Tuesday, January 23, 2018

Enamel defects in the complete primary dentition of children born at term and preterm

Resident’s Name: Brian Darling                                                                    
Article Title: Enamel defects in the complete primary dentition of children born at term and preterm
Author(s): Takaoka et al
Journal: Pediatric Dentistry
Date: 2011 33: 171-6
Major Topic: Enamel defects in preterm children
Type of Article: Retrospective cohort study
Main Purpose: This article aimed to describe differences in enamel defects in children born pre-term versus children born at term.
Key Points: Pre-term children are more likely to have enamel defects and caries. Intubation is strongly associated with enamel defects.
Pre-Term Birth: occurs prior to 37th week of gestation (normal births occur 37-42 weeks post-gestation)
Low Birth Weight = <2.5 kg (5 lbs 8 oz)

·      Increasing number of preterm births are surviving.
·      Complications associated with low birth weight: respiratory distress, cardiac disease (patent ductus arteriosus), sepsis, necrotizing enterocolitis, metabolic disorders like hyperbilirubinemia, hypoglycema, hypocalcemia, metabolic bone disease, nutritional and neurological disorders
·      Pre-term infants often require intubation because of perinatal asphyxia or respiratory distress 
·      Dental calcification begins at around the 15th week of intrauterine life
·      Orotracheal intubation/laryngoscopy is associated with enamel defects
·      Enamel defects increase risk of caries because of higher porosity and increased plaque retention

Study Findings
·      Preterm children had more enamel defects (87%) than term children (44%)
·      Caries was more prevalent in preterm children but did not have a significant difference with term children
·      All children with tracheal intubation had enamel defects
·      Small at term postconceptual age (malnourished) was associated with enamel defects at 7.8x higher chance than well-nourished infants
·      Facial surfaces of anterior teeth were the areas most affected by enamel defects. Maxillary incisors were the most affected teeth. Lesions were more frequently observed in the incisal half.
·      Hypocalcification opacities were common than hypoplasias, which agrees with the gestational age of newborns in this study who were born between 25-37 weeks gestation
·      The complications associated with low birth weight (metabolic disorders like hypoglycemia, hypocalcemia, hypophosphatemia, hyponatremia; respiratory distress; sepsis; neurological disorders) may interfere with odontogenesis
·      Local effects of traumatic forces in anterior teeth of premature infants may be caused by laryngoscope during tracheal intubation

Assessment of Article:  Level of Evidence/Comments: II-2

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