Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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home environment can be determinants <strong>of</strong> childhood health and well-being during early childhood. A total <strong>of</strong> 135 infants underwent a dental screening examination at an average age <strong>of</strong> 16.1 months. Since this longitudinal cohort study involved a considerable proportion <strong>of</strong> Aboriginal participants it provides a unique snapshot <strong>of</strong> the prevalence <strong>of</strong> enamel hypoplasia and incidence <strong>of</strong> ECC in this population in the Winnipeg region. Not surprising, teeth showing the greatest prevalence <strong>of</strong> DDEs were the primary maxillary incisors as incisors are the only erupted teeth at this age. Approximately one-fifth <strong>of</strong> infants examined had evidence <strong>of</strong> enamel hypopolasia in their primary teeth. An epidemiological study partnering with a northern Manitoba First Nation reported that 50% <strong>of</strong> the preschool cohort had obvious signs <strong>of</strong> hypoplastic enamel. 22 A study involving Australian Indigenous preschool children reported that virtually all children (98%) had at least one tooth affected by an enamel defect, either an opacity or hypoplasia. 29 On average, children in that study had at least four primary teeth with hypoplasia. 29 Another study by the same investigator reported a much lower prevalence <strong>of</strong> DDE; only 20% <strong>of</strong> this small sample <strong>of</strong> Aborigine were affected. 30 This is closer to the prevalence reported in this prospective Canadian birth cohort study. A total <strong>of</strong> 31 infants (23.0%) were determined to have ECC when using cavitated lesions as the definition for caries. When incipient (i.e. white spot) lesions were included, 49 infants were found to have ECC. New efforts have attempted to standardize caries diagnosis, classification, and reporting for epidemiological purposes. 31 The newly proposed International Caries Detection and Assessment System (ICDAS) allows for early incipiencies be recorded as decay. 32 Although these incipient lesions may be 6-8
emineralized with fluoride they still serve as markers <strong>of</strong> considerable cariogenic activity and risk for the young child. The incidence <strong>of</strong> ECC in this infant cohort is high compared to that <strong>of</strong> urban dwelling Canadian children <strong>of</strong> similar ages. 33 However, the social and physical environment in which these children reside may be contributing to their heightened risk. In fact, the incidence <strong>of</strong> ECC is comparable to previously reported prevalence rates <strong>of</strong> ECC in Manitoba. A 2005 study reported a prevalence <strong>of</strong> ECC <strong>of</strong> 30.4% among infants < 24 months <strong>of</strong> age. 23 The average deft score was 1.47 ± 2.80 (range 0-17) with over 80% being attributable to the decayed teeth score (dt). The data reveal that a minority <strong>of</strong> children bore the bulk <strong>of</strong> the caries burden in this cohort. Very few had undergone treatment for ECC. A more rampant form <strong>of</strong> ECC is S-ECC. This sub-classification is reserved for children with more severe forms <strong>of</strong> caries, and is site, pattern, and age specific. 34,35 However, any caries experience, even one isolated decayed smooth tooth surface is enough to garner the diagnosis <strong>of</strong> S-ECC among children under 36 months <strong>of</strong> age. This in fact means that 23% <strong>of</strong> the infants in this study actually met the criteria for S-ECC at a mean age <strong>of</strong> 16.1 months. This is concerning as children with S-ECC frequently need to undergo rehabilitative treatment in hospital under general anesthesia (GA), primarily because <strong>of</strong> their young ages and the volume <strong>of</strong> dental treatment they require. Correlation analysis revealed that there was no statistically significant relationship between 25(OH)D levels and calcium, phosphorus, or alkaline phosphatase. The other metabolites were anticipated to be associated with vitamin D levels as others have used some <strong>of</strong> these metabolites as pseudo markers for 25(OH)D. 19,36,37 However, no such relationship was substantiated. Recent research reports that biomarkers like parathyroid 6-9
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
Page 29 and 30:
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
Page 53 and 54:
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
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36 month trial had ended. 45 The nu
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Recently, a cross-sectional study <
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andomized, placebo-controlled study
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Further, amelogenin and enamelin, p
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A study of Austral
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Both dietary interventions and supp
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incidence of carie
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important nutrient. However, many <
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caries, and more hardening
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controls. 106 Interestingly, childr
