How well do parents identify their child's baby teeth? Engagement and accuracy of parent-reported information on a tooth checklist survey

OBJECTIVES

Naturally exfoliated primary teeth are being increasingly collected in child development studies. Most of these odontological collections and tooth biobanks use parent-reported information from questionnaires or tooth checklists to collect data on offspring teeth. To the best of the authors' knowledge, no studies have assessed parental engagement in tooth checklists, nor parental accuracy in identifying their child's baby tooth. This study aimed to evaluate these dimensions by analysing data from the about this tooth checklist returned with donated primary teeth in a natural experimental study called STRONG (the Stories Teeth Record of Newborn Growth).

METHODS

Parental self-reported information were analysed on checklists returned with 825 primary teeth belonging to 199 children. The percentage of blank answers was calculated for each question. The accuracy of parents-reported tooth identification was evaluated by comparing parental ratings to researchers' ratings. Reliability of researchers' tooth identification was first evaluated by calculating intra-observer and inter-observer agreements, as well as Cohen's Kappa values. The percentage of accuracy of parents' tooth identification (relative to researcher's) was then calculated, and logistic regressions were used to evaluate if time elapsed between when exfoliation occurred and the checklist was completed associated with parental accuracy in tooth identification.

RESULTS

Parents returned 98.4% of the checklists and completed 74.9% to 97.7% of the questions. Excellent reliability was demonstrated for researchers' intra- and inter-rater tooth identification (agreement percentages >90%; Cohen's Kappa values >.83). Moderate accuracy of parents-reported tooth identifications was found, with parents correctly identifying 49.5% of the donated tooth. Better parental accuracies were highlighted for partial identifications (87.1% of correct jaw, 75.6% of correct tooth type, and 65.8% of correct lateralization). Logistic regressions showed the odds of correct parental identifications decreased on average by 1.8% every 30 days of distance between tooth exfoliation and checklist completion.

CONCLUSIONS

While parental engagement is high, parents-reported tooth identifications have moderate accuracy, which decreases over time. High accuracy is however found for partial identifications. Parent-reported information on the accompanying questionnaire of naturally exfoliated primary teeth collection or tooth biobanks, even when filled in a long time after exfoliation took place, should be encouraged. However, expert identifications of teeth should remain best practice.

Sex-specific effects of environmental temperature during gestation on fluctuating asymmetry in deciduous teeth

OBJECTIVES

External environmental heat exposure during gestation impacts the physiology of human development in utero, but evidence for these impacts has not yet been explored in dentition. We examined deciduous teeth for fluctuating asymmetry (FA), a measure of developmental instability, together with gestational environmental temperature data drawn from historical weather statistics.

MATERIALS AND METHODS

We measured dental casts from the longitudinal Burlington Growth Study, representing 172 participants (ages 3-6 years) with health records. FA was calculated from crown dimensions and intercuspal distances that develop during gestation. Multiple regression separated by sex (nfemale = 81) examined the effects of mean temperatures in each trimester, controlling for birth year.

RESULTS

In females, increased temperatures during the first trimester are significantly associated with an increase in FA (p = 0.03), specifically during the second and third prenatal months (p = 0.03). There is no relationship between temperature and FA for either sex in the second or third trimesters, when enamel is formed.

DISCUSSION

Dental instability may be sensitive to temperature in the first trimester in females during the scaffolding of crown shape and size in the earliest stages of tooth formation. Sexual dimorphism in growth investment strategies may explain the differences in results between males and females. Using enduring dental characteristics, these results advance our understanding of the effects of temperature on fetal physiology within a discrete period.

Enamel incremental markings in the deciduous teeth of children from the Early Bronze and modern ages

OBJECTIVE

The purpose of this study was to determine whether children from Early Bronze Age and modern populations differ in terms of the width of the neonatal line (NNL) and the occurrence of accentuated lines in enamel.

DESIGN

The sample (N = 59) consisted of two groups: 29 deciduous teeth removed from the jaws of children (dental age range from 1 to 10 years) whose skeletal remains were found in Early Bronze archaeological graves in Mokrin Serbia, and 30 present-day exfoliated deciduous teeth from 6 to 11 year old children. Mothers, whose children participated in this study, provided information regarding their health during pregnancy. The analysis was carried out on ground sections with a scanning electron microscope. Two clinicians measured the width of the NNL and counted the accentuated lines in the enamel.

RESULTS

There was a statistically significant difference between the children from the two groups regarding the width of the NNL. The width of the NNL between children whose mothers were healthy and diagnosed with gestational diabetes was significantly different. Most subjects did not have accentuated lines in the prenatal enamel, regardless of whether they were from the Bronze or Modern age. Accentuated lines were dominantly found in the postnatal enamel of the children from the Early Bronze age.

CONCLUSIONS

This study is the first to investigate the width of the NNL in teeth of Maros children and Serbian children from the modern age. The wider NNL of children from the Early Bronze age indicates the possibility that they have experienced more overall stress in perinatal life.

Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel

IMPORTANCE

Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure.

