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Enamel hypoplasia and dental caries in very-low birthweight children: a case-controlled, longitudinal study
P Y Lai1, W K Seow, D I Tudehope
1University of Queensland Dental School, Brisbane, Australia.
Insights
Very-low birthweight (VLBW) preterm children show higher enamel defect prevalence. Despite this, VLBW children did not have significantly more dental caries than normal birthweight controls.
Area of Science:
- Pediatric Dentistry
- Neonatal Health
- Developmental Biology
Background:
- Preterm birth and very-low birthweight (VLBW) are associated with increased risks for various health complications.
- Enamel defects, such as hypoplasia, can arise during tooth development, particularly in vulnerable populations.
- The long-term dental health outcomes for VLBW children require further investigation.
Purpose of the Study:
- To longitudinally assess the prevalence and sequelae of enamel defects in very-low birthweight (VLBW) preterm children.
- To compare enamel defect prevalence and dental caries incidence between VLBW children and normal birthweight (NBW) controls.
- To identify specific enamel defect types associated with dental caries in VLBW children.
Main Methods:
- Longitudinal study design following 25 VLBW preterm children and 25 matched NBW controls.
- Dental examinations conducted at approximately 30, 44, and 52 months of age.
- Assessment of enamel hypoplasia, dental caries, and other risk factors including Streptococcus mutans levels, fluoride exposure, and oral hygiene.
Main Results:
- VLBW children exhibited significantly higher prevalence of enamel hypoplasia at all examination points compared to NBW controls.
- At 52 months, 96% of VLBW children had enamel defects versus 45% of NBW controls, with a mean of 7.6 affected teeth in VLBW vs 1.0 in NBW.
- A significant association between enamel defects and dental caries was found in VLBW children, particularly defects with both hypoplasia and opacity, yet overall caries prevalence did not differ significantly between groups.
Conclusions:
- VLBW preterm children are at high risk for developing enamel defects.
- While enamel defects are common in VLBW children and associated with caries risk, overall dental caries prevalence is not significantly elevated compared to normal birthweight peers.
- Further research is needed to understand the protective factors or compensatory mechanisms mitigating caries development in VLBW children despite enamel defects.
Abstract:
This longitudinal study investigated the sequelae of enamel defects in a group of 25 white, very-low birthweight (VLBW), preterm children (mean birthweight 969 +/- 218 g, mean gestational age 27 +/- 1.9 weeks). Twenty-five race-, age-, and sex-matched, full-term normal birthweight (NBW) control children born at the same hospital, were selected randomly from hospital records. The children were examined at approximate ages of 30, 44, and 52 months. At all examinations, VLBW children had significantly higher prevalence of enamel hypoplasia than did the NBW children. At the last recall examination, 96% of VLBW group, and 45% of the NBW group had at least one tooth with enamel defect, with a mean of 7.6 +/- 4.9 affected teeth per VLBW child, and only 1.0 +/- 1.3 affected teeth per control child (P < 0.001). A significant association of enamel defects with dental caries was observed only in the VLBW group on the second and third examinations (P < 0.001). The defect identified to be most significantly associated with dental caries was a variant showing both enamel hypoplasia and opacity. In spite of a high prevalence of enamel defects, the overall prevalence of dental caries in the VLBW children was not significantly different from that of NBW controls at all three examinations (P < 0.1). Other caries risk factors such as levels of Streptococcus mutans infection, fluoride supplementation, plaque scores, toothbrushing frequency, and daily sugar exposures were examined but none was found to be related significantly to development of dental caries.