Distribution of Enamel Defects and the Association with Respiratory Distress in Very Low Birthweight Infants

Abstract

Although dental defects have long been observed among surviving pre-term infants, only few systematic studies address this problem. In a clinic limited to recall of infants of very low birthweight (<1.5 kg), enamel hypoplasia of primary incisors was found in 14/67 (21%) children, and enamel opacities were found in an additional 31% of the children. In contrast, enamel hypoplasia and opacities were found in 4% and 22%, respectively, of a control group of 46 normal birthweight children. The difference was significant (p < 0.05) for the hypoplasia but not for the opacities. Primary incisor enamel hypoplasia was more commonly noted in maxillary central incisors than in lateral incisors (X² = 28.0, p < 0.01). Furthermore, hypoplasia was more common in maxillary incisors than in mandibular incisors (X² = 48.4, p < 0.01).

In infants with dental defects, there was no significant correlation with pregnancy risk factors, gestational age, birth weight, septicemia, first-week caloric intake, serum bilirubin, or calcium. Infants with enamel hypoplasia were more likely, however, to have severe respiratory distress syndrome (X² = 7.2, p < 0.01), than infants with unaltered enamel.

Central incisor edge involvement may indicate post-natal processes and/or a systemic disturbance extending back to the middle trimester of pregnancy.

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References

Ainamo, J. and Cutress, T.W. : An Epidemiological Index of Developmental Defects of Dental Enamel (DDE Index) . Commission on Oral Health Research and Epidemiology, FDI, Int Dent J 32:159-167, 1982.

Boice, J.B. ; Krous, H.F. ; and Foley, J.M. : Gingival and Dental Complications of Orotracheal Intubation, J Amer Med Assoc 236 :957-958, 1976.

Cook, D.C. and Buikstra, J.E. : Health and Differential Survival

in Prehistoric Populations: Prenatal Dental Defects, Am J Phys Anthropol 51:649-664, 1979.

Dubowitz, L. ; Dubowitz, V. ; and Goldberg, C. : Clinical Assessment of Gestational Age in the Newborn Infant, J Pediatr 77:1-10, 1970.

Funakoshi, Y. ; Kushida, Y. ; and Hieda, T. : Dental Observations of Low Birth Weight Infants, Pediatr Dent 3 :21-25, 1981.

Grahnen, H. and Larssen, P.G. : Enamel Defects in the Deciduous Dentition of Prematurely Born Children , Odontol Revy 9:193-204, 1958.

Grahnen, H. and Granath, L.E. : The Effect of Hyperbilirubinemia on Primary Teeth, Odontol Revy 13 :337-343, 1962.

Grahnen, H. ; Sjolin, S. ; Arwill, T. ; and Magnusson, B. : Neonatal Asphyxia and Mineralization Defects of the Primary Teeth , Caries Res 3:301-307, 1969.

10.

Grahnen, H. ; Holm, A.K. ; Magnusson, B. ; and Sjolin, S. : Mineralization Defects of the Primary Teeth in Intra-Uterine Undernutrition . I. Results of a Clinical Investigation, Caries Res 6 :224-228, 1972.

11.

Grahnen, H. ; Sjolin, S. ; and Stenstrom, A. : Mineralization Defects of Primary Teeth in Children Born Pre-Term , Scand J Dent Res 82:396-400, 1974.

12.

Hack, M. ; Fanaroff, A.A. ; and Merkatz, I.R. : The Low-Birth-Weight Infant - Evolution of a Changing Outlook, N Eng J Med 301:1162-1166, 1979 .

13.

Hobel, C. ; Gyvarinen, M. ; and Okada, D. : Prenatal and Intrapartum High-Risk Screening: Prediction of the High-Risk Neonate, Am J Obstet Gynecol 117 :1-9, 1973.

14.

Infante, P.F. and Gillespie, G.M. : An Epidemiologic Study of Linear Enamel Hypoplasia of Deciduous Anterior Teeth in Guatemalan Children, Arch Oral Biol 19:1055-1061, 1974.

15.

Jelliffe, J.B. and Jelliffe, E.F.P. : Letter: Linear Enamel Hypoplasia of Deciduous Incisor Teeth in Malnourished Children, Am J Clin Nutr 24:893, 1971.

16.

Klaus, M.H. and Fanaroff, A.A. , Eds.: Care of the High Risk Neonate. Philadelphia: W.B. Saunders Co., 1979.

17.

Kraus, B.S. and Jordan, F.E. : The Human Dentition Before Birth. Philadelphia : Lea and Febiger, 1965.

18.

Kronfield, R. and Schour, I : Neonatal Dental Hypoplasia, JADA 26:18-32, 1939.

19.

Mellander, M. ; Noren, J.G. ; Freden, H. ; and Kjelimer, I. : Mineralization Defects in Deciduous Teeth of Low Birth Weight Infants , Acta Pediatr Scand 71:727-733, 1982.

20.

Miller, J. and Forrester, R.M. : Neonatal Enamel Hypoplasia, Br Dent J 106 :93-104, 1959.

21.

Moylan, F.M.B. : SELDIN, E.B.: SHANNON, D.C.: and TOD-RES, I.D.: Defective Primary Dentition in Survivors of Neonatal Mechanical Ventilation, J Pediatr 96:106-108, 1980.

22.

Rosenstein, S.N. : Premature Infants: The Relation of Dental Abnormalities to Neurological/Psychometric Status at Age Two Years, Dev Med Child Neurol 16:158-162, 1974.

23.

Stein, G. : Enamel Damage of Systemic Origin in Premature Birth and Diseases of Early Infancy, Am J Orthod Oral Surg 33 :831-841, 1947.

24.

Sweeney, E.A. ; Cabrera, J. ; Urrutia, J. ; and Mata, L. : Factors Associated with Linear Hypoplasia of Human Deciduous Incisors , J Dent Res 48:1275-1279,1969.

25.

Sweeney, E.A. ; Saffir, A.J. ; and Deleon, D. : Linear Hypoplasia of Deciduous Incisor Teeth in Malnourished Children , Am J Clin Nutr 24:29-31, 1971.

26.

Usher, R. and McLean, F. : Intrauterine Growth of Live-born Caucasian Infants at Sea Level: Standards Obtained from Measurements in 7 Dimensions of Infants Born Between 25 and 44 Weeks of Gestation, J Pediatr 74:901-910, 1969.

27.

Via, W.F. and Churchill, J.A. : Relationship of Enamel Hypoplasia to Abnormal Events of Gestation and Birth , JADA 59 :702-707, 1959.