Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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Table 2.2 – Recognized case definitions for ECC and S-ECC 8,11 Age (months) ECC S-ECC < 12 1 or more teeth 1 or more smooth dmf surfaces 12-23 1 or more teeth 1 or more smooth dmf surfaces 24-35 1 or more teeth 1 or more smooth dmf surfaces 36-47 1 or more teeth dmfs score ≥ 4 OR 1 or more smooth dmf surfaces in the primary maxillary anteriors 48-59 1 or more teeth dmfs score ≥ 5 OR 1 or more smooth dmf surfaces in the primary maxillary anteriors 60-71 1 or more teeth dmfs score ≥ 6 OR 1 or more smooth dmf surfaces in the primary maxillary anteriors dmfs=decayed, missing, filled surfaces in primary teeth A prospective cohort study design was selected. This allowed the natural progression <strong>of</strong> outcome to be observed, a useful approach when the exposure is not common. This was beneficial, as serum 25(OH)D status was considered as the exposure <strong>of</strong> interest. While technically common, 25(OH)D measurements are not and the majority <strong>of</strong> the population and their health care providers are unaware <strong>of</strong> their actual vitamin D concentration. This same design also allows multiple outcomes <strong>of</strong> a single exposure to be examined and ensures that a temporal sequence can be established (Table 2.3). 12-15 Although there are several benefits to this type <strong>of</strong> study design, prospective cohort investigations typically require considerable time and expense. 12 There are also challenges in maintaining cohorts over the period <strong>of</strong> study and the design does not enable the impact <strong>of</strong> many other possible exposures to be evaluated. 12,13 A description <strong>of</strong> the 2-5
methods used to minimize participant withdrawals and dropouts appears later in this chapter. Table 2.3 – Advantages and disadvantages <strong>of</strong> cohort studies (including this investigation <strong>of</strong> 25(OH)D, enamel hypoplasia, and ECC) 12,14,15 Advantages Disadvantages Opportunity to observe the natural history <strong>of</strong> disease (e.g. DDE, enamel hypoplasia, and ECC) Important when the exposure may be somewhat uncommon (e.g. prenatal vitamin D (25(OH)D) deficiency) Not useful for studying rare diseases (However, ECC is all too common) Limited to investigating only a few exposures as the exposure is the start <strong>of</strong> the starting point (e.g. prenatal 25(OH)D deficiency) Allow multiple outcomes to be assessed (e.g. enamel hypoplasia, enamel opacities, ECC, birth outcomes) for a single exposure once it is defined (e.g. prenatal 25(OH)D deficiency) Costly, time consuming, and observational period may be <strong>of</strong> long duration (e.g. 2 nd trimester to 12 months <strong>of</strong> age) Logistically complex Guarantees the establishment <strong>of</strong> a chronological timeline (e.g. 2 nd trimester to 12 months <strong>of</strong> age) Allows for the calculation <strong>of</strong> incidence/prevalence <strong>of</strong> disease (e.g. enamel hypoplasia or ECC) among those either exposed or unexposed (e.g. prenatal 25(OH)D deficiency) to determine relative risk <strong>of</strong> developing the disease/outcome <strong>of</strong> interest May require a large number <strong>of</strong> participants Cohort maintenance and prone to loss to follow-up Difficulty with missing data and subsequent need to account for missing data in statistical analyses Reduced bias 2-6
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Influence
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Abstract Influence
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Acknowledgements This longitudinal
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Table of Contents
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Status and Non-<st
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Table 1.1-1 - Recent studies report
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Table 1.1-2 - Previous used terms f
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The Link Between Enamel Hypoplasia
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If enamel hypoplasia results from n
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malocclusions. 145 Additional human
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Daily intakes of v
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13. Milnes AR, Rubin CW, Karpa M, T
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40. Definition of
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71. Watt RG. From victim blaming to
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97. Fearne JM, Bryan EM, Elliman AM
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124. Burt BA, Pai S. Does low birth
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151. Tinanoff N, D
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Section 2 - Risk Factors for Enamel
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correspond to the timing of
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een published. 3,4,17,19 The intent
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Table 1.2-2 - Risk factors for DDE
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Opacity 51 Implicated Risk Developm
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Implicated Risk Factor Factors asso
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o Metabolic Abnormalities and Healt
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12 months of life.
