{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T07:59:25Z","timestamp":1780991965168,"version":"3.54.1"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2010,9,27]],"date-time":"2010-09-27T00:00:00Z","timestamp":1285545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Evidence suggests that energy-protein malnutrition is associated with impaired growth and development of facial bones. The objective of this study was to investigate the association between nutritional status and reduced space for dental eruption (crowding) in permanent dentition. A cross-sectional study with probabilistic sampling design was used. We evaluated 2,060 students aged 12 to 15 years enrolled in schools in the northeast of Brazil. Crowding was defined according to World Health Organization (WHO) as misalignment of teeth due to lack of space for them to erupt in the correct position. Nutritional status was evaluated by means of body mass index and height-for-age, using the WHO\u2019s reference curves. Parents and adolescents responded to a questionnaire about demographic, socioeconomic, biological and behavioral characteristics. The associations were estimated by odds ratio (OR) in multivariate logistic regression analysis (alpha = 0.05). Confounding and effect-modification were taken into account. An association between low height-for-age (z-score &lt; \u20131SD) and crowding was only observed in adolescents with a prolonged history of mouth breathing (OR = 3.1). No association was observed between underweight and crowding. Malnutrition is related to crowding in permanent dentition among mouth-breathing adolescents. Policy actions aimed at reducing low height-for-age and unhealthy oral habits are strongly recommended. However, further studies are needed to increase the consistency of these findings and improve understanding of the subject.<\/jats:p>","DOI":"10.3390\/ijerph7093531","type":"journal-article","created":{"date-parts":[[2010,9,27]],"date-time":"2010-09-27T11:23:33Z","timestamp":1285586613000},"page":"3531-3544","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Is Malnutrition Associated with Crowding in Permanent Dentition?"],"prefix":"10.3390","volume":"7","author":[{"given":"Erika B. A. F.","family":"Thomaz","sequence":"first","affiliation":[{"name":"Department of Public Health, Federal University of Maranh\u00e3o, Maranh\u00e3o, Rua Bar\u00e3o de Itapary, 155, Centro, S\u00e3o Lu\u00eds, Maranh\u00e3o, CEP: 65020\u2013070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina T.","family":"Cangussu","sequence":"additional","affiliation":[{"name":"Dentistry School, Federal University of Bahia, Av. Ara\u00fajo Pinho, 32, Canela, Salvador, Bahia, CEP: 40110\u2013150, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f4nio Augusto M. da","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Public Health, Federal University of Maranh\u00e3o, Maranh\u00e3o, Rua Bar\u00e3o de Itapary, 155, Centro, S\u00e3o Lu\u00eds, Maranh\u00e3o, CEP: 65020\u2013070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Marl\u00facia O.","family":"Assis","sequence":"additional","affiliation":[{"name":"Nutrition School, Federal University of Bahia, Av. Ara\u00fajo Pinho, 32, Canela, Salvador, Bahia, CEP: 40110\u2013150, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2010,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1111\/j.1600-0528.2006.00345.x","article-title":"Are intrauterine growth restriction and preterm birth associated with dental caries?","volume":"35","author":"Saraiva","year":"2007","journal-title":"Community Dent. Oral Epidemiol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1600-0528.2007.00384.x","article-title":"Caries status and overweight in 2- to 18-year-old US children: Findings from national surveys","volume":"36","author":"Auinger","year":"2008","journal-title":"Community Dent. Oral Epidemiol"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1600-0722.2007.00507.x","article-title":"Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children","volume":"116","author":"Oliveira","year":"2008","journal-title":"Eur. J. Oral Sci"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1590\/S0021-75572009000200005","article-title":"Relationship between childhood underweight and dental crowding in deciduous teething","volume":"85","author":"Thomaz","year":"2009","journal-title":"J. Pediatr"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"75","DOI":"10.17796\/jcpd.33.1.3457qg88w37h2405","article-title":"Relationship between malocclusion and behavioral, demographic and socioeconomic variables: A cross-sectional study of 5-year-olds","volume":"33","author":"Hebling","year":"2008","journal-title":"J. Clin. Pediatr. Dent"},{"key":"ref_6","unstructured":"Caceda, J (,  1996). Nutritional status and dental and skeletal development in peruvian children. San Francisco, CA, USA."