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Table of Contents
Year : 2021  |  Volume : 5  |  Issue : 3  |  Page : 144-147

Relationship between nutritional status and mandibular length in subjects aged 10–16 years

1 Department of Orthodontics, Faculty of Dentistry, Universitas Sumatera Utara, Indonesia
2 Faculty of Dentistry, Universitas Sumatera Utara, Indonesia

Date of Submission15-Jul-2020
Date of Decision04-Jan-2021
Date of Acceptance15-Aug-2021
Date of Web Publication18-Oct-2021

Correspondence Address:
Hilda Fitria Lubis
Kompleks Tasbi 2 Blok 4 No. 85, Medan, North Sumatra.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_32_20

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Background: Malocclusion is a significant dental health problem in Indonesia. Malocclusion has multifactorial causes, including nutrition. Malnutrition may have an adverse effect on mandibular length and lead to tooth malposition. Objective: The aim of this article is to investigate the relationship between nutritional status and mandibular length in subjects aged 10–16 years. Methods: This was an observational analytic study with a cross-sectional design. The sampling method was purposive sampling. The subjects were 100 children (50 children with normal nutrition and 50 children with nutrition lower than normal) aged 10–16 years from Al-Ikhlas Islamic Elementary School and Advent 2 School in Medan, with no history of orthodontic treatment and facial trauma and not wearing prostheses. All the subjects were photographed with their heads held in a natural position. The photographs were analyzed using a computer program CorelDraw X7 to measure the length of the mandible. All statistical analyses were performed using SPSS. Univariate analyses were performed to obtain the mean and standard deviation (SD) values of all parameters. Descriptive statistics were obtained, and data were tested for normality using the Kolmogorov–Smirnov test for distribution. Variables that conformed to a normal distribution were analyzed using unpaired t-tests. Results: The mean mandibular length in those with nutritional status lower than normal was 94.52 ± 5.89 mm, whereas it was 109.44 ± 4.85 mm in those with normal nutritional status. The results of an unpaired t-test (P = 0.001) revealed that there was a difference of mandibular length between subjects with normal nutrition status and lower than normal nutrition status. Conclusion: There was a relationship between nutritional status and mandibular length in subjects aged 10–16 years.

Keywords: Length, malnutrition, mandibular, nutritional status

How to cite this article:
Lubis HF, Tiong R. Relationship between nutritional status and mandibular length in subjects aged 10–16 years. Sci Dent J 2021;5:144-7

How to cite this URL:
Lubis HF, Tiong R. Relationship between nutritional status and mandibular length in subjects aged 10–16 years. Sci Dent J [serial online] 2021 [cited 2021 Nov 27];5:144-7. Available from: https://www.scidentj.com/text.asp?2021/5/3/144/328422

  Background Top

The mandible, which consists of the corpus and ramus, is part of the craniofacial anatomy and the largest bone in the human skull. The function of the mandible is to form the lower jaw, support the teeth, and aid mastication. The mandible undergoes changes in shape and size through a process of bone remodeling.[1],[2] Mandibular length can be determined using a face photograph or a lateral cephalometric radiograph.[3],[4] According to Van Limborgh’s theory, craniofacial growth is influenced by genetic factors, which include local and general epigenetic factors, as well as local and general environmental variables, with the latter including nutritional status.[2]

Nutrition, especially dietary protein, calcium, magnesium, and fluoride, plays an important role in mandibular growth and development. Dietary imbalances and nutrient deficiencies can affect craniofacial growth and cause malocclusions.[4],[5],[6] A malocclusion has implications for esthetics and a person’s appearance. Anomalies that affect facial features can have adverse psychological consequences, especially during adolescence.[2] Body mass index (BMI) is the most common method used to indicate nutritional status.[6] According to basic health research on the nutritional status of individuals aged 13–15 years in Indonesia in 2018, based on BMI values, 1.9% were very underweight, 6.8% were underweight, 75.3% were normal weight, 11.2% were overweight, and 4.8% were obese.[7]

Previous studies by Bozzini et al.[8],[9] showed that protein is critical for mandibular growth and that protein deficiency affects mandibular bone size, mass, strength, morphology, and biomechanics. There has been little research on the use of mandibular length measurements based on photographic image to determine the nutritional status of subjects aged 10–16 years in Medan. Besides, the nutrition is dependent on arch length and arch width in the age of 10–16 years, which is bad nutrition and has a bad effect on the growth of arch length and arch width. Therefore, the objective of this study was to investigate the relationship between nutritional status and mandibular length in subjects aged 10–16 years.

