Unconjugated Hyperbilirubinemia and Early Childhood Caries in a Diverse Group of Neonates

ABSTRACT

We evaluated if the development of early childhood caries is associated with the severity of unconjugated hyperbilirubinemia during the first 2 weeks after birth. We performed a retrospective case-control study of children less than 6 years of age seen for comprehensive dental examination by pediatric dentists years following a hospital stay in the neonatal intensive care unit. Exclusion criteria included genetic disorders, cleft palate, direct hyperbilirubinemia, and missing information on jaundice. Children with early childhood caries were compared with those without dental caries for a panel of perinatal and neonatal clinical variables. Seventy-six children met study criteria. Of 76 children, 42 children had early childhood caries, while 34 children had healthy primary dentitions. Among clinical variables, only race and peak total serum bilirubin concentration differed significantly between the two groups on bivariate analysis. On logistic regression, peak total serum bilirubin concentration was significantly associated with early childhood caries (adjusted odds ratio 1.17, 95% confidence interval 1.04 to 1.32). Neonatal unconjugated hyperbilirubinemia may be associated with early childhood caries in children.

KEYWORDS

Dental enamel hypoplasia - free bilirubin - total serum bilirubin - dental caries

REFERENCES

• 1 Aine L, Backström M C, Mäki R et al.. Enamel defects in primary and permanent teeth of children born prematurely.  J Oral Pathol Med. 2000;  29 403-409
• 2 Seow W K, Humphrys C, Tudehope D I. Increased prevalence of developmental dental defects in low birth-weight, prematurely born children: a controlled study.  Pediatr Dent. 1987;  9 221-225
• 3 Fearne J M, Bryan E M, Elliman A M, Brook A H, Williams D M. Enamel defects in the primary dentition of children born weighing less than 2000 g.  Br Dent J. 1990;  168 433-437
• 4 Lai P Y, Seow W K, Tudehope D I, Rogers Y. Enamel hypoplasia and dental caries in very-low birthweight children: a case-controlled, longitudinal study.  Pediatr Dent. 1997;  19 42-49
• 5 Pascoe L, Seow W K. Enamel hypoplasia and dental caries in Australian aboriginal children: prevalence and correlation between the two diseases.  Pediatr Dent. 1994;  16 193-199
• 6 Oliveira A F, Chaves A M, Rosenblatt A. The influence of enamel defects on the development of early childhood caries in a population with low socioeconomic status: a longitudinal study.  Caries Res. 2006;  40 296-302
• 7 Montero M J, Douglass J M, Mathieu G M. Prevalence of dental caries and enamel defects in Connecticut Head Start children.  Pediatr Dent. 2003;  25 235-239
• 8 American Academy on Pediatric Dentistry . Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies.  Pediatr Dent. 2008-2009;  30(7 Suppl) 40-43
• 9 Acs G, Shulman R, Ng M W, Chussid S. The effect of dental rehabilitation on the body weight of children with early childhood caries.  Pediatr Dent. 1999;  21 109-113
• 10 Almeida A G, Roseman M M, Sheff M, Huntington N, Hughes C V. Future caries susceptibility in children with early childhood caries following treatment under general anesthesia.  Pediatr Dent. 2000;  22 302-306
• 11 Graves C E, Berkowitz R J, Proskin H M, Chase I, Weinstein P, Billings R. Clinical outcomes for early childhood caries: influence of aggressive dental surgery.  J Dent Child (Chic). 2004;  71 114-117
• 12 Casamassimo P S, Thikkurissy S, Edelstein B L, Maiorini E. Beyond the dmft: the human and economic cost of early childhood caries.  J Am Dent Assoc. 2009;  140 650-657
• 13 Funakoshi Y, Kushida Y, Hieda T. Dental observations of low birth weight infants.  Pediatr Dent. 1981;  3 21-25
• 14 Grahnén H, Sjölin S, Stenström A. Mineralization defects of primary teeth in children born pre-term.  Scand J Dent Res. 1974;  82 396-400
• 15 Via Jr W F, Churchill J A. Relationship of enamel hypoplasia to abnormal events of gestation and birth.  J Am Dent Assoc. 1959;  59 702-707
• 16 Massler M, Perlstein M A. Prenatal dental enamel dysplasia, with special reference to its occurrence in kernicterus.  Am J Phys Med. 1956;  35 324-325
• 17 Solyga P. [Clinical follow-up studies on late prognosis of Rh-related hemolytic disease of the newborn. II. Stomatologic findings].  Padiatr Grenzgeb. 1970;  9 162-175
• 18 Weber H, Ströder J. [Late damage after Rh-erythroblastosis, ABO-erythroblastosis and hyperbilirubinemia in the neonate (author's transl)].  Klin Padiatr. 1973;  185 383-399
• 19 Forrester R M, Miller J. The dental changes associated with kernikterus.  Arch Dis Child. 1955;  30 224-231
• 20 Deutsch D, Pe'er E. Development of enamel in human fetal teeth.  J Dent Res. 1982;  Dec(Spec No) 1543-1551
• 21 Hals E, Grahnén H. The effect of hyperbilirubinaemia on primary teeth. II. A histological and microradiographic study.  Odontol Revy. 1965;  16 182-192
• 22 Amin S B. Clinical assessment of bilirubin-induced neurotoxicity in premature infants.  Semin Perinatol. 2004;  28 340-347
• 23 Seow W K, Perham S. Enamel hypoplasia in prematurely-born children: a scanning electron microscopic study.  J Pedod. 1990;  14 235-239
• 24 Seow W K, Young W G, Tsang A K, Daley T. A study of primary dental enamel from preterm and full-term children using light and scanning electron microscopy.  Pediatr Dent. 2005;  27 374-379
• 25 Seow W K, Masel J P, Weir C, Tudehope D I. Mineral deficiency in the pathogenesis of enamel hypoplasia in prematurely born, very low birthweight children.  Pediatr Dent. 1989;  11 297-302
• 26 Johnsen D, Krejci C, Hack M, Fanaroff A. Distribution of enamel defects and the association with respiratory distress in very low birthweight infants.  J Dent Res. 1984;  63 59-64
• 27 Grahnén H, Edlund K. Maternal diabetes and changes in the hard tissues of primary teeth. I. A clinical study.  Odontol Revy. 1967;  18 157-162
• 28 Seow W K, Brown J P, Tudehope D I, O'Callaghan M. Developmental defects in the primary dentition of low birth-weight infants: adverse effects of laryngoscopy and prolonged endotracheal intubation.  Pediatr Dent. 1984;  6 28-31
• 29 Seow W K, Perham S, Young W G, Daley T. Dilaceration of a primary maxillary incisor associated with neonatal laryngoscopy.  Pediatr Dent. 1990;  12 321-324