Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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women <strong>of</strong> limited means to assist with food purchasing ability. If eligible, recipients begin to receive the benefit during their second trimester <strong>of</strong> pregnancy and it ceases in the last month <strong>of</strong> pregnancy. 29 Further questioning focused on the consumption <strong>of</strong> calcium and vitamin D containing food products (e.g. fortified milk and dairy, fish, eggs, etc.), and whether participants were open to various ways to enhance vitamin D and calcium intake. Few foods naturally contain vitamin D, <strong>of</strong>ten leaving fortified milk as the main dietary source for a larger proportion <strong>of</strong> the population. 30 Intake <strong>of</strong> calcium and vitamin D containing foodstuffs were assessed to determine if women and their developing <strong>of</strong>fspring were at risk <strong>of</strong> having insufficient vitamin D concentrations. Two other sections focused on oral health. The “ECC pr<strong>of</strong>ile” examined whether expectant mothers had heard <strong>of</strong> ECC or “baby bottle tooth decay” in the vernacular, how they came to learn about it, whether they believed it to be a normal part <strong>of</strong> childhood, and what they believed were its causes. It also asked mothers whether they believed ECC was preventable. Participant’s knowledge <strong>of</strong> caring for an infant’s teeth, including when brushing should first be initiated, when the first dental visit should occur, and issues relating to breast and bottle feeding were assessed. The “maternal oral health pr<strong>of</strong>ile” assessed dental attendance and whether participants were experiencing dental problems. The “exposure to sunlight” theme evaluated participant exposure to sunlight during summer months for endogenous production, amount <strong>of</strong> sun exposure received, and duration <strong>of</strong> sun exposure. Use <strong>of</strong> sunscreens, clothing, and insect repellants was also reviewed. The final theme, the “family & financial pr<strong>of</strong>ile” recorded their relational status, number <strong>of</strong> persons in the household, highest level <strong>of</strong> education, and issues related to 2-11
annual income, to establish a socioeconomic pr<strong>of</strong>ile. This was necessary so that the analysis could control for low SES and related issues as these may influence maternal health and nutrition, enamel hypoplasia, and ECC. Lactose intolerance is a known issue within this population. 19,31 Therefore, assessing milk consumption alone may not be the most beneficial method <strong>of</strong> determining risk <strong>of</strong> inadequate or low vitamin D. Other foods were considered to determine the potential risk for vitamin D and calcium deficiencies. Foods containing vitamin D include fish, eggs, liver, and fortified dairy products including milk and cheese. 32 Calcium rich foods are usually dairy-based, although many other foods contain calcium 32 , including some green vegetables. Daily recommendations (adequate intake) <strong>of</strong> vitamin D and calcium intake during pregnancy when this study began called for 5-10 ug/day (200-400 IU/day) and 1000 mg/day respectively. 32-34 For instance, 1 cup <strong>of</strong> milk contains approximately 2.3 ug <strong>of</strong> vitamin D and 300 mg <strong>of</strong> calcium. 32 However, controversy surrounding the recommended dietary allowances (RDA) for vitamin D exist and the real RDA remains obscure although there is growing consensus that current daily recommendations are set too low. 34-36 The final component in the research protocol was a blinded assessment <strong>of</strong> the integrity <strong>of</strong> the primary teeth that were erupted into the infant’s oral cavity. The principal investigator served as the dental examiner and was blinded to the prenatal vitamin D level <strong>of</strong> each infant’s mother. The infant dental examination involved an assessment <strong>of</strong> the primary dentition with particular focus on the maxillary incisors (i.e. those teeth predominantly affected by ECC and S-ECC). Digital photographs were taken when possible. The working definition <strong>of</strong> enamel hypoplasia used for this study was “a defect 2-12
Page 1 and 2:
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
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Vitamin D may be d
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have been used to prof</str
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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 112 and 113: Table 2.2 - Recognized case definit
Page 114 and 115: Population The target population fo
Page 116 and 117: allowed the project to suffer some
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
Page 162 and 163: did not (42.9 ± 21.2 nmol/L vs. 49
Page 164 and 165: Early Childhood Caries (ECC) Pr<str
Page 166 and 167: 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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