The Special Needs of Preterm Children – An Oral Health Perspective

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Key points

  • Preterm low birthweight children are at higher risks of orodental anomalies and acquired oral conditions.

  • Oral health care for preterm children should commence as early as possible to enable early risk assessment, detection, and management of orodental anomalies and prevention of acquired oral conditions, through the establishment of a dental home.

  • Parents and carers of preterm children need to be provided with timely advice and support regarding oral health in the context of general health,

Developmental Enamel Defects

The prevalence of developmental enamel defects may be as high as 96% among infants born preterm and/or very low birthweight and extremely low birthweight.15, 17, 18, 19, 20, 21 The incidence and severity of developmental enamel defects are highest among the sickest preterm infants and preterm infants with congenital conditions or syndromes.15, 22, 23

The most commonly affected teeth are the primary incisors, molars, and canines (Fig. 2, Fig. 3, Fig. 4).19, 24, 25, 26 Maxillary teeth tend to be

Dental Home and Risk Assessment

Given that preterm infants, in particular, preterm infants with low birthweights, are at higher risks of oral conditions compared with infants born full-term and/or with normal birthweights, early dental consultation with a specialist pediatric dentist or general dentist experienced with managing young children may be of benefit. This is likely most beneficial when the pediatric dentist or general dentist contributes as part of a multidisciplinary growth and development health care team, so

Developmental enamel defects

The presence of developmental enamel defects increases the likelihood of dentine exposure and hypersensitivity, dental caries, tooth wear, and, if anteriorly located, aesthetic concerns.10, 15, 38, 39, 54, 98 The presence of developmental enamel defects in the primary dentition exponentially increases the likelihood of early childhood caries, more specifically “hypoplasia-associated early childhood caries (HAS-ECC)” (see Fig. 7).39, 54, 99 In addition, given that enamel formation of the

Dental caries

Given that preterm infants are potentially at greater risk of early childhood caries than their full-term counterparts due to multiple factors, including higher risk of enamel defects; medication-related issues, such as sugar content in medications and medication-induced xerostomia; high-caloric diets that are often also high in sugar, and so forth, caries risk assessment, early risk-based prevention, and anticipatory guidance are of high priority.

Preterm infants assessed as at high caries risk

Tooth wear

Tooth wear in primary teeth resulting in dentine exposure and symptoms increases with age; therefore, identification of risks and then implementing risk-based prevention is of utmost importance.58, 60, 108 Agents, such as CPP-ACP and combined polyvalent metal ions with fluorides, have been suggested for the prevention of tooth wear, in particular erosion, through remineralization of surface enamel.57, 101, 109, 110 Severe tooth wear may render restoration, stainless steel crown, pulp therapy,

Tooth, dental arch, palatal anomalies, and malocclusion

Preterm infants may be at greater risk of tooth anomalies, dental arch deformations, palatal anomalies, and malocclusion due to both systemic (eg, clefts and hypotonia) and local (eg, prolonged oral intubation and prolonged non-nutritive sucking habits) factors. Therefore, parents and carers should be advised of these possibilities to reduce anxiety and increase coping.

Prevention may or may not be possible, depending on risk factors. Interception and/or treatment options are available, however,

Summary

Preterm infants, especially preterm infants with low, very low, or extremely low birthweights, are at potentially higher risks of developmental oral anomalies and acquired oral conditions. These are not limited to the primary dentition but also may involve the permanent dentition. Furthermore, complications are not limited to teeth but also may affect anatomic structures, such as the palate. Strategies for optimizing the oral health of preterm infants should involve early risk assessment,

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      Citation Excerpt :

      It is believed that the onset of oral diseases, changes in orofacial growth and malocclusions is usually a gradual process that begins in early childhood, justifying early preventive and interceptive actions that promote oral health and adequately stimulate all structures of the stomatognathic system to favour the harmonious growth and development of the entire orofacial complex. Ideally, these efforts to promote child oral health should begin early and be implemented by pediatricians and pediatric dentists working in an integrated manner and using strategies specific to the needs of preterm infants.8–10 The face and oral cavity should not be neglected during neonatal physical examinations, especially of very low-birth-weight preterm infants, and a neonatal dental examination consisting of an extra and intraoral morphological and functional examination guided by an integrative axis established through dialogue and the exchange of multidisciplinary knowledge must be included to ensure the best, most individualized neonatal care possible.

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