by":"crossref","first-page":"7114","DOI":"10.3390\/ijerph19127114","article-title":"Individual, family, and socioeconomic contributors to dental caries in children from low- and middle-income countries","volume":"19","author":"M Yousaf","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0323522.ref021","doi-asserted-by":"crossref","first-page":"1510143","DOI":"10.3389\/fcvm.2024.1510143","article-title":"Mid-term outcomes of atrioventricular valve repair in functional single ventricle patients","volume":"11","author":"Y-Q Jin","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"pone.0323522.ref022","article-title":"Oral hygiene practices, knowledge, and self-reported dental and gingival problems with rural-urban disparities among primary school children in Lilongwe, Malawi","author":"F Mlenga","year":"2021","journal-title":"Malawi Med J"},{"issue":"3","key":"pone.0323522.ref023","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1136\/jech-2021-216455","article-title":"Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0-12 years of age: a cross-sectional study from 2013 to 2019","volume":"76","author":"LN Anderson","year":"2022","journal-title":"J Epidemiol Community Health"},{"issue":"7","key":"pone.0323522.ref024","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1038\/sj.ejcn.1602592","article-title":"Quality of food eaten in English primary schools: school dinners vs packed lunches","volume":"61","author":"IS Rogers","year":"2007","journal-title":"Eur J Clin Nutr"},{"issue":"2","key":"pone.0323522.ref025","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1017\/S1368980010002120","article-title":"Children\u2019s lunchtime food choices following the introduction of food-based standards for school meals: observations from six primary schools in Sheffield","volume":"14","author":"R Golley","year":"2011","journal-title":"Public Health Nutr"},{"key":"pone.0323522.ref026","volume-title":"Guideline: sugars intake for adults and children","author":"World Health Organization","year":"2015"},{"issue":"19","key":"pone.0323522.ref027","article-title":"Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association","volume":"135","author":"MB Vos","year":"2017","journal-title":"Circulation"},{"issue":"4","key":"pone.0323522.ref028","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/MCO.0b013e328346df65","article-title":"Innate and learned preferences for sweet taste during childhood","volume":"14","author":"AK Ventura","year":"2011","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"16","key":"pone.0323522.ref029","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1017\/S1368980019003458","article-title":"Relationships between children\u2019s sugar consumption at home and their food choices and consumption at school lunch","volume":"23","author":"K Baghlaf","year":"2020","journal-title":"Public Health Nutr"},{"key":"pone.0323522.ref030","first-page":"8811974","article-title":"Relationship between obesity and dental caries in saudi male adolescents","author":"A Al-Ansari","year":"2020","journal-title":"Int J Dent"},{"issue":"3","key":"pone.0323522.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0194555","article-title":"Effectiveness of school food environment policies on children\u2019s dietary behaviors: a systematic review and meta-analysis","volume":"13","author":"R Micha","year":"2018","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323522","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T18:14:40Z","timestamp":1748456080000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323522"}},"subtitle":[],"editor":[{"given":"Rizwan","family":"Jouhar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,28]]},"references-count":31,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323522","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,28]]}}}