An important randomized trial shows that when vitamin D is supplemented at high doses in the last three months of pregnancy, there is a fall in the occurrence of enamel defects in the deciduous (milk) and permanent teeth of the offspring by half, over the next 6 years, compared to a low dose supplementation. However, the incidence of caries was not affected.
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The research titled ‘Vitamin D Supplement During Pregnancy and Enamel Defects in Offspring’ is published in the jounral JAMA Pediatrics.
Enamel defects refer to enamel breakdown, opacity in the molars, and other characteristic findings. are among the most prevalent of dental problems the world over, affecting almost 40% of schoolchildren. The lack of durable enamel results in toothache, pain on consuming hot or cold foods or beverages, the rapid onset and progression of tooth decay and cavities, and the need for tooth extraction in some patients.
It is a matter of intense research to find the factors possibly contributing to its occurrence. This could be possibly counteracted by providing vitamin D supplements at high doses in the third trimester of pregnancy.
The Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort (COPSAC2010). Enrollment ran from March 2009 onward. This was a randomized double-blinded placebo-controlled clinical trial.
There were 623 participants, all women at 24 weeks of pregnancy given 2400 IU of vitamin D from this point to 1 week after delivery. This was in addition to the standard supplement of 400 IU/day. 588 of their children were also followed up throughout the study period. At 6 years of age, the teeth of the children were examined in 84% of cases, making up 496 children.
At follow up, enamel defects were looked for.
It was found that the risk of enamel defects in both the milk teeth and the permanent teeth was cut by half. However, there was no change in the risk of caries.
Even though the two groups of patients were randomly assigned, to avoid any bias in the composition of the groups, other oral health habits were also considered. For instance, the use of fluoride toothpaste has been shown to reduce enamel defects, by another team of researchers. In fact, the presence of stannous and chitosan in toothpaste is also beneficial in this regard.
The frequency of brushing the teeth, and the use of flossing and other oral hygiene practices is also associated with better dental health. The impact of differences in these parameters on the prevalence of enamel defects in the two groups was therefore ruled out by analysis of possible confounding factors. The results show that lifestyle factors like the above are equally present in both groups.
Secondly, sunlight is a key factor in ensuring that vitamin D is present at adequate levels in the blood, including those who are at high latitudes and who are on high doses of the vitamin. However, this is not a source of bias in this study as equal numbers of patients in both groups were exposed to sunlight at similar levels.
After ruling out potential sources of bias due to lifestyle factors, the administration of high-dose supplements is found to reduce the risk of enamel defects in the children at 6 years of age, in both the milk teeth and the permanent teeth. This suggests an effective means of intervention during pregnancy to reduce the rate of dental disease in later life.
Deng X, Niu W. Vitamin D Supplement During Pregnancy and Enamel Defects in Offspring. JAMA Pediatr. Published online January 27, 2020. doi:10.1001/jamapediatrics.2019.5728
Nørrisgaard PE, Bønnelykke K, Bisgaard H. Vitamin D Supplement During Pregnancy and Enamel Defects in Offspring—Reply. JAMA Pediatr. Published online January 27, 2020. doi:10.1001/jamapediatrics.2019.5731