},{"key":"ref_7","first-page":"389","article-title":"Prevalence of malocclusion in public school students of the Manaus, AM, Brazil","volume":"55","author":"Almeida","year":"2007","journal-title":"R.G.O"},{"key":"ref_8","unstructured":"(2005). Manual de atendimento da crian\u00e7a com desnutri\u00e7\u00e3o grave em n\u00edvel hospitalar, MS."},{"key":"ref_9","unstructured":"UNICEF Progress for children: A world fit for children statistical review. Available online: http:\/\/www.unicef.org\/publications\/files\/Progress_for_Children_No_6_revised.pdf (accessed on 12 January 2008)."},{"key":"ref_10","unstructured":"World Health Organization (2003). Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO\/FAO Expert Consultation, WHO."},{"key":"ref_11","first-page":"35","article-title":"Causes for the decline in child under-nutrition in Brazil, 1996\u20132007","volume":"43","author":"Monteiro","year":"2009","journal-title":"J. Pub. Health"},{"key":"ref_12","first-page":"181","article-title":"Nutritional transition in Brazil: Geographic and temporal trends","volume":"19","author":"Rissin","year":"2003","journal-title":"Cad. Saude Publica"},{"key":"ref_13","unstructured":"Songvasin, C (,  1994). Early mal-nutrition and craniofacial growth. Seattle, WA, USA."},{"key":"ref_14","unstructured":"Caceda, J (,  1994). Effect of nutritional status on dental age. Seattle, WA, USA."},{"key":"ref_15","unstructured":"Weissman, S (,  1993). Craniofacial growth and development in nutritionally compromised peruvian children. Chicago, IL, USA."},{"key":"ref_16","first-page":"19","article-title":"Inter-relationship between dental, skeletal and chronological ages in well-nourished and mal-nourished children","volume":"8","author":"Gulati","year":"1991","journal-title":"J. Indian Soc. Pedod. Prev. Dent"},{"key":"ref_17","first-page":"48","article-title":"Bone age and dental occlusion","volume":"30","author":"Ayala","year":"1993","journal-title":"Rev. Cuba. Estomatol"},{"key":"ref_18","unstructured":"World Health Organization (1997). Oral Health Surveys: Basic Methods, ORH\/EPID. [4th ed]."},{"key":"ref_19","first-page":"449","article-title":"Metrical analysis of growth changes in the jaws and teeth of normal, protein deficient and calorie deficient pigs","volume":"129","author":"Luke","year":"1979","journal-title":"J. Anat"},{"key":"ref_20","first-page":"1","article-title":"Normal development of the jaws and teeth in pigs, and the delay and malocclusion produced by calorie deficiencies","volume":"115","author":"Tonge","year":"1973","journal-title":"J. Anat"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1093\/jn\/103.6.856","article-title":"The separate effects of protein and calorie malnutrition on the development and growth of rat bones and teeth","volume":"103","author":"DiOrio","year":"1973","journal-title":"J. Nutr"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1590\/S0102-311X2005000400012","article-title":"Malocclusion prevalence and orthodontic treatment need in 10\u201314-year-old schoolchildren in Belo Horizonte, Minas Gerais State, Brazil: A psychosocial focus","volume":"21","author":"Marques","year":"2005","journal-title":"Cad. Saude Publica"},{"key":"ref_23","unstructured":"(2005). Censo Escolar 2004, Instituto Nacional de Estudos e Pesquisas Educacionais An\u00edsio Teixeira (INEP)."},{"key":"ref_24","unstructured":"World Health Organization (1995). Physical Status: The Use and Interpretation of Anthropometry, WHO."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onis","year":"2007","journal-title":"Bull. World Health Organ"},{"key":"ref_26","unstructured":"AnthroPlus-WHO (2009). WHO AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the World\u2019s Children and Adolescents, World Health Organization."},{"key":"ref_27","unstructured":"(1996). Pesquisa Nacional por Amostra de Domic\u00edlios\u20141993. Regi\u00e3o Metropolitana de S\u00e3o Paulo, IBGE. Brasil."},{"key":"ref_28","unstructured":"Lohman, TG, Roche, AF, and Martorell, R (1988). Anthropometrics Standardization Reference Manual, Human Kinetics Books."},{"key":"ref_29","unstructured":"Rothman, K, Greenland, S, and Lash, T (2008). Modern Epidemiology, Lippincott Williams & Wilkins. [3rd ed]."