Enamel defects are fast becoming a global public health
challenge, affecting more than 30 percent of school children and
reducing quality of life, however new research finds they may be
prevented by prenatal vitamin D supplementation.
Reporting in JAMA Pediatric,
the study finds that high dose vitamin D supplementation during
pregnancy was associated with approximately 50 percent reduced odds of
enamel defects in the offspring at six years of age.
A total of 496 children from 115 eligible women were examined in the
study. While pregnant, women were randomised 1:1 to a daily dose of
2400 IU vitamin D3 supplementation or matching placebo tablets from
pregnancy week 24 to 1 week post-partum. In addition, all women were
instructed to continue supplementation of 400 IU of vitamin D3 during
pregnancy as recommended by the Danish National Board of Health.
Thus, the study was a dose comparison of 2800 IU/d vs 400 IU/d of
vitamin D3 supplementation. All the women also participated in a
concomitant factorial designed double blind randomised controlled trial
of 2.4 g per day of omega-3 fatty acids during pregnancy.
“Adherence to the intervention, defined as mothers taking more than
80 percent of the prescribed tablets, was 74% (n = 462 of 623) and the
vitamin D intervention resulted in a significant increase in maternal
serum vitamin D3 level in the treatment group from randomisation to the
postpartum assessment but not in the control group,” the authors said.
“Of the 496 examined children, 332 (66.9%) had at least 1 fully
erupted first permanent molar and 234 (47.2%) had all four. Enamel
defects in the permanent dentition and the deciduous dentition were
diagnosed in 70 children (21.1%) and 61 children (12.3%), respectively,
and in either the permanent or the deciduous dentition in 118 children
(23.8%).
“The prevalence of enamel defects in the permanent dentitions was
lower in the children whose mothers received high-dose vitamin D
supplementation in pregnancy compared with standard dose, and a similar
association was observed for enamel defects in the deciduous dentition
and in the combined analysis of both the deciduous and permanent
dentition,” the authors reported.
With very little known about the aetiology of developmental enamel
defects there are no causal preventive strategies and the authors of
this study suggest that these results indicate a breakthrough in
understanding and preventing the disease.
“Our finding suggests a simple and safe prevention strategy against
enamel defects with a considerable effect size, which could have an
important effect on long-term dental health. Considering the key role
of vitamin D in enamel mineralisation, the association between vitamin D
supplementation and enamel defects seems biologically plausible.”
“Enamel defects are a challenging dental health problem for many
children and adults. Children with severe defects experience pain and
need for dental treatments, have increased risk of caries, and may
develop dental anxiety over time. In some cases, enamel defects lead to
extensive and expensive treatment types, i.e. artificial crowns or
orthodontic treatment as a consequence of extraction of permanent first
molars, which pose a significant economic burden to society and
negatively affect quality of life for the affected children.”
“The implications of our findings of prenatal high-dose vitamin D
supplementation as a new and nontoxic primary preventive agent of enamel
defects, with a clinically significant odds reduction of approximately
50%, may therefore have substantial effects on dental health and health
care use,” the authors concluded.
Source:
JAMA Pediatr. doi:10.1001/jamapediatrics.2019.2545
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