J Bagh College Dentistry Vol.

22(2), 2010 The effect of intelligence

The effect of intelligence quotient and nutritional status on

oral health condition among 6 years old school children in
Baghdad/Iraq.
Jenan O. Almaas B.D.S, M.Sc.(1)
Ban S. Diab B.D.S., M. Sc., Ph.D (2)

ABSTRACT
Background: The intelligence and nutritional status have an effect on the health of oral cavity. The aim of this study
was to investigate the oral cleanliness and gingival health condition (in primary teeth) among 6 years old children of
the three intelligence scales in relation to gender and the influence of nutritional status on these variables.
Materials and Methods: The total sample composed of 660 children aged 6 years old, 220 children in each
intelligence scale. The measurement of intelligence was done using Raven's test for non-verbal intelligence. The
assessment of nutritional status was performed using Body Mass Index specific for age and gender. Plaque index of
Silness and Loe (1964) was used for plaque assessment, gingival index of Loe and Silness (1963) was used for gingival
health condition.
Results: The results of this study showed that the plaque and gingival indices among children with high intelligence
scale was reported to be highly significant lower than those with moderate and low intelligence scales, as well as
among well nourished children than that among malnourished children but the highly significant was found only in
gingival index.
Conclusion: The intelligence status and nutritional status affect oral health condition as gingival index were found to
be lower among the children with high intelligence scale, this may explained the role of intelligence levels and
nutritional status in protection of oral tissue from dental and periodontal disease.
Key words: Intelligence, gingival heallth condition, nutritional status. (J Bagh Coll Dentistry 2010;22(2):93-98).

INTRODUCTION Oral health and nutrition share an

Teeth are hard tissue vital for human life
because they maintain general health by chewing
food, this biting action is also very important in
maintaining brain activity through the impulse of
the biting force (1). Malnutrition occurs when the
diet contains incorrect amounts of one or more
nutrients. There is an indication that a child's
mental performance may be influenced by
malnutrition with the effect correlated with the
severity, nature, duration, and onset of dietary
deprivation; the earlier, the longer, and the more
severe the deficiency, the greater the impairment
(2).
Researchers believe that the timing of
malnutrition is an important predictor in
determining whether problems will develop. This
means that the absence of a particular nutrient
that required by a specific part of a growing brain
may cause a specific damage there (3). Oral
tissues, such as the gingival, teeth, and muscles
of mastication, are living tissues, and they have
the same nutritional requirements as any other
living tissue in the body (4).
(1) MSc student, dep. of preventive and paedodontic
dentistry, college of dentistry, university of Baghdad.
(2) Assistant professor, dep. of preventive and paedodontic
dentistry, college of dentistry, university of Baghdad.
interdependent relationship that good nutritional
health promoting good oral health and vice versa
(5, 6).
In Iraq a significant differences was found in
amount of dental plaque among children between
different governorates (7,8), On the other hand,
rural students had higher amount of dental
plaque than urban student as that found by (7) and
this is attributed to life style, type of foods, level
of education. Concerning gender differences, it
has been found that the males had statistically
higher mean plaque index than female (7-9). While
other studies found no statistical significant
difference between males and females (10, 11).
There are many factors affect the prevalence
and severity of gingivitis; concerning
geographical location in the same country, a
higher prevalence of gingivitis was recorded
among children in rural areas compared to those
living in urban (7). The marginal gingivitis begins
in early childhood, increases in prevalence and
severity to the early ten years. However, the
prevalence of plaque-related periodontal disease
is not considered to be age-dependent (4). Many
studies were conducted to indicate the relation
between age and gingival inflammation most of
them concluded that the disease positively related
to age (9). On the other hand, other studies
showed no statistical significant difference of
gingivitis with age (7).
Concerning gender, many of the studies
regarding the prevalence and severity of