OBJECTIVE

To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021.

EXPOSURES

Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy.

MAIN OUTCOMES AND MEASURES

Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines.

RESULTS

A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White) were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks' gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = -2.04; 95% CI, -3.70 to -0.38; P = .02). The magnitude of these associations was large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors.

CONCLUSIONS AND RELEVANCE

In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.

Conventional microscopy makes perikymata count and spacing data feasible for large samples

OBJECTIVES

Current methods of quantifying defects of dental enamel (DDE) include either gross or low-level examination for linear enamel hypoplasia, histological analysis of striae of Retzius, or scanning electron microscopy (SEM) of a tooth or a tooth cast. Gross examination has been shown to miss many defects. Other methods can be destructive, require transporting samples, and are expensive. Here, we show that digital light microscopy (DLM) can be used for the analysis of DDE as indicated by widened perikymata spacing (WPS). This method takes advantage of high-power (100×) microscopy, but is non-destructive, can be implemented almost anywhere, and is inexpensive.

MATERIALS AND METHODS

As proof of concept, we created photomontages of labial surfaces of five human canines from images made using DLM and SEM. We counted and measured the widths of all visible perikymata for each imaging modality and fit measurements to a negative curve representing the expected values for each tooth. We calculated residuals for each measurement. WPS were defined when R² was in the 90th percentile, and were considered matched in DLM and SEM images when observed within the same decile of the tooth surface.

RESULTS

There were more WPS detected in the images derived from DLM than from SEM. Overall, the data derived from the two imaging modalities provided similar information about the frequency and timing of stress during dental development.

CONCLUSIONS

The method described here allows for DDE data acquisition as WPS from large samples, making feasible population-level studies that reflect sophisticated understanding of dental development.

Assessment of physiological disturbances during pre- and early postnatal development based on microscopic analysis of human deciduous teeth from the Late Epipaleolithic site of Shubayqa 1 (Jordan)

OBJECTIVES

To study pre- and early postnatal tooth formation and to analyze the effects of physiological disturbances on enamel and dentin formation in deciduous teeth of infants from the Late Epipaleolithic (Natufian) site Shubayqa 1.

MATERIALS AND METHODS

Ten deciduous teeth from six infants (ages at death between 21 and 239 days) were analyzed by light and scanning electron microscopy.

RESULTS

Marked prism cross-striations and an abnormal wavy course of the prisms were recorded in pre- and postnatal enamel of all analyzed teeth. Single or multiple accentuated incremental lines were observed in prenatal enamel of nine teeth and in postnatal enamel of eight teeth. Accentuated Andresen lines and broader zones exhibiting an enhanced calcospheritic pattern were recorded in the pre- and postnatally formed dentin of nine teeth.

DISCUSSION

The structural abnormalities in the pre- and postnatally formed enamel of the infants are considered indicative of chronic stress that negatively affected the activity of secretory ameloblasts. The structural aberrations in pre- and postnatal dentin denote that odontoblasts were also affected by this stress. The presence of single or multiple accentuated incremental lines in pre- and postnatal enamel is interpreted as reflecting (short-term) impacts of higher intensity superimposed on the chronic stress. Our findings suggest compromised maternal health affecting the late fetus and compromised health in newborns. Although limited by the small number of analyzed individuals, the present study contributes to the knowledge of maternal and early infant health conditions in Late Epipaleolithic populations.

Variation in mineral, organic, and water volumes at the neonatal line and in pre- and postnatal enamel

OBJETIVES

The neonatal line (NNL) in enamel is hypomineralized, but quantitative data on the enamel component volumes of the NNL are lacking. This study aimed at quantifying the variation in the mineral, organic, and water volumes at the NNL and in pre- and postnatal enamel.

MATERIALS AND METHODS

In buccal enamel longitudinal ground sections of exfoliated primary incisors (upper and lower; n = 17), the enamel component volumes were quantified at five histological sites (located at 40 μm intervals along a transversal line): the NNL, two sites in prenatal enamel, and two sites in postnatal enamel. Mineral volume was quantified using microradiography, and non-mineral volumes were quantified using polarizing microscopy.

RESULTS

Differences in component volumes between the NNL and pre- and postnatal enamel had high effect sizes (Hedge's G ranging from 0.89, for the water volume, to 1.88, for the mineral volume; power > 90 %). The distance from the NNL correlated with the normalized component volume: r = 0.459, 95 % CI = 0.274/0.612 (mineral); r = -0.504; 95 % CI= -0.328/-0.647 (organic), and r = -0.294; 95 % CI= -0.087/-0.476 (water). Approaching the NNL from postnatal enamel, the percentage differences in component volumes were: -1.93 to -3.22 % for the mineral volume, +21.26 to +35.42 % for the organic volume, and +3.86 to +6.03 % for the water volume. Towards postnatal enamel, the percentage differences had the opposite trend.

CONCLUSIONS

The enamel NNL is slightly hypomineralized with an increased organic volume one order of magnitude higher than the percentage differences in both mineral and water volumes.