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ORIGINAL RESEARCH
Year : 2023 | Volume
: 14
| Issue : 2 | Page : 52-54
Effect of Feeding Pattern and Salivary Level of Growth Hormone on the Stage of Primary Tooth Eruption: An Analytical Cross-Sectional Study
Dhay Haider Mohamed Hassan, Shahbaa Munther Al-joranii
Department of Pedodontic and Preventive Dentistry, College of Dentistry, University of Baghdad, Baghdad, Iraq
Correspondence Address:
Dhay Haider Mohamed Hassan
Department of Pedodontic and Preventive Dentistry, College of Dentistry, University of Baghdad, Baghdad
Iraq
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/denthyp.denthyp_43_23
Introduction: We aimed to evaluate the effect of feeding pattern and salivary level of growth hormone on the stage of primary tooth eruption among infants aged 6 to 18 months. Methods: The sample size of this analytical cross-sectional study was 300 healthy infants from Karbala, Iraq. Feeding pattern answered by the parents, stage of dental eruption assessed according to criteria described by Damodar P. Swami, and level of salivary growth hormone determined using an ELISA assay. Data were analyzed via a linear regression model using R software. Results: The model (adjusted R2: 0.668) showed the feeding pattern (beast, bottle, or mix), gender, and salivary level of growth hormone were not significant predicators for the stage of primary tooth eruption (p > 0.05). Yet, age was a significant predicator (p < 0.001). Conclusion: The infant’s feeding pattern and salivary level of growth hormone did not affect the timing of the eruption of primary teeth.
Keywords: Bottle feeding, breastfeeding, ELISA assay, feeding pattern, growth hormone, infant, primary tooth eruption, salivary biomarkers
Breastfeeding and bottle feeding are two methods of feeding infants. Health experts agree that breastfeeding is the healthiest option for both mom and baby. Morley-Hewitt and Owen, in a systematic review, found that pregnant women with a higher body image are more likely to exclusively breastfeed, while those with body concerns have less intention to breastfeed or initiate, with those who start having a shorter duration.[1] Children who were breastfed had a lower incidence of dental caries compared to those who were bottle-fed (odds ratio: 0.43: 0.43), according to a systematic review and meta-analysis of cross-sectional studies conducted by Avila et al.[2] The results of a systematic review offered by Abreu et al., do not support a relationship between breastfeeding and bottle feeding and the development of malocclusion in mixed and permanent dentitions.[3] Another systematic review of cohort studies conducted by Hermont et al. did not find any specific type of malocclusion associated with feeding habits in the primary dentition or a specific duration of breastfeeding that could protect children against malocclusion.[4] There is no direct information in the literature about how somatotropin affects teething timing. However, the growth hormone has a marked effect on the development of oro-facial structures, including eruption and shedding patterns of teeth. This suggests that growth hormone may have an effect on teething timing, but further research is needed to determine the exact nature of this effect.[5]
Nevertheless, the aim of this study was to evaluate the effect of feeding pattern and salivary level of growth hormone on the stage of primary tooth eruption among infants aged 6 to 18 months.
Materials and methodsEthical approval of the study was obtained from the central ethics committee in the College of Dentistry, University of Baghdad (approval number: 557322, February 6, 2022). An authorization was issued by the Karbala Health Department/Center Sector in Karbala city permitting the study to be conveyed to the Primary Health Care Center (PHCC) (Immunization Unit) without impediments. Written informed consent forms were signed by all parents/guardians. The duration of the study extended between January and April 2022. Using G Power 3.1.9.7 software (http://www.gpower.hhu.de/) with a power of 95%, a two-sided alpha error of probability of 0.05, and an effect size of 0.25, the sample size was 300 subjects. The researcher utilized an information sheet to gather information concerning the type of feeding pattern practiced. Under daylight, the examiner performed the intraoral examination using a single-use dental examination kit (JPS Dental Co., Shanghai, China). According to criteria described by Damodar P. Swami, the dentition’s eruption stage was assessed.[6] The stages were as follows: Stage 0: the tooth is not visible in the oral cavity; Stage 1: at least one cusp is visible in the oral cavity; Stage 2: the entire occlusal surface/mesiodistal width of the tooth is visible; Stage 3: if the antagonistic tooth has not fully erupted, the tooth is in occlusion or at the occlusal level. The collection of unstimulated saliva was conducted between 9 and 11 a.m., 1 hour after the child has eaten, been breast, or bottle fed, using sterilized cotton swabs (AnQing Jiaxin, Shanghai, China). The saturated end of the swab was cut free and placed in a 3 to 5 mL syringe. Two drops of distilled water were added to the salivary sample, and the sample was centrifuged (Kokusan, Tokyo, Japan) at 3000 rpm for 5 minutes. The salivary supernatant was stored at −20 °C.[7],[8] Growth hormone was measured blindly using enzyme-linked immunosorbent assay (ELISA) kit (Shanghai YL Biotech Co., Shanghai, China). Data were analyzed via a linear regression model using R 4.3.0 (R Foundation for Statistical Computing, Vienna, Austria).