Orthodontics, Pedodontics and Preventive Dentistry93

J Bagh College Dentistry Vol. 22(2), 2010
gingivitis in children indicated a significantly
healthier gingiva in females compared to males
(9, 12).
On the other hand, other studies showed no
statistical significant differences in gingival
health between both genders (7, 10, 12). A highly
significant positive relationship was reported by
many studies between amount of dental plaque
and the condition of periodontal tissue (7, 8).
Nutritional status is also linked to immune
response. With periodontal infection, the ability
of the oral tissues to utilize nutrients is altered,
thus interfering with normal healing and repair
(13).
At the same time, nutritional deficiencies can
weaken the resistance of oral tissues to plaque
bacteria, causing increasing inflammation (14).
The need for deeper understanding on
the influence of intelligence on the oral health
and because there is no previous Iraqi study
concerning the relation between intelligence and
oral health among school aged children in
Baghdad city, it was decided to conduct this
study.
MATERIALS AND MATHODS
All 660 children aged 6 years from 10
primary schools that were selected randomly
from Al-Russafa-1 and Al-Russafa-2 parts of
Baghdad, were chosen for intelligence quotient
measurement according to Colored Progressive
Matrices of Raven's test and divided into 220
children for each intelligence scale (High,
Moderate and Low intelligence scales) (15).
Nutritional status is assessed by using
anthropomrtric measuements included
measurement of wieght and height according to
Trowbidge using Bathroom scale and height
measuring tape. Body Mass Index (BMI) is a
simple index of weight for height; it is defined as
the individual's body weight divided by the
square of his or her height (16).
BMI is used defiantly for children. The
BMI percentile allows comparison with children
of the same gender and age. Children with BMI
that is less than the 5th percentile were considered
malnourished while children with BMI that is
between the 5th and 85th percentiles were
considered well nourished (17).
The examination and oral health assessments
were performed according to the basic method of
oral survey of (18). Dental plaque thickness
adjacent to gingival margin was assessed by
using plaque index (PI) of Silness and Loe
(1964). Gingival index described by Loe and
Silness (1963) was used in order to assess
gingival health. Only fully erupted teeth (when
Orthodontics, Pedodontics and Preventive Dentistry94
The effect of intelligence
the occlusal or incisal surface has reached the
occlusal plane) were involved. All primary teeth
were examined. Each of the four areas of the
teeth was scored (buccal, mesial, lingual and
distal).
RESULTS
The distribution of the total sample
according to intelligence scales by gender is
shown in Table 1. Concerning nutritional status,
Figure 1 illustrates that for the total sample
among high intelligence scale, the percentage of
well nourished children was higher than that of
malnourished children (62.73% and 37.27%,
respectively). The same picture was found
concerning children with moderate intelligence
scale (57.27% and 42.73%, respectively), while
among low intelligence scale the opposite picture
was found where by the percentage of
malnourished children was higher than that of
well nourished children (59.09% and 40.91%,
respectively). The same results were found
concerning each gender. Concerning gender
differences, the data of the present study showed
that among well nourished children for the three
scales of intelligence, the percentage of males
was higher than that of females, while the
opposite result was found among malnourished
children.
The mean values of plaque index among
children according to intelligence scales by
gender are shown in Table 2, this table shows
that for the total sample, the difference of plaque
index among the three scales of intelligence was
highly significant (F=20.86, df=2, p<0.01). The
same result was found concerning each gender.
Concerning gender differences, data of the
present study showed that the mean plaque index
among females was higher than that among
males in the three scales of intelligence;
however, these differences were not significant
(p>0.05).
The mean values of plaque index among
children according to intelligence scales by
nutritional status and gender are shown in Table
3, this table illustrates that there was no
significant difference between well nourished
and malnourished children among the three
scales of intelligence (p>0.05). This table also
shows that there was highly significant difference
in mean of plaque index among the three scales
of intelligence concerning both well nourished
and malnourished children (F=10.10 and 9.29
respectively, df=2, p<0.01), while concerning
each gender, the differences were significant
among both well nourished and malnourished
males (F=4.56 and 4.29 respectively, df=2,
J Bagh College Dentistry Vol. 22(2), 2010
p<0.05), and these differences were highly
significant among both well nourished and
malnourished females (F=5.76 and 4.76
respectively, df=2, p<0.01).
The mean gingival index among children
according to intelligence scales by gender is
shown in Table 4. This table shows that for the
total sample, the difference of gingival index
among the three scales of intelligence was highly
significant (F=19.54, df=2, p<0.01). The same
result was found concerning each gender.
Concerning gender differences, data of the
present study showed that the mean of gingival
index among females was higher than that among
males in the three scales of intelligence,
however, these differences were not significant
(p>0.05), except that among moderate
intelligence scale where the difference was
highly significant (t=-3.65, df=218, p<0.01).
The severity of gingivitis among children
according to intelligence scales by gender is
shown in Figure 2. This figure shows that for the
total sample the higher percentage of mild
gingivitis was found among children with high
intelligence scale (64.55%), and the higher
percentage of moderate gingivitis was found
among children with moderate intelligence scale
(51.36%), while the percentage of sever
gingivitis was higher among children with low
intelligence scale (30.00%). The same results
were found concerning each gender. Concerning
gender differences, the percentage of children
with mild gingivitis was higher among males
than that among females for the three scales of
intelligence, while the opposite pictures were
found concerning sever gingivitis where by the
percentages of sever gingivitis among females
was higher than that among males for the three
scales of intelligence.
The mean values of gingival index among
children according to intelligence scales by
nutritional status and gender are shown in Table
5. This table shows that the mean gingival index
among well nourished children was highly
significantly lower than that among
malnourished children in high, moderate and low
intelligence scales (t=-3.24, -8.13 and -3.72
respectively, df=218, p<0.01). However, the
results of the present study showed that there was
highly significant difference in mean gingival
index among the three scales of intelligence
concerning both well nourished and
malnourished children (F=6.77 and 6.10
respectively, df=2, p<0.01), while concerning
each gender, these differences were significant
among both well nourished and malnourished
males (F=3.44 and 3.29 respectively, df=2,
Orthodontics, Pedodontics and Preventive Dentistry95
The effect of intelligence
p<0.05), as well as among both well nourished
and malnourished females (F=3.25 and 3.27
respectively, df=2, p<0.05).
The severity of gingivitis among children
according to intelligence scales by nutritional
status and gender are shown in Figure 3. This
figure shows that the higher percentage of mild
gingivitis was found in high intelligence scale,
this percentage was higher among total well
nourished than total malnourished children
(72.46% and 51.22% respectively). On the other
hand, the higher percentage of moderate
gingivitis was found in moderate intelligence
scale, and the higher percentage of sever
gingivitis was found in low intelligence scale.
However, these percentages were higher in
malnourished children (56.38% and 42.31%
respectively) than that among well nourished
children (47.62% and 12.22% respectively). The
same results were found concerning each gender.
The sever gingivitis was absent among well
nourished children with high intelligence scale.
Concerning gender differences, for both well
nourished and malnourished children, the
percentage of males with mild gingivitis was
higher than that among females for the three
scales of intelligence except that concerning
malnourished children with moderate intelligence
scale where by the opposite picture was found.
On the other hand, the percentage of females
with sever gingivitis was found to be higher than
that of males for both well nourished and
malnourished children in the three scales of
intelligence except that concerning malnourished
children with moderate intelligence scale where
by the percentage was equal for both gender.
DISCUSSION
The present study was conducted to explore
the effect of intelligence on oral health condition
and the possible etiological factors of this state,
furthermore, the relation of nutritional status to
dental and periodontal diseases. The result of the
present study showed that children with high
intelligence scale were better nourished than
those with moderate and low intelligence scales
as malnutrition at an early age may affect brain
development, IQ and scholastic achievement in
school-age children (21).. So malnourished
children are typically less responsive to adults,
less motivated to learn, and less active in
exploration than their more adequately nourished
counterparts (22).
Children in the present study included with
primary dentition in which the association
between plaque and gingivitis is expected; as
dental plaque is considered to be the main
J Bagh College Dentistry Vol. 22(2), 2010 The effect of intelligence

