Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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observed and it allowed multiple outcomes to be assessed for a single exposure (i.e. vitamin D status). Additionally, a temporal sequence was established spanning pregnancy through infancy. Cohort studies also have the advantage <strong>of</strong> reduced bias. Another notable strength <strong>of</strong> this study was that the infant dental assessments were made while being blinded to maternal 25(OH)D levels. This was a unique aspect <strong>of</strong> this study design ensuring that the dental examiner was not biased by prenatal vitamin D concentrations <strong>of</strong> mothers when performing the infant dental examination for enamel hypoplasia and caries. Findings from this study may have implications for early childhood oral health policy. Health policy is loosely defined as the actions <strong>of</strong> key players such as decisionmakers, the public, and various levels <strong>of</strong> government that are concentrated on improving the overall health <strong>of</strong> the population. 63 Policy development is not a static process. It is continually changing and subjected to several factors including social and political influences, technological advancements, changes in the general population, the overall importance <strong>of</strong> a health issue and the population at-risk, and the ongoing debate between a preventive view <strong>of</strong> health (i.e. promoting wellness) versus a fixation with treatment (i.e. disease based approach). 64 Undoubtedly, these forces are at play with oral health policy for infants and preschool aged children. Assuming that low maternal calcium and vitamin D concentrations during pregnancy predispose enamel hypoplasia and caries in <strong>of</strong>fspring, translating this knowledge in an effective manner may assist in shaping needed oral health policy for young children. Research evidence already links these DDEs with ECC. 30,65-69 6-26
Over the last decade ECC has garnered much attention in the province <strong>of</strong> Manitoba and at times has become a politically charged issue. 70-73 Unfortunately, there is little policy in the area <strong>of</strong> preschool oral health in the province. For children’s oral health to gain importance some have suggested that ECC should increasingly be viewed as a public health dilemma 74 or a broader pediatric health issue 75 that can influence overall childhood well-being rather than a dental problem so those in policy circles take note. It makes sense to view early childhood oral health in the context <strong>of</strong> an overall healthy living strategy. ECC is known to negatively impact child health and well-being. 76 Good health policy for young children and expectant women must be based on credible evidence. The evidence-based movement has resulted in the formulation <strong>of</strong> clinical practice guidelines, forever changing the way health care pr<strong>of</strong>essionals care for their patients. 77-80 Evidence-based health care has led to the establishment <strong>of</strong> hierarchical methods <strong>of</strong> reviewing and rating the scientific literature, with randomized controlled trials (RCT) being touted as having the most superior evidence. Prospective cohorts also provide valuable evidence. However, there are clear distinctions between evidence-based health care practice and evidence-based policy as neither evidence-based medicine, nor strong scientific findings lead to direct policy change. 81 While basing policy decisions on sound information is the ultimate goal, both researchers and decision-makers must be cognizant <strong>of</strong> additional factors that influence how evidence is utilized to shape public health policy. They must also be aware <strong>of</strong> other barriers that can hinder the formulation and adoption <strong>of</strong> policy for early childhood oral health. These factors should be properly considered when designing a comprehensive policy strategy to prevent ECC. While this longitudinal investigation has provided some 6-27
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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
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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
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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
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 216 and 217: home environment can be determinant
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 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
Page 271 and 272: If you are taking vitamins during t
Page 273 and 274: Do you Eat? Never Rarely (less than
Page 275 and 276: What problems can early childhood c
Page 277 and 278: Prenatal Nutrition
Page 279 and 280: Did you ever add sugar to the bottl
Page 281 and 282: Enamel Hypoplasia Enamel Hypoplasia
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Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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