  Materials and Methods Top


All human research procedures were in accordance with the standards set forth in the Helsinki Declaration of 1975. Approval of this study was obtained from the Health Research Ethics Committee (Approval No. 904/TGL/KEPK FK USU-RSUP HAM/2019) at the Universitas Sumatera Utara.

Study design

This was an observational analytic study with a cross-sectional design. The study population comprised children aged 10–16 years attending Al-Ikhlas Islamic Elementary School and Advent 2 School in Medan, Indonesia. Based on the height and weight measurement, the subjects were divided into normal nutritional status (n = 50) and lower than normal nutritional status (n = 50) groups. The sampling method was purposive sampling. The inclusion criteria were as follows: aged 10–16 years, no history of orthodontic treatment or facial traumas, no prostheses, and willing to participate in the study. The exclusion criteria were as follows: congenital abnormalities, facial deformities, severe facial asymmetry, a history of lower jaw surgery, and unwilling to participate in the study.

Nutritional status evaluation

Height and weight were measured using a stature meter and a digital weighing balance. The data obtained were used to calculate the BMI, using the formula BMI = kg/m2. The nutritional status was then evaluated using the z-score test on a BMI–age graph.[10]

Mandibular length evaluation

The subjects were instructed to sit on a chair and hold their heads in a natural position, before turning their bodies to the left, so that the right-sided profile of the face faced the operator. The jaws were closed, and the lips were in a resting state. Masking tape was placed in the area to be measured on the subject’s face. The mandibular angle point [gonion (Go) point) was palpated using the thumb and the point was marked using a marker on a masking tape. Prior to the measurements, the subjects were instructed to remove any face coverings. The position of the subject’s head was adjusted, thus the Frankfort plane is parallel to the horizontal frame of the photograph. A lateral photograph was taken using a mirrorless digital camera at a distance of a meter. Three lines were drawn from the nasion (Na) to the chin, and the Menton (Me) point was identified by the intersection point between the mandibular plane and Na-Me line. Various points on the lateral photograph were identified: the midpoint of tragus/Co (condylion) point (A1), mandibular angle/Go point (A2), and symphysis of the mandible/Me point (A3). The distance from A1 to A2 (Co-Go) and A2 to A3 (Go-Me) was measured using Corel® (CorelDRAW Graphics Suite version X7, Ontario, Canada) [Figure 1].
Figure 1: Mandibular length evaluation

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Statistical analysis

The data were analyzed using statistical software (SPSS version 23.0, Chicago, IL, USA). The nutritional status data and mandibular length data were analyzed using unpaired t-tests.

  Results Top

The mean mandibular length in the subjects aged 10–16 years with nutritional status lower than normal was 94.52 ± 5.9 mm. The mean mandibular length in the normal nutritional status group was 109.44 ± 4.85 mm. This study revealed a very significant relationship (P = 0.001) between nutritional status and mandibular length at the 90% confidence interval level [Table 1].
Table 1: Relationship between nutritional status and mandibular length in subjects aged 10–16 years

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  Discussion Top

Mandibular growth and development are a complex process involving interactions between multiple factors (i.e., genes, hormones, and nutrients).[5],[11] Disruption of any one of these factors affects the pattern of mandibular growth. Knowledge of the factors affecting mandibular growth is important to prevent abnormal mandibular growth and dentocraniofacial disharmony (i.e., malocclusions).[2],[5],[11],[12] Taibah and Al-Hummayani[13] showed that adolescents with malocclusions, such as spacing, crowding, and proclined anterior teeth, have significantly lower self-esteem than those with normal dentition. Information on age-specific mandibular length can aid the diagnosis of malocclusion and treatment planning.[2],[5],[11],[12]

The advantage of using photograph images to determine the mandibular length was that this method has a simpler approach and avoids problems of landmark identification, thus presenting a clinically useful method of quantifying asymmetry.

