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Malnutrition and developmental defects of enamel in 2- to 6-year-old Saudi boys
A J Rugg-Gunn1, S M Al-Mohammadi, T J Butler
1Department of Child Dental Health, Newcastle University Dental School, Newcastle upon Tyne, UK. a.j.rugg-gunn@ncl.ac.uk
Insights
Malnutrition in young children is linked to low birth weight, reduced water intake, early cessation of breastfeeding, and socioeconomic factors. These, along with childhood illness and toothpaste use, also correlate with enamel defects in primary teeth.
Area of Science:
- Pediatric Nutrition
- Dental Public Health
- Developmental Biology
Background:
- Previous research linked malnutrition to enamel defects in permanent teeth.
- Developmental defects of enamel (DDE) in primary teeth require further investigation into associated factors.
Purpose of the Study:
- Identify factors associated with malnutrition in young children.
- Determine factors related to the prevalence of developmental defects of primary teeth.
Main Methods:
- Clinical examination of primary teeth using the DDE index.
- Parental questionnaires on socio-economic status, health, and feeding practices.
- Nutritional status assessment (height-for-age) and dietary/urine analysis.
Main Results:
- Malnutrition in children was associated with low birth weight, low water intake, early weaning, and lower socioeconomic status.
- Low birth weight was linked to residential area, parental education, and maternal illness.
- Prevalence of primary tooth enamel defects correlated with malnutrition, low birth weight, childhood illness, tooth brushing, and toothpaste swallowing.
Conclusions:
- Several independent variables are associated with enamel defects in primary and permanent teeth.
- Longitudinal studies are necessary to establish causality between identified factors and enamel defects.
Abstract:
Three hundred and ninety boys aged 2, 4 or 6 years from Riyadh, Saudi Arabia, took part in a survey in 1993/94. The main aims of the study were first, to identify factors related to malnutrition in young children since a study of older children from the same area 1 year before had shown malnutrition to be strongly related to prevalence of developmental defects of enamel (DDE) of permanent teeth and, second, to identify factors related to the prevalence of developmental defects of primary teeth. Enamel defects were recorded by clinical examination of the buccal surfaces of all primary teeth by 1 examiner using the DDE index. A questionnaire to parents provided information on socio-economic status, illness in the mother and child, infant feeding, trauma to teeth and toothbrushing. A 24-hour dietary record, to estimate water and milk intake, and a 24-hour urine collection were obtained for each child twice. Nutritional status was calculated from height for age using WHO methods. Multiple regression analyses revealed four variables related (p<0.05) to malnourished status: low birth-weight, low volume of water drunk, child stopped breast- and bottle-feeding before 1 year of age, and low class urban or rural area of residence. Birth-weight was itself related to area of residence (p = 0.02), parental education (p = 0.02) and maternal illness during pregnancy (p = 0.06). Malnutrition (p<0.001), low birth-weight (p<0.001), childhood illness (p<0.001), brushing of child's teeth (p = 0.003) and swallowing toothpaste (p<0.001) were related to the prevalence of developmental defects of primary teeth. This study indicated several independent variables which may be related to the prevalence of enamel defects in primary and permanent teeth, but longitudinal studies are required to determine which are causes and which are markers of these developmental defects.