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Delayed primary tooth eruption in premature infants: relationship to neonatal factors
R M Viscardi1, E Romberg, R G Abrams
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore.
Insights
Primary tooth eruption in preterm infants is influenced by neonatal factors beyond gestational age. Duration of oral intubation and postnatal nutrition significantly impact tooth eruption timing.
Area of Science:
- Neonatal Health
- Pediatric Dentistry
- Developmental Biology
Background:
- Previous research linked primary tooth eruption (PTE) in preterm infants mainly to gestational age.
- The influence of other neonatal factors on PTE timing remained understudied.
Purpose of the Study:
- To investigate the impact of neonatal factors, including illness severity and nutrition, on the timing of primary tooth eruption in preterm infants.
- To identify specific neonatal variables that correlate with delayed or normal primary tooth eruption.
Main Methods:
- A prospective longitudinal study involving 35 preterm infants, categorized into normal (eruption ≤10 months) and late (eruption >10 months) eruption groups.
- Data collection included parental pictorial primary tooth eruption records and frequent oral examinations.
- Analysis focused on correlations between eruption timing and neonatal factors like birthweight, gestational age, feeding attainment, and duration of oral intubation.
Main Results:
- Primary tooth eruption occurred significantly later in infants with lower birthweight (<1000 g) or earlier gestational age (≤30 weeks).
- Age at first tooth eruption correlated with the age of achieving full enteral feedings, initiation of oral vitamin supplementation, and average daily weight gain.
- Five neonatal factors (duration of oral intubation, birthweight, gestational age, age of full enteral feedings, and apnea of prematurity) explained 44% of the variability in eruption age, with oral intubation duration being the most significant factor (77% of the explained variability).
Conclusions:
- The timing of primary tooth eruption in preterm infants is influenced by the severity of neonatal illness and postnatal nutritional status, in addition to the degree of prematurity.
- Duration of oral intubation emerged as a critical factor affecting primary tooth eruption timing in this population.
- These findings highlight the complex interplay of factors affecting early dental development in vulnerable preterm infants.
Abstract:
Previous studies suggest that primary tooth eruption (PTE) in preterm infants is related primarily to gestational age, but the impact of other neonatal factors has not been studied. In a prospective longitudinal study, the timing and sequence of PTE were documented by a pictorial PTE record completed by the parents and by frequent oral exams in 14 preterm infants whose first tooth erupted at < or = 10 months chronologic age (normal group) and 21 preterm infants whose first tooth erupted at > 10 months (late group). Initial eruption sequence in both groups was the same as full-term infants, with the two lower central incisors erupting first. PTE occurred significantly later in children with BW < 1000 g (t = 3.4, P < 0.01) or < or = 30 weeks (t = 2.41, P < 0.05). Factors related to nutrition appeared to be important. Age at first tooth correlated significantly with age when full enteral feedings were attained, age when oral vitamin supplementation was started, and with average weight gain per day. Five neonatal factors (duration of oral intubation, birthweight, gestational age, age when full enteral feedings were attained, and apnea of prematurity) explained 44% (R = 0.67, P < 0.05) of the variability in age at which the first tooth erupted. Of that 44%, 77% was explained by a single factor, duration of oral intubation. These results suggest that factors related to severity of neonatal illness and postnatal nutrition as well as degree of prematurity affect timing of primary tooth eruption.