By Pia Elisabeth Nørrisgaard
Summary
Chair person: Azam Bakhshandeh
Opponent: Ruth Santamaría
Opponent: David Manton
ABSTRACT
Dental health of children has significantly improved in industrialized countries through decades due to a substantial focus on the identification of risk factors and the improvement of preventive strategies. However, poor dental health is still a major problem worldwide and has a substantial impact on children’s well-being and quality of life. Children with dental diseases often need treatment very early in life, may experience pain, and over time develop anxiety for going to the dentist, which is a considerable burden for the child that may persist into adulthood. The two most common dental diseases among children are dental caries and enamel hypomineralization with prevalence of up to 90% and 42%, respectively.
Caries is a demineralization of the tooth structure resulting from acid, produced by the metabolism of sugar by specific bacteria on the tooth surface. Caries is often referred to as a lifestyle disease related to dietary habits and the standard of oral hygiene, while little is known about the impact of other early life risk factors. Enamel hypomineralization of developmental origin is present when the affected tooth erupts, and the lesions are hypomineralized with white, yellow, and/or-brown opacities. The mineral density in enamel hypomineralization is lower than in sound enamel, and in worst case the hypomineralized enamel will breakdown after eruption. The etiology of enamel hypomineralization is largely unknown and thereby no identified possible prevention is available.
The overall objective of this thesis was to determine risk factors for dental caries and enamel hypomineralization in the population-based COpenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC2010) mother-child cohort in the prenatal period and the first three years of life of the children, and thereby contribute to prevention strategies for the dental diseases. 700 children were followed from birth and attended several clinical
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examinations with extensive clinical data collection. They were invited for a comprehensive dental examination at age six years.
In paper I, the effect of a high-dose vitamin D supplementation during pregnancy on the risk of dental diseases of the offspring was investigated. The mothers of the COPSAC2010 cohort had participated in a randomized clinical trial in pregnancy, where one group received a standard dose vitamin D supplementation, and the other group received a sevenfold vitamin D supplementation. We found that in the group of mothers receiving the high-dose supplementation, the risk of enamel hypomineralization in the offspring by six years of age was significantly reduced, compared to the group with standard dose. No effect on the risk of caries was seen.
In paper II, we extensively assessed prenatal and early life exposures as risk factors for caries and enamel hypomineralization. We focused specifically on the use of inhaled asthma medication that was registered prospectively from birth. We found no associations between inhaled corticosteroids or β2‐agonists or asthma symptoms in early childhood and the risk of caries or enamel hypomineralization by six years of age. Furthermore, we found no strong pre-, peri-, or postnatal risk factors for dental diseases at six years, except from nominally significant associations between use of antibiotics in pregnancy, maternal education level, and having a dog at home and the risk of enamel hypomineralization.
In conclusion, these findings provide new knowledge on high-dose vitamin D supplementation in pregnancy as a preventive measure for enamel hypomineralization in the offspring with a potentially large effect on dental health, and a reassurance to physicians and parents of children with asthma that asthma and inhaled asthma medication do not affect the dental health status.