etiological factor for the gingival inflammation gingival indices among them than those with
due to interaction between the microorganisms high and moderate intelligence scales, this could
found in the dental plaque and the tissues and be partially explained by fact that low education
inflammatory cells of the host (23). The same may affect plaque index because of poor
result was found in the present study as the brushing behavior and ignorance of children to
correlation analysis between plaque and gingival their oral hygiene (25).
index was in positive direction, this finding in Data analyses in the present study showed
agreement with previous studies (8, 9, 24). increased percentage of sever gingivitis among
Concerning gender, data of the present study malnourished children in compared with well
showed that the mean plaque and gingival index nourished children in the three scales of
was higher among females than that among intelligence; this is in accordance with previous
males this finding is in agreement with (26), while studies (8, 9, 26). As in severe gingivitis, the easy
it is disagreement with (8, 9, 24). bleeding and soreness of the gingival tissue may
The results of the present study revealed that make eating difficult and contribute to poor
children with high intelligence scale have lower intake (14, 27, 28). In addition to that Malnutrition
mean of plaque and gingival indices than those may make the periodontium more susceptible to
with moderate and low intelligence scales, this infectious organisms that are a normal
may be attributed to increased prevalence of low component of the oral flora. This could result in a
education among children with low intelligence greater amount of periodontal disease.
scale result in increased mean of plaque and

Table 1: Distribution of the total sample according to intelligence scales by gender.

High Moderate Low
intelligence scale intelligence scale intelligence scale
Gender % %
% % % %
No. within No. No. within
of total within scale of total of total
scale scale
Males 116 52.73 17.58 113 51.36 17.12 99 45.00 15.00
Females 104 47.27 15.76 107 48.64 16.21 121 55.00 18.33
Total 220 100.00 33.34 220 100.00 33.33 220 100.00 33.33

70
60
% Percentages
of intelligence

50
40
30 High intelligence scale
20
Moderate intelligence scale
10
Low intelligence scale
0
Total

Total
Males

Females

Males

Females

Well nourished Malnourished

Figure 1: Distribution of the total sample according to intelligence scales by nutritional

status and gender.

