Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

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cognizant that children who undergo dental surgery under GA <strong>of</strong>ten experience new or recurrent decay following surgery and those experiencing decay during the preschool period are significantly more likely to experience decay throughout childhood and adolescence. 89,90 Future improvements in infant and preschool oral health may eventually reduce the high demand for GA and free up surgical time for other pediatric disciplines. As this study has shown that low calcium and vitamin D levels during pregnancy are associated with enamel hypoplasia and ECC, it suggests that prevention should really begin during the prenatal period. Bolstering maternal nutrition during prenatal periods, either through improved dietary intakes or supplementation with vitamin D is one place to start in the hope that this will translate into improved host resistance to caries development. The province <strong>of</strong> Manitoba implemented a Healthy Baby prenatal benefit program a few years ago aimed at improving prenatal nutrition. 91 Our results suggest that many women with limited incomes who are recipients <strong>of</strong> Employment and Income Assistance (EIA) are not presently benefiting from this subsidy. 91 Only 75% <strong>of</strong> these high risk mothers returning with their infants (99/133) in our study indicated that they had received this supplement. This form <strong>of</strong> financial assistance should arguably be expanded given the growing evidence that many expectant women in Manitoba and Winnipeg have inadequate vitamin D levels. However, those receiving this benefit at the time <strong>of</strong> enrollment into this study did not have statistically higher 25(OH)D levels. <strong>Vitamin</strong> D supplements could be recommended to government as an affordable means to improve maternal and infant health. Findings from this investigation also suggest that a first dental visit during the first year <strong>of</strong> life may be an important preventive practice to adopt in order to minimize 6-30
caries-risk. This is not a universal practice in Manitoba as seen by a recent survey <strong>of</strong> practicing dentists. 92 However, this is now the recommended practice according to national pr<strong>of</strong>essional organizations. 93,94 This has prompted the Manitoba Dental Association to develop a first dental visit promotional program for children under three years <strong>of</strong> age with particular emphasis on the first visit by 12 months <strong>of</strong> age. 95 This program will compliment the recommendations coming from the Canadian Dental Association’s Task Force on ECC. 86 Results from the vitamin D assessment <strong>of</strong> participants in this thesis have already been shared with members involved in the <strong>Maternal</strong> and Child Healthcare Services (MACHS) Task Force. The growing concern over the vitamin D status <strong>of</strong> young children in Manitoba prompted MACHS to raise this issue with the Minister <strong>of</strong> Health for the Province <strong>of</strong> Manitoba. MACHS recommended that attention to improving the vitamin D status <strong>of</strong> newborns and examining the relationship between vitamin D status and childhood oral health is needed. 96 As such, Manitoba Health is now funding an upcoming high dose (100,000 IU vitamin D 3 ) supplementation pilot project for expectant mothers in Winnipeg. The eventual goal, should this project prove to be beneficial and feasible is to include high dose vitamin D supplementation as part <strong>of</strong> routine prenatal health care in this province. While this might improve host resistance to caries this does not necessarily eliminate caries-risk as ECC is still a complex multifactorial disease that is heavily influenced by dietary practice, oral hygiene, and the social determinants <strong>of</strong> health. Unfortunately, crowded political healthcare agendas and limited government funds may ultimately dictate whether a provincial government will ever undertake a comprehensive and needs-based preventive approach to deal with ECC. Such a 6-31
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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
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Table 5.6 - Multiple regression sta
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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 234 and 235: observed and it allowed multiple ou
Page 236 and 237: scientific evidence linking prenata
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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