PEDIATRIC DENTISTRY

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SEP / OCT 15

Guest Editorial
The Influence of Early Life Events on Adult Oral Health: The Role of Pediatric Dentistry
Recently, available research from various health and science disciplines point to the profound and long-term impact early
life events can have on oral health long beyond childhood.
These diverse streams of new knowledge bolster the already well
established role and need for pediatric dentistry as a specialty.
The pediatric dental specialist, working interdisciplinarily with
other pediatric health professionals, is uniquely positioned to
influence many of those events to alter the trajectory of oral
health or disease.
Emerging evidence in the following fields: mode of birth,
early childhood food preferences, feeding habits, illnesses and
medical treatments, environmental exposures, and early childhood dental disease, points to sequelae beyond childhood
(Figure).
Mode of birth/delivery. Modes of delivery shape the acquisition and structure of the initial microbiota across multiple
body habitats in newborns1. Vaginal delivery of babies exposes
them to the bacteria in the birth canal. These early colonizers
influence the succeeding bacteria, which are more compatible
with health.1-5 In contrast, C-section babies are predisposed to
the early acquisition of pathogenic oral species including cariogenic bacteria.2-5 Also, caesarean deliveries have now been tied
to obesity, asthma, and allergies,6 probably due to missing out
on the benefits of the mothers microbiome. Unfortunately,
rates of elective C-sections are on the rise in countries with an
expanding affluent middle class.7
Food preferences. An individuals food preferences are influenced by exposures to tastes and textures early in life.8-11 Some
evidence even points to a childs prenatal exposure depending on
the mothers food preferences during pregnancy,10 which often
change radically due to hormonal changes. All children are born
with a natural predilection for sweet and salty tastes and energy
dense foods that are characterized as junk food.8-11 In addition
to the overall health hazards of such foods, the dental community is well aware of the effects of frequent exposures of such
foods on oral health.11 Fortunately, research also shows us how
childrens food preferences can be molded through persistent,
repeated early exposure to healthy food choices, despite a childs
natural initial resistance.12 A stark example of such an influence
is resistance of infants to breastfeeding when they are exposed
to artificially sweetened beverages, thus not only depriving them
of all the well-known benefits of breastfeeding but also exposing
them to all the well-know detriments of sugary drinks.13,14
Infant feeding habits. The developmental and emotional
benefits of breastfeeding for both mother and child are welldocumented.14 New and mounting evidence now points to the
benefits of breastfeeding for normal oral and dental development. For example, longer duration (equal to or greater than
nine months) of breastfeeding in children is being associated
with a lesser frequency of children engaging in non-nutritive

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sucking habits. 15,16 In non-breastfed children, a higher frequency of non-nutritive sucking habits is seen, which in turn
translates into reduced intra-arch transverse dimensions,
leading to increased prevalence of posterior crossbites and
anterior open bites15,16. Additionally, babies who feed from a
bottle, especially while lying down,17 tend to have more ear
infections than do babies who are breast-fed. The connections between ad-lib feeding without oral hygiene, early childhood caries, ear infections and the antibiotic treatments for
those infections should be apparent to all pediatric dentists.
Illnesses and medical treatments. Children are born with
immature immune systems and thus experience multiple bacterial or viral infections in the first few years of life. Examples
of such conditions include streptococcal or respiratory syncytial
virus (RSV) middle ear infections,18 which are often treated by
the childrens physicians with antibiotics.20,21 This age window
also coincides with mineralization stages of the permanent
anterior teeth and the first permanent molars leading to hypomineralization defects of those teeth, a condition that readers
will recognize as Molar-Incisor-Hypomineralization (MIH).20,21
Teeth afflicted with severe MIH require treatment and maintenance long beyond childhood years.
Environmental exposures. The dangers of inhalation or
ingestion of particulates from cigarette smoke to overall health
are well-known.21 How these environmental toxins affect oral
bacterial flora is being studied by many groups. Even trace
amounts of these toxins are believed to alter the oral biofilm
in babies who might be exposed to second or third hand
smoke.22,23 Early acquisition of cariogenic microflora contributes to ECC. The association of higher rates of ECC in households where a parent/s smoke is well documented in the dental
literature.24,25

Figure. Some key events and behaviors from early childhood that can
influence the oral health of an individual as an adult.

