Paying special attention to oral health is key to promoting overall good general health and fostering well-being and a good quality of life.1 With this in mind, pediatric dental care should be linked together with measures aimed at prenatal and neonatal care with a view to promoting good oral health, and this should continue throughout childhood and adolescence.
The characteristics of a newborn’s stomatognathic system are precisely designed for sucking and swallowing whilst breathing nasally, which supports breastfeeding and overall growth and development.2 Following the recommendations of the WHO, it has been established that exclusively breastfeeding for a period of six months and continuing to breastfeed thereafter until the age of two (or more) alongside a complementary and balanced diet, in line with pediatrician guidance, provides a natural and optimal scenario to stimulate harmonious craniofacial growth and development. This has positive outcomes on later stages of life.3,4 As such, and assuming it is a viable choice for the mother-child dyad, breastfeeding as an exclusive form of feeding for newborns should be encouraged and advocated. However, it’s possible that alterations in the pre-, peri- or postnatal period may occur with repercussions for the oral cavity, which hinder or prevent oral functionality and breastfeeding, or may cause parents to doubt this functionality.5,6,7,8 This context highlights the importance of professional dental consultations in the neonatal phase for prompt diagnosis, leading to monitoring or even to immediate multi-disciplinary dental treatment.9 In turn this brings into focus oral health from an early age alongside appropriate child growth and development.
Changes or dysfunctions in the orofacial complex may occur due to the own prematurity by deprivation of the period of growth and development intrauterine life is involved in prematurity, leading to physiological immaturity and neurological condition or complications and morbidities soon after birth. There is to mention that there may be other complex modifying factors associated with prematurity, such as congenital craniofacial alterations, muscle hypotonia, and orofacial asymmetries. In addition, during the period of hospitalization in the Neonatal Intensive Care Unit, some the neonatal morbidities lead to the need for the use of devices used orally, such as invasive mechanical ventilation and orogastric tube, or even harmful oral habits and an inappropriate position of the head and neck in the incubator, which may reflect changes in growth and development of the structures of the craniofacial complex, since behaviors and environment factors are capable of interfere in the process of formation of these structures and their functions.10,11,12,13,14,15
Several studies describe how prematurity can increase the risk of maxillary atresia, variations in muscle tone and orofacial motricity, as well as the risk of deficiency in the quality of sucking, swallowing, and nasal breathing, leading to future consequences for oral health, such as malocclusion. In addition, studies show variations in dental enamel formation, such as hypoplasia (quantitative defect) and hypomineralization (qualitative defect), resulting in sensitivity, dental fracture, dental caries, and aesthetic impairment in children’s smiles.16,17,18,19,20
In this context, Ruiz et al. (2021) suggest that the pediatric dentist join the team of health professionals who work with preterm and term newborns, aiming to promote oral health with adequate growth and orofacial development. These authors describe a model protocol for Neonatal Dental Examination that should take place after adequate identification, careful anamnesis, and thorough global examination of the newborn born, with dental emphasis on the evaluation of the head, neck, face, movements of the temporomandibular joints and all structures and functions of the oral cavity. They emphasize that this dental examination must follow procedures that respect all biosafety norms and with non-invasive actions, soft touch, delicate, precise, and minimal orofacial manipulation. Moreover, they promote the benefits of starting to monitor the occlusion of the gum pads, the relationship between the maxilla and the mandible and the growth and development of the other stomatognathic system structures, targeting measures that stimulate the future achievement of a balanced and functional occlusion in the deciduous dentition with facial harmony. In the case of these transdisciplinary measures, family support, understanding, and motivation are essential when it comes to following a lifestyle that promotes children’s oral health, through receiving proactive advice on topics such as:
so that pediatric dental consultations are made regularly throughout childhood and adolescence.
1 World Health Organization. Oral health [Internet]. 15 March 2022 [retrieved on April 28 2022 from Oral health (who.int)
2 World Health Organization. (2019). Ending childhood dental caries: WHO implementation manual. World Health Organization. https://apps.who.int/iris/handle/10665/330643. License: CC BY-NC-SA 3.0 IGO.