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Other Factors Some uncommon risk fa
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devastating problem of</str
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13. An epidemiological index <stron
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54. Seow WK, Perham S. Enamel hypop
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82. Berdal A, Papagerakis P, Hotton
Page 62 and 63: Vitamin D may be d
Page 64 and 65: have been used to prof</str
Page 66 and 67: health’. In addition, articles we
Page 68 and 69: 36 month trial had ended. 45 The nu
Page 70 and 71: Recently, a cross-sectional study <
Page 72 and 73: andomized, placebo-controlled study
Page 74 and 75: Further, amelogenin and enamelin, p
Page 76 and 77: A study of Austral
Page 78 and 79: Both dietary interventions and supp
Page 80 and 81: incidence of carie
Page 82 and 83: important nutrient. However, many <
Page 84 and 85: caries, and more hardening
Page 86 and 87: controls. 106 Interestingly, childr
Page 88 and 89: A few years later, additional resea
Page 90 and 91: Delayed Tooth Eruption Vita
Page 92 and 93: Description of Pop
Page 94 and 95: Influence
Page 96 and 97: D has an effect on the dentition, p
Page 98 and 99: 14. Utiger RD. The need for more vi
Page 100 and 101: 42. Spiller WF, Jr. A clinical eval
Page 102 and 103: 67. Itota T, Tashiro Y, Torii Y, Ni
Page 104 and 105: 95. Bruszt P. Kariesuntersuchungen
Page 106 and 107: 121. Seow WK, Needleman HL, Holm IA
Page 108 and 109: Chapter 2 - Methods for a Prospecti
Page 110 and 111: Each participant also completed an
Page 114 and 115: Population The target population fo
Page 116 and 117: allowed the project to suffer some
Page 118 and 119: women of limited m
Page 120 and 121: involving the surface of</s
Page 122 and 123: and training cup. In addition, each
Page 124 and 125: The questionnaire was administered
Page 126 and 127: statistics including frequencies an
Page 128 and 129: elationship between the two. Poisso
Page 130 and 131: References 1. Combs GF. Vit
Page 132 and 133: 27. Seow WK, Amaratunge A, Bennett
Page 134 and 135: Table 3.2 - Self-declared heritage
Page 136 and 137: Question Number Valid % Do you take
Page 138 and 139: Maternal Awareness
Page 140 and 141: time of recruitmen
Page 142 and 143: Table 3.6- Prenatal</strong
Page 144 and 145: A total of 77 care
Page 146 and 147: indicated that they were receiving
Page 148 and 149: and 11 hypoplasia). DDEs were also
Page 150 and 151: Caries rates for children in this p
Page 152 and 153: Table 3.12 - Frequency of</
Page 154 and 155: Chapter 4 - Results: Associations <
Page 156 and 157: II. Relationship Between 25(OH)D Le
Page 158 and 159: Pregnancy & Health Prof</st
Page 160 and 161: The frequency of v
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did not (42.9 ± 21.2 nmol/L vs. 49
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Early Childhood Caries (ECC) Pr<str
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likely to have vitamin D levels at
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did not statistically differ from v
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Figure 4.4 - Predicted number <stro
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Table 4.7 - Relationship between ds
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frequently, and less likely to have
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health as average or poor, and more
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tail (p=.034) suggesting that early
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The next series of
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Results from the second model appea
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Table 5.6 - Multiple regression sta
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vitamin D. However, it did suggest
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significant at the bivariate level
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Table 5.12(a) - Logistic regression
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III. Multivariate Regression Analys
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Table 5.14 - Logistic regression fo
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Table 5.19(b) - Backwards logistic
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Table 5.20(a) - Logistic regression
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Table 5.21 - Poisson regression for
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If enamel hypoplasia is present and
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Since maternal calcium levels were
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vitamin D deficiency, and rickets)
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to obtain it. Health literacy may b
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vitamin D from the diet as dietary
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home environment can be determinant
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hormone, calcium absorption and bon
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important nutrient. For many, this
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this potential relationship with ac
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genetic conditions, childhood medic
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vitamin D status including milk int
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y cariogenic oral flora. 49 Since e
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(49.8 ± 26.3 nmol/L vs. 45.1 ± 20
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pregnancy, which may have influence
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observed and it allowed multiple ou
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scientific evidence linking prenata
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cognizant that children who undergo
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preventive program would need to be
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makers in the formative stages. As
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Surprisingly, the final regression
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13. First Nations IaMHCCPS. <strong
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38. Hollis BW. Circulating 25-hydro
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65. Li Y, Navia JM, Bian JY. Caries
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91. Brownell MD, Guevremont A, Au W
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Chapter 7 - Conclusions This thesis
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This study provided an interesting
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esiding in disadvantaged communitie
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If you are taking vitamins during t
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Do you Eat? Never Rarely (less than
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What problems can early childhood c
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Prenatal Nutrition
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Did you ever add sugar to the bottl
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Enamel Hypoplasia Enamel Hypoplasia
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Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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