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Early childhood dental disease. Lastly, the relationship

between ECC and adult caries is well recognized. A 2012 study
by the author and co-workers26 found a 7-fold higher DMFT
in those adults who had a history of S-ECC and who required
treatment under general anesthesia as compared with those
adults who had no caries in their primary dentition. That study
and others of a similar nature,27 have suggested that an individuals risk for dental caries is likely established early in life
and therefore can and should be managed for preventing future
disease, starting in early childhood.
Taken together, the emerging body of evidence points towards the influence of early childhood events on the life-long
oral health of an individual. Pediatric dentists have a unique
opportunity to influence not only families in their care but
also their medical colleagues for better health outcomes. Given
the need for some medically necessary interventions for general health conditions, oral consequences of those interventions
will sometimes be inevitable and unavoidable, and will have to
be managed by a dentist. However, an updated perspective on
the etiology of early childhood conditions might lead to more
prudent and judicious advice to families for improved oral
health outcomes not just in childhood but also adulthood.
Early anticipatory guidance should include discussions on the
above topics as applicable to individual families.

References

1. Maria G, Dominguez-Belloa EK, Costellob MC, Magda

M, Glida H, Noah F, Rob K. Delivery mode shapes the
acquisition and structure of the initial microbiota across
multiple body habitats in newborns. PNAS 2010;107:
11971-5.
2. Zaura E, Nicu EA, Krom BP, Keijser BJ. Acquiring and
maintaining a normal oral microbiome: current perspective. Front Cell Infect Microbiol 2014;4:85.
3. Lif Holgerson P, Harnevik L, Hernell O, Tanner AC, Johansson I. Mode of birth delivery affects oral microbiota
in infants. J Dent Res 2011;90(10):1183-8.
4. Nelun Barfod M, Magnusson K, Lexner MO, Blomqvist
S, Dahln G, Twetman S. Oral microflora in infants delivered vaginally and by caesarean section. Int J Paediatr
Dent 2011;21(6):401-6.
5. Li Y, Caufield PW, Dasanayake AP, Wiener HW, Vermund
SH. Mode of delivery and other maternal factors influence the acquisition of Streptococcus mutans in infants. J
Dent Res 2005;84(9):806-11.
6. Sevelsted A, Stokholm J, Bnnelykke K, Bisgaard, H. Cesarean section and chronic immune disorders. Pediatrics
2015;135(1):e92-8.
7. Gibbons L, Belizn JM, Lauer JA, Betrn AP, Merialdi M,
Althabe F. The Global numbers and costs of additionally needed and unnecessary caesarean sections performed
per Year: Overuse as a barrier to universal coverage.
World Health Report 2010; Background Paper, No 30.
Health Systems Financing. The Path of Universal Coverage. World Health Organization. Available at: http://
www.who.int/healthsystems/topics/financing/healthreport/
30C-sectioncosts.pdf . Accessed September 21, 2015.
8. Mennella, JA, Ventura, AK. Understanding the basic biology underlying the flavor world of children. Current
Zoology 2010;56:834-41.
9. Gugusheff JR, Ong ZY, Muhlhausler BS. The early origins
of food preferences: targeting the critical windows of
development. FASEB J 2015;29(2):365-73.