3 Boronat-Catalá M, Montiel-Company JM, Bellot-Arcís C, Almerich-Silla JM, Catalá-Pizarro M. Association between duration of breastfeeding and malocclusions in primary and mixed dentition: a systematic review and meta-analysis. Sci Rep. 2017 Jul 11;7(1):5048.
4 de Oliveira AJ, Duarte DA, Diniz MB. Oral Anomalies In Newborns: An Observational Cross-Sectional Study. J Dent Child (Chic). 2019 May 15;86(2):75-80.
5 Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in Neonates. Int J Clin Pediatr Dent. 2016;9(2):131-138.
6 Brogårdh-Roth S. The preterm child in dentistry. Behavioural aspects and oral health. Swed Dent J Suppl. 2010;(208):11-85.
7 Tsang AK. The Special Needs of Preterm Children - An Oral Health Perspective. Dent Clin North Am. 2016 Jul;60(3):737-56.
8 Wang Y, Briere CE, Xu W, Cong X. Factors Affecting Breastfeeding Outcomes at Six Months in Preterm Infants. J Hum Lact. 2019 Feb;35(1):80-89.
9 Ruiz DR. Clinical oral health care for newborn, infant and toddler. In: Andrade DJC, Ruiz DR, Groisman S, Coordinators. Promotion of maternal and child oral health. [ebook on the Internet]. São Paulo; 2022. 195 p. Available from: http://www.diferencas.net/. ISBN 9798428370911
10 Merglova V, Hauer L, Broukal Z, Dort J, Koberova Ivancakova R. General and oral health status of preterm one-year-old very low and extremely low birthweight infants (a cross - sectional study). Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021 Jun;165(2):209-215
11 Garg A, Kumar G, Goswami M, Kumar D, Mishra D. Evaluation of eruption of deciduous teeth among infants born after low risk pregnancy compared to infants diagnosed with Intra Uterine Growth Restriction. J Oral Biol Craniofac Res. 2021 Oct-Dec;11(4):638-642.
12 Žemgulytė S, Vasiliauskienė I, Slabšinskienė E, Sandūnaitė K, Narbutaitė J. Influence of preterm birth for child's oral health status. Stomatologija. 2019;21(4):107-112.
13 Guedes KM, Guimarães AM, Bastos Ade S, Salviano KG, Sales NJ, Almeida ML, Gurgel RQ. Stomatognathic evaluation at five years of age in children born premature and at term. BMC Pediatr. 2015 Mar 29;15:27.
14 Greene Z, O'Donnell CP, Walshe M. Oral stimulation for promoting oral feeding in preterm infants. Cochrane Database Syst Rev. 2016 Sep 20;9(9):CD009720.
15 Hummel P, Fortado D. Impacting infant head shapes. Adv Neonatal Care. 2005 Dec;5(6):329-40.
16 Bensi C, Costacurta M, Belli S, Paradiso D, Docimo R. Relationship between preterm birth and developmental defects of enamel: A systematic review and meta-analysis. Int J Paediatr Dent. 2020 Nov;30(6):676-686.
17 Costa FS, Silveira ER, Pinto GS, Nascimento GG, Thomson WM, Demarco FF. Developmental defects of enamel and dental caries in the primary dentition: A systematic review and meta-analysis. J Dent. 2017 May;60:1-7.
18 Maaniitty E, Vahlberg T, Lüthje P, Rautava P, Svedström-Oristo AL. Malocclusions in primary and early mixed dentition in very preterm children. Acta Odontol Scand. 2020 Jan;78(1):52-56.
19 Objois C, Gebeile-Chauty S. Is premature birth an orthodontic risk factor? A controlled epidemiological clinical study. Int Orthod. 2019 Sep;17(3):544-553.
20 Hohoff A, Rabe H, Ehmer U, Harms E. Palatal development of preterm and low birthweight infants compared to term infants -- What do we know? Part 3: discussion and conclusion. Head Face Med. 2005 Nov 2;1:10. doi: 10.1186/1746-160X-1-10. PMID: 16270912; PMCID: PMC1298320.