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A few years later, additional resea
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Delayed Tooth Eruption Vita
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Description of Pop
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Influence
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D has an effect on the dentition, p
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14. Utiger RD. The need for more vi
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42. Spiller WF, Jr. A clinical eval
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67. Itota T, Tashiro Y, Torii Y, Ni
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95. Bruszt P. Kariesuntersuchungen
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121. Seow WK, Needleman HL, Holm IA
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Chapter 2 - Methods for a Prospecti
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Each participant also completed an
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Table 2.2 - Recognized case definit
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Population The target population fo
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allowed the project to suffer some
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women of limited m
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involving the surface of</s
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and training cup. In addition, each
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The questionnaire was administered
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statistics including frequencies an
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elationship between the two. Poisso
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References 1. Combs GF. Vit
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27. Seow WK, Amaratunge A, Bennett
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Table 3.2 - Self-declared heritage
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Question Number Valid % Do you take
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Maternal Awareness
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time of recruitmen
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Table 3.6- Prenatal</strong
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A total of 77 care
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indicated that they were receiving
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and 11 hypoplasia). DDEs were also
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Caries rates for children in this p
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Table 3.12 - Frequency of</
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Chapter 4 - Results: Associations <
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II. Relationship Between 25(OH)D Le
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Pregnancy & Health Prof</st
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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
Page 166 and 167: likely to have vitamin D levels at
Page 168 and 169: did not statistically differ from v
Page 170 and 171: Figure 4.4 - Predicted number <stro
Page 172 and 173: Table 4.7 - Relationship between ds
Page 174 and 175: frequently, and less likely to have
Page 176 and 177: health as average or poor, and more
Page 178 and 179: tail (p=.034) suggesting that early
Page 180 and 181: The next series of
Page 182 and 183: Results from the second model appea
Page 184 and 185: Table 5.6 - Multiple regression sta
Page 186 and 187: vitamin D. However, it did suggest
Page 188 and 189: significant at the bivariate level
Page 190 and 191: Table 5.12(a) - Logistic regression
Page 192 and 193: III. Multivariate Regression Analys
Page 194 and 195: Table 5.14 - Logistic regression fo
Page 200 and 201: Table 5.19(b) - Backwards logistic
Page 202 and 203: Table 5.20(a) - Logistic regression
Page 204 and 205: Table 5.21 - Poisson regression for
Page 206 and 207: If enamel hypoplasia is present and
Page 208 and 209: Since maternal calcium levels were
Page 210 and 211: vitamin D deficiency, and rickets)
Page 212 and 213: to obtain it. Health literacy may b
Page 214 and 215: vitamin D from the diet as dietary
Page 218 and 219: hormone, calcium absorption and bon
Page 220 and 221: important nutrient. For many, this
Page 222 and 223: this potential relationship with ac
Page 224 and 225: genetic conditions, childhood medic
Page 226 and 227: vitamin D status including milk int
Page 228 and 229: y cariogenic oral flora. 49 Since e
Page 230 and 231: (49.8 ± 26.3 nmol/L vs. 45.1 ± 20
Page 232 and 233: pregnancy, which may have influence
Page 234 and 235: observed and it allowed multiple ou
Page 236 and 237: scientific evidence linking prenata
Page 238 and 239: cognizant that children who undergo
Page 240 and 241: preventive program would need to be
Page 242 and 243: makers in the formative stages. As
Page 244 and 245: Surprisingly, the final regression
Page 246 and 247: 13. First Nations IaMHCCPS. <strong
Page 248 and 249: 38. Hollis BW. Circulating 25-hydro
Page 250 and 251: 65. Li Y, Navia JM, Bian JY. Caries
Page 252 and 253: 91. Brownell MD, Guevremont A, Au W
Page 254 and 255: Chapter 7 - Conclusions This thesis
Page 256 and 257: This study provided an interesting
Page 258: 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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