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10. Ventura AK, Worobey J. Early influences on the development of food preferences. Current Biology 2013;23(9):
R401-8.
11. Alanzi A, Minah G, Romberg E, Catalanotto F, Bartoshok L, Tinanoff N. Motherss Taste Perceptions and Their
Preschool Childrens Dental Caries Experience. Pediatric
Dent 2013;35(7):510-4.
12. Mennella JA. Ontogeny of taste preferences: basic biology and implications for health. Am J Clin Nutr 2014;
99(3):704S-11S.
13. American Academy of Pediatrics, Committee on Nutrition. American Academy Of Pediatrics: The Use and
Misuse of Fruit Juice in Pediatrics. Pediatrics 2001;107
(5):1210-13.
14. American Academy of Pediatrics. Policy on Breastfeeding and Use of Human Milk. Pediatrics 2012;129(3):
e827-41.
15. Scavone-Jr H, Guimares-Jr CH, Ferreira RI, Nahs AC,
Vellini-Ferreira F. Association between breastfeeding
duration and non-nutritive sucking habits. Community
Dent Health2008;25(3):161-5.
16. Agarwal SS, Nehra K, Sharma M, Jayan B, et al. Association between breastfeeding duration, non-nutritive
sucking habits and dental arch dimensions in deciduous
dentition: a cross-sectional study. Progress in Orthodontics
2014;15:59-67. Available at: http://www.progressinor
thodontics.com/content/15/1/59. Accessed September
21, 2015.
17. Tully SB, Bar-Haim Y, Bradley RL. Abnormal tympanography after supine bottle feeding. J Pediatr 1995;126
(6):S105-11.
18. Murphy TF, Chonmaitree T, Barenkamp S, Kyd J, et al.
Panel 5: Microbiology and immunology panel. Otolaryngol Head Neck Surg 2013;148(4 Suppl):E64-E89.
19. Laisi S, Ess A, Sahlberg C, Arvio P, Lukinmaa PL, Alaluusua S. Amoxicillin may cause molar incisor hypomineralization. J Dent Res 2009;88(2):132-6.
20. Allazzam SM, Alaki SM, El Meligy OAS. Molar incisor
hypomineralization, prevalence, and etiology. Int J Dent
2014;2014:234508.
21. Thacher JD, Gruzieva O, Pershagen G, Neuman A, et
al. Pre- and postnatal exposure to parental smoking and
allergic disease through adolescence. Pediatrics 2014;134
(3):428-34.
22. Kumar PS, Matthews CR, Joshi V, de Jager M, Aspiras M.
Tobacco smoking affects bacterial acquisition and colonization in oral biofilms. Infect Immun 2011;79(11):
4730-8.
23. Hutcherson JA, Scott DA, Bagaitkar J. Scratching the
surface-tobacco-induced bacterial biofilms. Tob Induc
Dis 2015;13(1):1-7.
24. Hanioka T, Ojima M, Tanaka K, Yamamoto M. Does
secondhand smoke affect the development of dental caries
in children? A systematic review. Int J Environ Res Public
Health 2011;8(5):1503-19.
25. Majorana A, Cagetti MG, Bardellini E, Amadori F, Conti
G, Strohmenger L, Campus G. Feeding and smoking
habits as cumulative risk factors for early childhood caries
in toddlers, after adjustment for several behavioral determinants: a retrospective study. BMC Pediatrics 2014;
14(1):45-53.

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26. Nicolae A. Is severe early childhood caries associated with

dental caries in adulthood? A pilot project, University of
Toronto, Master of Science thesis; 2012:1-64. Available
at: https://tspace.library.utoronto.ca/bitstream/1807/
33700/5/Nicolae_Alexandra_201211_MSc_thesis.pdf .
Accessed September 21, 2015.

27. Li Y, Wang W. Predicting caries in permanent teeth from

caries in primary teeth: An eight-year cohort study. J Dent
Res 2002;81(8):561-6.

Gajanan Kulkarni, BDS, MSc, DPed Dent, PhD, FRCD(C)
Diplomate, American Board of Pediatric Dentistry
Associate Professor, Pediatric and Preventive Dentistry
University of Toronto, Faculty of Dentistry

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