ResultsThree hundred five infants were examined, three infants did not meet inclusion criteria, parents of two infants refused to participate, and 300 infants (mean age: 10.8 ± 3.94 months, 55.6% male) completed the study and were included in the analysis. Two hundred forty infants were being fed by breast, 31 infants by bottle, and the other 65 had a mixed pattern. The linear regression model (adjusted R2: 0.668) [Figure 1] showed the feeding pattern (beast, bottle, or mix), gender, and salivary level of growth hormone were not significant predicators for the stage of primary tooth eruption (P > 0.05). Yet, age was a significant predicator (P < 0.001) [Table 1].
Figure 1 Scatter plot displayed predicted versus actual values showing the fit of linear regression model.
Table 1 Results of linear regression model evaluating predictor parameters related to the stage of primary tooth eruption Discussion Results of this study showed that feeding pattern was not a significant predictor related to the stage of primary tooth eruption. Al-Ansari et al., investigated the possible influence of breast- and bottle-feeding on the eruption time of the first primary tooth in Saudi children aged 6 to 12 months. The study found no significant difference in the mean-time of eruption for the first primary tooth between breast- and bottle-feeding children. However, the mean number of erupting primary incisor teeth was lower in the breast feeding group than in the bottle feeding group.[9] Ahmadi-Motamayel et al. evaluated the factors related to the first deciduous tooth eruption time in infants born in Hamadan, Iran. They reported no significant relationship between first deciduous tooth eruption and breastfeeding or formula feeding.[10] Holman et al. longitudinally analyzed the effects of nutritional status, breastfeeding behavior, and sex on the emergence of deciduous teeth in a sample of 114 Japanese children born in Tokyo in 1914 and 1924. According to a study, partial breastfeeding did not affect tooth emergence, but children who were not breastfed at all showed delayed emergence of the upper incisors. No significant differences were found between genders in terms of tooth emergence.[11]
In contrast, Sahin et al., in a prospective cohort study, analyzed the effect of feeding pattern and growth parameters on the timing of teething in 1200 healthy newborn Turkish kids. They reported that being nourished by cow’s milk or formula negatively affected tooth eruption in the sixth and ninth months.[12] Khalid et al. assessed the relationship between nursing habits and the timing of primary tooth eruption in Kerbala, Iraq, and involved 400 children aged 6 to 36 months. They reported that the mean age of the eruption of first deciduous tooth (central incisors) in the maxilla and mandible was significantly earlier in the breastfeeding group in comparison with the bottle feeding group.[13]
Saliva is a non-invasive and simple way to measure growth hormone levels. Salivary growth hormone levels were 1000 times lower than the respective values in serum. However, there was a moderately positive correlation between salivary and serum growth hormone levels (r = 0.59).[14] To our knowledge, growth hormone has not been analyzed in saliva in relation to tooth eruption. Our results showed salivary levels of growth hormone were not a significant predictor related to the stage of primary tooth eruption. Yet, a systematic review conducted by Torlińska-Walkowiak et al. showed dental age delayed in serum growth hormone deficient children by about 1 to 2 years.[15]
It is important to note that cross-sectional studies have inherent limitations, such as the inability to establish causality and the lack of follow-up. Additionally, the study sample in this particular research is limited to a single city, which may not be representative of larger populations. Therefore, large-scale, multicentral cohort studies are needed to reach more reliable conclusions. Despite these limitations, cross-sectional studies are often inexpensive and easy to conduct, making them a valuable tool in certain research contexts. However, researchers and readers alike must be aware of the predictive limitations of cross-sectional studies, including the difficulty of determining the temporal relationship between exposure and outcome.
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
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