As shown in [Table 1], The mean mandibular length in the normal nutritional status group was 109.44 ± 4.85 mm, whereas the mean mandibular length in the subjects aged 10–16 years with nutritional status lower than normal was 94.52 ± 5.9 mm. This finding differs from that of two previous studies, in which Moshfeghi et al. and Bushchang et al. reported mean mandibular lengths of 101.83 ± 1.83 and 97.54 ± 0.39 mm, respectively.[13],[14] The difference may be due to sample size and ethnicity. Facial morphology differs according to racial background, as the facial phenotype is genetically inherited. For example, a narrow V-shaped jaw is a characteristic of the Caucasoid race.[15],[16] The mean mandibular length in the group with normal nutritional status (109.44 ± 4.85 mm) is not in line with that of previous studies.[17],[18],[19] The difference may be due to the study populations, with these studies including only adult subjects. Mandibular length increases with age until the age of 20 years.[18] A pattern of mandibular growth similar to a Scammon curve is found in children, with accelerated growth during puberty, starting at the age of 8–13 years in females and 9–14 years in males.[17],[18],[19],[20]

The results of the statistical analysis indicated a significant relationship between nutritional status and mandibular length in our study population (P = 0.001). This finding is in accordance with that of a study by Olszewska,[21] who used lateral cephalometry to determine mandibular lengths in females aged 11–16 years, with the study population divided into an excess nutritional status group and normal nutritional status group. The mean mandibular length in the excess nutritional status group was 115.73 ± 2.12 mm versus 110.33 ± 2.51 mm in the normal nutritional status group, thereby revealing a relationship between nutritional status and mandibular length. Previous studies demonstrated that poor nutrition, especially at important junctures in development, such as puberty, can permanently disrupt the pattern of normal development of organs and tissues.[2],[4],[5] As shown in the present study, poor nutritional status as determined by mandibular length measurements in different BMI groups is a risk factor for reduced mandibular growth in subjects aged 10–16 years.

  Conclusion Top

This study showed that mandibular length in subjects with normal nutritional status was significantly longer than that of subjects with lower nutritional status. Given the apparent important role of nutritional status in mandibular growth, nutritional status should be taken into consideration in treatment planning.

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Conflict of interest

The authors declare that there are no conflicts of interest.

  References Top

Lipski M, Tomaszewska IM, Lipska W, Lis GJ, Tomaszewski KA. The mandible and its foramen: Anatomy, anthropology, embryology and resulting clinical implications. Folia Morphol (Warsz) 2013;72:285-92.  Back to cited text no. 1
Sridhar P. Textbook of Orthodontics. New Delhi: Elsevier; 2015. p. 53-54.  Back to cited text no. 2
Olayemi AB. Assessment and determination of human mandibular and dental arch profiles in subjects with lower third molar impaction in Port Harcourt, Nigeria. Ann Maxillofac Surg 2011;1:126-30.  Back to cited text no. 3
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Ongkosuwito EM, Dieleman MM, Kuijpers-Jagtman AM, Mulder PG, van Neck JW. Linear mandibular measurements: Comparison between orthopantomograms and lateral cephalograms. Cleft Palate Craniofac J 2009;46:147-53.  Back to cited text no. 4
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Bozzini CE, Champin G, Alippi RM, Bozzini C. Bone mineral density and bone strength from the mandible of chronically protein restricted rats. Acta Odontol Latinoam 2011;24:223-8.  Back to cited text no. 8
Bozzini C, Champin GM, Bozzini CE, Alippi RM. Growth inhibition in rats fed inadequate and incomplete proteins: Repercussion on mandibular biomechanics. Acta Odontol Latinoam 2013;26:43-53.  Back to cited text no. 9
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Moshfeghi M, Nouri M, Mirbeigi S, Baghban AA. Correlation between symphyseal morphology and mandibular growth. Dent Res J (Isfahan) 2014;11:375-9.  Back to cited text no. 12
Taibah SM, Al-Hummayani FM. Effect of malocclusion on the self-esteem of adolescents. J Orthod Sci 2017;6:123-8.  Back to cited text no. 13
Buschang PH, Jacob HB, Demirjian A. Female adolescent craniofacial growth spurts: Real or fiction? Eur J Orthod 2013;35:819-25.  Back to cited text no. 14
Richmond S, Howe LJ, Lewis S, Stergiakouli E, Zhurov A. Facial genetics: A brief overview. Front Genet 2018;9:462.  Back to cited text no. 15
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Olszewska K. Craniofacial morphology in overweight and obese orthodontic adolescent patients. J Pre-Clin Clin Res 2017;11:42-25.  Back to cited text no. 21


  [Figure 1]

  [Table 1]


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