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CHAPTER 3
3.1 Subject and Method
Subject were 150 children born with prenatal malnutrition aged 4-48 months and 300 normal children as control. We had complete data of mothers pregnancy mothers age at
birth, disease during pregnancy, and smoking habits and childrens birth including birth weight, gestational age, birth length, head circumference, hypoxia, and gender.
This was a clinical epidemiology study. Enamel defects were examined using DDE scoring modification and FDI index and determinate; mild defect score 12,
severe defect; 12
b
and Interviews were done to collect data on birth weight and length, head circumference, gestational age, gender, and hypoxia in neonates. Enamel defects
were recorded three times with 2 months intervals. We recorded the defects of deciduous teeth enamel and confounding variable factors of the child such as
gendersex, gestational age, birth weight and length, head circumference, and hypoxia. All data were analysed using multivariate analysis.
3.2 Operational Definition
1.
Children with prenatal malnutrition means a neonate with birth weight beyond - 2SD of intrauterine growth curve. Birth weight usually below 2500 gram, some
children are 2600 gram
2.
The defect of deciduous teeth including hypoplasia and hypocalcification and the severity was measured using DDE index and FDI modification and determinate
with mild defect with score 12 dan severe with score 12
17
Confounding variable Childrens factors: birth weight, birth length, head circumference, sex, and hypoxia during delivery
7
CHAPTER 4
4.1 Result and Discussion
8
Figure 1 shows that the lower the birth weight, the more the probability of the severity. The higher the birth-weight the lower the probability of severity. Prenatal
malnutrional. Children had less nutritional intakes that occur during the first trimeter of pregnancy, and further during the second or third trimester that might occur in a short till a
long time. A healthy pregnant woman with adequate nutritional status will deliver a healthy
neonate with normal birth weight, while a sick or unhealthy pregnant woman with low socio- economic condition will deliver a low birth weight neonate. About 70 of the low birth
weights are SGA babies with birth weight lower than -2SD normal weight or the 10th percentile of Lubchenco intra uterine growth curve 2500 g, or even has a birth weight of
2600 grams.
9,15-6
This condition could be caused by systemic condition such intra uterine growth retardation IUGR as a result of maternal factors such as severe infection during pregnancy, preeclampsia
hypertension, maternal diabetes, smoking, alcohol, and mothers age at delivery of 35 years.
9,11
Other causes of IUGR are placental abnormalities, and childs factors such as genetic abnormalities, syndromes, multiple gestation, that might cause intrauterine malnutrition.
9,15-6,19
Prenatal nutrition has an important role in matrics construction and enamel mineralisation of deciduous teeth, while postnatal nutrition has a role in matrics and mineralisation of permanent
teeth.
2,5,14
Vitamin A, C, D, K, and minerals calcium, phosphor, magnesium, fluor are the nutrition needed in constructing the teeth. Nutritional deficiency during bellstage might result in
decreased activities of ameloblast in matrix secretion, so that
9
the enamel matrix decrease and hypoplasia occur to become a further permanent defect. Nutritional deficiency caused hypoplasia and hypocalcification or both, according to the
period and intensity of the defect.
5-8,14
Systemic condition such as Intra Uterine growth retardation IUGR might cause SGA children and defects in the development of organs, and the abnormalities depend on the time
of occurence and intensity of the abnormalities.
9
The abnormalities of organ developments might cause hypoplasia or enamel hypocalcification, or both, of the teeth.
10,
The risk of SGA children to have enamel defect is 79.
18
A good growth of a fetus is described as a mean weight gain in each phasestage, i.e. 5 gday up to 15 weeks, 15-20 gday up to 24 weeks and 30-35 gday up to 34 weeks
pregnancy. Low nutritional status of the fetus might result in low birth weight, and this mightcause a defect of the organ growth and development might be including the teeth.
18
Birth weight and gestational age reflect the Fetal Growth Rate that means the birth weight reflects the nutritional status of the fetus, the better the nutritional status, the better the
birth weight, and that means the intrauterine growth and development restriction did nor occur or only in a mild intensity.
14
Birth weight is the reflection of the intrauterine growth and development, so that the decrease of birth weight due to malnutritrition might be a risk to
become a growth defect.
9,15-6,19
Mal nutrition is caused by lack of absorption of the placenta. The above figure shows the association between birth weight and the severity of the
defect of deciduous teeth, that is the lower the birth weight in small for gestational age children the more the probability of the severity of the defect.
10
CHAPTER 5
5.1 Conclusion
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