Dental Outcomes of Preterm Infants

Diane L. Eastman, MA, RN, CPNP

Disclosures

NAINR. 2003;3(3) 

In This Article

Implications for Long-Term Care and Follow-Up

From the literature review, it is clear that primary and permanent teeth of the preterm infant can be affected in a variety of ways. Risk factors for dental problems are linked to a number of prenatal and postnatal conditions. The dental problems discussed may, in some cases, be permanent and cannot be corrected. Some problems can be minimized with good dental care.

Education of both health care professionals and parents regarding overall dental health is important not only to minimize problems but also to promote good overall health. Health care providers need to include oral health and dental care as part of a routine examination and discussion with parents. Parent education needs to focus on preventive dental care and why good dental health is important. Parents need to appreciate the link between the oral cavity and systemic health issues as well. Maternal dental care and good prenatal care must also be included in the education provided.

Good dental hygiene is important for all infants and toddlers, especially for preterm infants who are at higher risk for dental problems. Parents should be given a demonstration of how to properly clean their child's teeth, starting with the eruption of the first tooth. Teeth should be cleaned routinely after feedings and especially at bedtime. Fluoride-containing toothpaste should not be used until the child has some control of the swallowing reflex and only "pea size" amounts should be used then. Young children swallow much of the toothpaste and this may lead to systemic overexposure to fluoride and subsequent mild discoloration of developing teeth.[34]

Feeding practices should be assessed and monitored carefully at each follow-up visit. To prevent caries, prolonged use of bottles, especially at night, and sippy cups should be discouraged.[34] Discussion with parents should begin before the first tooth has erupted. It is not uncommon to find former preterm toddlers still drinking from a bottle long after the age when they are developmentally ready to progress to a cup. Preterm infant development should be monitored closely for readiness to begin using a cup. Toddlers who are developmentally functioning at 12 to 14 months are capable of transitioning to a cup. Growth and feeding is often a problem for premature infants. Many parents are hesitant to give up the bottle fearing their child may not eat and grow as well. More frequent monitoring of growth may be needed at this time to support parents in their effort to wean to a cup. Prolonged at-will breastfeeding should also be discussed after tooth eruption has occurred since infants who fall asleep while nursing may be at a higher risk of developing caries.[34] Infants should not be put to bed with a bottle containing anything other than water.

Parents need to be made aware of the important role of nutrition and good dental health. A thorough diet history is important to obtain at each follow-up visit. A referral to a dietician may be needed to assist if the child eats a very small variety of foods and is not receiving the recommended daily nutrient requirements. Education regarding which high carbohydrate foods and drinks promote decay should be provided. High carbohydrate foods that should be limited include crackers, presweetened cereals, muffins, breads, cookies, potato chips, and dried fruits. Foods that are less likely to contribute to caries development are high in protein, low in carbohydrates, high in calcium, and textures that stimulate saliva secretion. Cheese, meats, eggs, and some vegetables are in this group. Sweet carbonated drinks should be avoided. Juices are high in carbohydrates and should be offered sparingly only with meals. They should not be sipped all day from a cup or bottle.

There is considerable difference in the relative decay potential of the various infant formulas available on the market.[35] From in vitro studies, most infant formulas cause plaque pH to decrease to less than that associated with cavity formation.[36,37] This was also confirmed in vivo studies.[37] Considerable differences between the different brands and types of formulas were noted when the decay potential was quantified in these studies. Soy formulas rated the highest for cariogenic potential.[35]

Medications used commonly in pediatrics contain sucrose. Parent education is important when prescribing or reviewing medications at each health visit. Almost all liquid antibiotics contain sucrose.[34] Children receiving these medications should have their teeth cleaned after each dose. Substituting sugar-free formulations should be considered whenever possible.[34]

Fluoride supplementation should be prescribed as appropriate. The fluoride content in the primary water source must be determined before supplementation can be appropriately prescribed. Parents need to be educated about fluoride use and the dangers of excessive fluoride intake, which can lead to a mottled discoloration of the enamel ranging from chalky white to brown staining.[34]

The American Academy of Pediatric Dentistry (AAPD), the American Dental Association (ADA), and other dental organizations recommend that the first dental visit should be around 1 year of age.[35] Health care providers need to monitor and assess the oral cavity at each visit and recommend dental visits begin no later than 1 year of age. It is important for preterm infants who are at higher risk for dental problems to be evaluated by this time. Assisting parents to access dental services for these infants and toddlers is imperative. Promoting good oral health is an important aspect of promoting good overall health. Good dental care should be emphasized to parents of all preterm infants. At the first sign of dental abnormalities, referral to a dentist should be initiated. Before the age of 3 years, some family dentists are unwilling to see the child. In this case, a referral to a pediatric dentist should be made.

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