Foetal, neonatal and child vitamin D status and enamel hypomineralization.

Justin T Van Der Tas,Annemieke C Heijboer,Josje D Schoufour,Trudy Voortman,Edwin M Ongkosuwito,Vincent W.V Jaddoe,Fernando Rivadeneira,Marlies E.C Elfrink,Henriëtte A Moll,Henning Tiemeier,Eppo B Wolvius

doi:10.1111/cdoe.12372

Abstract

ObjectivesRecent literature suggested that higher vitamin D concentrations in childhood are associated with a lower prevalence of molar incisor hypomineralization (MIH). As tooth development already starts in utero, we aimed to study whether vitamin D status during foetal, postnatal and childhood periods is associated with the presence of hypomineralized second primary molars (HSPMs) and/or MIH at the age of six.MethodsOur study was embedded in the Generation R Study, a population‐based, prospective cohort from foetal life onwards in Rotterdam, the Netherlands. HSPMs and MIH were scored from intraoral photographs of the children at their age of six. Serum 25(OH)D concentrations were measured at three points in time, which resulted in three different samples; mid‐gestational in mothers’ blood (n = 4750), in umbilical cord blood (n = 3406) and in children's blood at the age of 6 years (n = 3983).ResultsThe children had a mean (±SD) age of 6.2 (±0.5) years at the moment of taking the intraoral photographs. After adjustment for confounders, no association was found between foetal 25(OH)D concentrations and the presence of HSPMs (OR 1.02 per 10 nmol/L higher 25(OH)D, 95% CI: 0.98‐1.07) or MIH (OR 1.05 per 10 nmol/L increase, 95% CI: 0.98‐1.12) in 6‐year‐olds. A higher 25(OH)D concentration in umbilical cord blood resulted in neither lower odds of having HSPM (OR 1.05, 95% CI: 0.98‐1.13) nor lower odds of having MIH (OR 0.95, 95% CI: 0.84‐1.07) by the age of six. Finally, we did not find higher 25(OH)D concentrations at the age of six to be associated with a significant change in the odds of having HSPM (OR 0.97, 95% CI: 0.92‐1.02) or MIH (OR 1.07, 95% CI: 0.98‐1.16).Conclusions25(OH)D concentrations in prenatal, early postnatal and later postnatal life are not associated with the presence of HPSMs or with MIH at the age of six. Future observational research is required to replicate our findings. Furthermore, it is encouraged to focus on identifying other modifiable risk factors, because prevention of hypomineralization is possible only if the causes are known.

Highlights

Dental enamel hypomineralization is an anomaly of dental enamel in which the affected enamel contains less mineral than sound enamel and is more susceptible to caries.[1,2,3] This anomaly can be divided into hypomineralization of second primary molars, called hypomineralized second primary molars (HSPMs), and hypomineralization of permanent first molars, called molar incisor hypomineralization (MIH).[3,4,5] In patients with MIH incisors of the upper jaw can be involved and in rare cases incisors of the lower jaw.[3]
Because vitamin D is important in the mineralization of these tissues, it is noteworthy that we recently discovered that lower bone mass is associated with the presence of HSPM but not with MIH in 6-year-old children.[21]
Our findings provide no evidence for an association between 25(OH) D status during foetal life, at birth or at age six with the presence of HSPMs or MIH in 6-year-olds

Summary

Introduction

Dental enamel hypomineralization is an anomaly of dental enamel in which the affected enamel contains less mineral than sound enamel and is more susceptible to caries.[1,2,3] This anomaly can be divided into hypomineralization of second primary molars, called hypomineralized second primary molars (HSPMs), and hypomineralization of permanent first molars, called molar incisor hypomineralization (MIH).[3,4,5] In patients with MIH incisors of the upper jaw can be involved and in rare cases incisors of the lower jaw.[3] hypomineralization is not restricted to those few index teeth and can be diagnosed in any tooth of both dentitions, a patient can only be diagnosed with HSPM/MIH if he or she has at least one affected second primary molar or first permanent molar, respectively.[6] The prevalence of HSPMs is about 4.9% in 6-year-old Dutch children.[7] For MIH, the prevalence ranges between 8% and 19% among Dutch and Scandinavian children aged six to thirteen years.[3,5,7,8] Children with HSPM have a higher chance of developing MIH.[9,10] Identifying modifiable risk factors is important to prevent development of dental enamel hypomineralization in children

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