Dental Outcomes of Preterm Infants

Diane L. Eastman, MA, RN, CPNP


NAINR. 2003;3(3) 

In This Article

Embryonic Development of the Dentition

Development of dentition begins as early as 4 weeks in utero and continues until approximately 20 years of age.[2] At 2 months gestation, primary tooth development begins and permanent teeth begin to form several months before birth. Premature birth may affect those teeth that are at a critical stage of development at this vulnerable time.

Teeth are formed by mineralization of a protein matrix. This process begins at about 4 months gestation and is not complete until late adolescence.[2] The essential nutrients required for dental development are calcium, phosphorus, fluoride, and vitamins A, C, and D. Collagen, the protein in dentin, must have vitamin C for normal synthesis. Enamel contains keratin, a protein that requires vitamin A for its formation. Calcium and phosphorus are the basic structural material of teeth, and vitamin D is needed for calcium and phosphorus to be deposited into the protein matrix.

At 40 weeks' gestation, mineralization of deciduous incisor crowns is nearly complete, and mineralization of the other deciduous crowns has begun. Calcification of the first permanent molar crown occurs at about 28 to 30 weeks gestation and is not complete until 3 to 4 years of age.[1] Formation of all anterior permanent teeth begins in utero but time to full development is highly variable.[1]

Maternal illness can impact tooth development and associated tooth abnormalities. Maternal diabetes, hypertension, preeclampsia, infection, and nutritional deficiencies have all been linked to size of the fetus and to oral abnormalities.[3,4] Maternal smoking has also been associated with smaller birth weight and reduced dimensions of the tooth crown.[1] Use of certain medications has also been associated with dental abnormalities.[1]


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