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Brian A. Burt, B.D.S., Ph.D., M.P.H., and Satishchandra Pai, B.D.S., M.D.S., M.P.H.:

The Relationship Between Low Birthweight and Subsequent Development of Caries: A Systematic Review

Low birthweight is a public health issue because it is closely related to infant mortality and a host of infant morbidity conditions. In 1997, 7.5 percent of all live births in the United States were babies of low birthweight (<2500 grams), and 1.4 percent were of very low birthweight (<1500 grams). Risk factors for low birthweight include maternal age (both <17 and >34 years), low socioeconomic status, the mother¹s being unmarried, and poor obstetric care during pregnancy. One especially depressing fact is that the proportion of low birthweight babies has remained fairly constant over the last 30 years.

The relationship between low birthweight and dental condition has not received much attention, and most of what has been done looks at enamel defects, such as hypoplasia, in low birthweight children. Little is known about whether low birthweight children are more prone to develop caries in later life, so this review addresses the following question: Do low birthweight children (birthweight <2500 grams) subsequently develop more caries than children with normal-to-high birthweight?

Material and Methods

Our study began with a search of the MEDLINE and EMBASE databases for English-language papers published between January, 1966, and July, 2000. Search terms included low birthweight, normal birthweight, premature birth, maternal nutrition, nutrition in pregnancy, enamel hypoplasia, hypomineralization, and hypomineralized enamel. The search terms were drawn up by an experienced librarian, and the full search expression is available from the authors on request.

The initial search produced a total of 198 reports. The first assessment was made by title and abstract, and clearly irrelevant articles were discarded. This reduced the original 198 reports to 37. These 37 were read in full by two readers. Another 33 papers were then eliminated because they did not satisfy all of our inclusion/exclusion criteria; the few differences between the readers at this point were settled by consensus.

Categories for scoring the quality of individual papers were established by the two readers, with a maximum score of 100 for each category. Table 1 shows the categories.

Table 1. Scoring categories for studies of low birthweight relation to caries

Clearly-stated research aims							12
Number of controls							10
Nature of controls							10
Stated inclusion/exclusion criteria for participants							7
Individual birthweights certified							8
Level of caries diagnosed (cavitated, noncavitated)							6
Nature of caries diagnosis (clinical, x-ray, FOTi, etc.)							7
Examiner reliability quantified							8
Confounders accounted for							12
Measure of risk stated							8
Internally valid conclusions							12
			Total:				100

The Results

Only four papers qualified under the criteria applied. These were read by both readers, and the few minor differences were settled by consensus. The scores for the four papers were 61, 60, 49, and 31. None of these papers reported any relationship between low birthweight and caries development.

Discussion

One of the reports involved children who were examined soon after eruption of their primary teeth, while the others involved children between 3 and 5 years of age. All four studies assessed the condition of the primary dentition only. (That is, no study was found that related caries in the permanent dentition to low birthweight.) It should be noted, however, that many of the 37 studies found a relationship between developmental defects of enamel and low birthweight, though that issue was not specifically studied. The literature also seems to assume that developmental enamel defects are more prone to become carious than normal enamel. Low birthweight is clearly a health problem to be prevented as far as possible, and seems to be related to conference questions 2 and 5:

2. What are the best indicators for an increased risk of dental caries?

If low birthweight does turn out to be associated with caries development, the link could either be a directly biological one through hypoplasia and other enamel defects, or it could be because low birthweight is so often a marker for deprived circumstances and all the caries risks that come with it. This review, however, found no evidence that low birthweight in itself is a risk factor for caries.

5. How should clinical decisions regarding prevention and/or treatment be affected by detection methods and risk assessment?

When clinicians are treating a low birthweight child for caries treatment or prevention, the child should be considered at high risk of caries. Even though a direct link has not been established, low birthweight is a marker of social deprivation that often leaves a child at high risk.

Further research could include documenting any link between developmental enamel defects and subsequent caries development, and the role of birth complications, frequently with the use of ventilators and intubation, in the later development of caries. Studies should also be conducted with older children to assess the effect of low birthweight on the permanent dentition.

References

Fearne JM, Bryan EM, Elliman AM, Brook AH, Williams DM. Enamel defects in the primary dentition of children born weighing less than 2000 g. Br Dent J 1990;168:433­7.

Lai PY, Seow WK, Tudehope DI, Rogers Y. Enamel hypoplasia and dental caries in very-low birthweight children: a case-controlled, longitudinal study. Pediatr Dent 1997;19:42­9.

Li Y, Navia JM, Bian JY. Caries experience in deciduous dentition of rural Chinese children 3-5 years old in relation to the presence or absence of enamel hypoplasia. Caries Res 1996;30:8­15.

Peretz B, Kafka I. Baby bottle tooth decay and complications during pregnancy and delivery. Pediatr Dent 1997;19:34­6.

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Index of Abstracts | Agenda.

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Background | Agenda | Questions/Topics | Searches | Abstracts

The main page for this site is located at http://www.lib.umich.edu/dentlib/nihcdc/ and is maintained by the University of Michigan Dentistry Library (dentistry.library@umich.edu) in partnership with the National Institutes of Health, National Institute of Dental and Craniofacial Research. Please see also the Consensus Development Program pages, and in particular the NIH Consensus Development Conference on Caries. Copyright © 2000 Regents of the University of Michigan. All rights reserved. URL of current page: http://www.lib.umich.edu/dentlib/nihcdc/abstracts/burt3.html Last Update: 10:32 AM EST on Monday, December 31, 2007

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