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lee, E, and Forthofer, R (2006). Analyzing Complex Survey Data, Sage Publications. [2nd ed].","DOI":"10.4135\/9781412983341"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.ajodo.2003.03.008","article-title":"Comparison of maxillary and mandibular growth","volume":"125","author":"Ochoa","year":"2004","journal-title":"Am. J. Orthod. Dentofacial Orthop"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1600-0528.2009.00474.x","article-title":"Income and oral health relationship in Brazil: Is there a threshold?","volume":"37","author":"Celeste","year":"2009","journal-title":"Community Dent. Oral Epidemiol"},{"key":"ref_33","unstructured":"World Health Organization (1997). Global Database on Child Growth and Malnutrition. Program of Nutrition, Family and Reproductive Health, WHO."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S1808-8694(15)31304-5","article-title":"Breathing mode influence in craniofacial development","volume":"71","author":"Lessa","year":"2005","journal-title":"Braz. J. Otorhinolaryngol"},{"key":"ref_35","first-page":"12","article-title":"Nutrition: Impact on oral and systemic health","volume":"22","author":"Enwonwu","year":"2001","journal-title":"Compend. Contin. Educ. Dent"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1590\/S1415-52732007000200008","article-title":"Food, nutritional status and oral condition of the child","volume":"20","author":"Batista","year":"2007","journal-title":"Rev. Nutr"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1093\/ajcn\/61.2.410S","article-title":"Nutrition, tooth development, and dental caries","volume":"61","author":"Alvarez","year":"1995","journal-title":"Am. J. Clin. Nutr"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/ejo\/cjm055","article-title":"The effect of mode of breathing on craniofacial growth\u2014Revisited","volume":"29","year":"2007","journal-title":"Eur. J. Orthod"},{"key":"ref_39","first-page":"441","article-title":"Dental arch diameters and relationships to oral habits","volume":"76","author":"Aznar","year":"2006","journal-title":"Angle Orthod"},{"key":"ref_40","first-page":"108","article-title":"The effect of malnutrition on maxilofacial development","volume":"8","author":"Gama","year":"2000","journal-title":"Rev. ABO Nac"},{"key":"ref_41","first-page":"28","article-title":"Sucking habits in Saudi children: Prevalence, contributing factors and effects on the primary dentition","volume":"19","author":"Farsi","year":"1997","journal-title":"Pediatr. Dent"},{"key":"ref_42","first-page":"80","article-title":"Evaluation of stomatological needs of 8-year-old children connected with premature loss of deciduous teeth","volume":"59","author":"Krawczyk","year":"2004","journal-title":"Ann. Univ. Mariae Curie Sklodowska Med"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.ajodo.2006.04.051","article-title":"Esthetic impact of premolar extraction and nonextraction treatments on Korean borderline patients","volume":"133","author":"Lim","year":"2008","journal-title":"Am. J. Orthod. Dentofacial Orthop"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1875-595X.2008.tb00184.x","article-title":"Tooth loss among Saudi adolescents: Social and behavioural risk factors","volume":"58","author":"Atieh","year":"2008","journal-title":"Int. Dent. J"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0889-5406(97)70249-X","article-title":"The functional matrix hypothesis revisited. 2. The role of an osseous connected cellular network","volume":"112","author":"Moss","year":"1997","journal-title":"Am. J. Orthod. Dentofacial Orthop"},{"key":"ref_46","unstructured":"World Health Organization (1996). Health Interview Surveys: Toward International Harmonization of Methods and Instruments, WHO."},{"key":"ref_47","first-page":"73","article-title":"Measurements of reported morbidity and interrelationships with health dimensions","volume":"42","author":"Szwarcwald","year":"2008","journal-title":"J. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.jclinepi.2004.04.005","article-title":"Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure","volume":"57","author":"Okura","year":"2004","journal-title":"J. Clin. Epidemiol"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/7\/9\/3531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T22:03:26Z","timestamp":1760220206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/7\/9\/3531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,9,27]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2010,9]]}},"alternative-id":["ijerph7093531"],"URL":"https:\/\/doi.org\/10.3390\/ijerph7093531","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,9,27]]}}}