Influence of BMI percentile on craniofacial morphology and development in children and adolescents

Background: The prevalence of childhood and adolescent obesity is increasing worldwide. Reports suggest that elevated body mass index (BMI) is associated with larger craniofacial dimensions and advanced dental and skeletal development. Such an association is important for timing orthodontic treatment relative to pubertal growth and dental eruption. Materials and Methods: To evaluate associations between BMI, craniofacial morphology, dental age, and cervical vertebrae maturation staging (CVMS), 400 participants were consecutively selected (8-15 years, n = 200 overweight and obese BMI >85%, 200 normal weight) from the University of North Carolina database. Records were analysed for cephalometric measures, Demirjian index values, and CVMS. Bivariate statistics and linear regression analysis evaluated whether CVMS, dental age, and cephalometric dimensions varied with BMI. Results: Overweight/obese children and adolescents had a proportionally larger bimaxillary prognathic skeletal pattern compared to those of normal weight.These cephalometric measurements [articulare-gnathion (Ar-Gn), condylion-anterior nasal spine (Co-ANS), sella-gonion (S-Go), nasion-menton (N-Me), anterior nasal spine-menton (ANS-Me), sella-nasion-A point (SNA), sellanasion-B point (SNB), and sella-nasion-pogonion (SNPg)] were significantly different [statistically (P < 0.05) and clinically (>2 mm or >2 degrees)] between the two study groups, with a linear relationship between BMI percentile and craniofacial dimension.The overweight/obese BMI group had a mean dental age 1.4 years advanced relative to the normal weight group (P< 0.05), with an advancement of nearly one CVM stage between the ages of 12 and 14 (P< 0.05). Limitations: The study is retrospective. Conclusions: Obese/overweight children and adolescents have proportionally larger anteroposterior and vertical dimensions and are more likely to experience advanced dental and skeletal maturation. Obese/overweight subjects may enter their growth spurt at a younger age and have earlier eruption of teeth, affecting treatment timing. BMI percentile should be a consideration for orthodontic treatment in growing patients.