Table 2: The mean plaque index among children according to intelligence scales by
gender.
High Moderate Low
Gender intelligence scale intelligence scale intelligence scale F-value
No. Mean ±SD ±SE No. Mean ±SD ±SE No. Mean ±SD ±SE
Male 116 1.44 0.72 0.07 113 1.50 0.76 0.07 99 1.86 0.80 0.08 9.18**
Female 104 1.48 0.51 0.05 107 1.52 0.77 0.07 121 1.88 0.75 0.07 11.52**
Total 220 1.46 0.63 0.04 220 1.51 0.77 0.05 220 1.87 0.77 0.05 20.86**

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J Bagh College Dentistry Vol. 22(2), 2010 The effect of intelligence

Table 3: The mean plaque index among children according to intelligence scales by
nutritional status and gender.
High Moderate Low
Nutritional
Gender intelligence scale intelligence scale intelligence scale F-value
status
Mean ±SD ±SE Mean ±SD ±SE Mean ±SD ±SE
Male 1.41 0.82 0.09 1.49 0.89 0.11 1.85 0.66 0.10 4.56*
Well
Female 1.43 0.51 0.06 1.50 0.71 0.09 1.87 0.84 0.13 5.76**
nourished
Total 1.42 0.70 0.06 1.50 0.81 0.07 1.86 0.75 0.08 10.10**
Male 1.50 0.46 0.07 1.52 0.54 0.08 1.86 0.91 0.13 4.29*
Malnourished Female 1.53 0.51 0.08 1.54 0.85 0.12 1.88 0.71 0.08 4.76**
Total 1.52 0.49 0.05 1.53 0.71 0.07 1.87 0.79 0.07 9.29**
Degree of freedom (df) = 2
* Significant p<0.05
** Highly significant p<0.01

Table 4: The mean gingival index among children according to intelligence scales by
gender.
High Moderate Low
Gender intelligence scale intelligence scale intelligence scale F-value
No. Mean ±SD ±SE No. Mean ±SD ±SE No. Mean ±SD ±SE
Male 116 1.24 0.66 0.06 113 1.27 0.36 0.03 99 1.54 0.65 0.07 8.62**
Female 104 1.34 0.61 0.06 107 1.46** 0.41 0.04 121 1.69 0.72 0.07 10.02**
Total 220 1.29 0.64 0.04 220 1.37 0.40 0.03 220 1.62 0.69 0.05 19.54**

80
severity of gingivitis
% Percentages of the

70
60
50
40
High intelligence scale
30
20 Moderate intelligence scale
10 Low intelligence scale
0
Moderate

Moderate

Moderate
gingivitis

gingivitis

gingivitis
gingivitis

gingivitis

gingivitis
gingivitis

gingivitis

gingivitis
Sever

Sever

Sever
Mild

Mild

Mild

Males Females Total

Figure 2: The severity of gingivitis among children according to intelligence scales by

gender.

Table 5: The mean gingival index among children according to intelligence scales by
nutritional status and gender.
High Moderate Low
Nutritional status
Gender intelligence scale Intelligence scale intelligence scale F-value
Mean ±SD ±SE Mean ±SD ±SE Mean ±SD ±SE
Males 1.18 0.59 0.07 1.20 0.32 0.04 1.41 0.54 0.08 3.44*
Well nourished Females 1.18 0.61 0.08 1.20 0.28 0.04 1.43 0.69 0.10 3.25*
Total 1.18 0.59 0.05 1.20 0.30 0.03 1.42 0.61 0.06 6.77**
Males 1.36 0.78 0.13 1.38 0.40 0.06 1.66 0.72 0.10 3.29*
Females 1.56 0.55 0.08 1.80 0.30 0.04 1.83 0.71 0.08 3.27*
Malnourished
Total 1.46** 0.67 0.07 1.59** 0.41 0.04 1.76** 0.72 0.06 6.10**
Degree of freedom (df) = 2
* Significant p<0.05
** Highly significant p<0.01

In order to improve gingival condition of as a window for the skilled dental practitioner to
children and especially the malnourished group: view overall health status so that take care the
educational programs, good oral hygiene and mouth is an important step on the road to good
proper diet must be performed. The mouth serves health.

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J Bagh College Dentistry Vol. 22(2), 2010 The effect of intelligence

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