In 2019, sociodemographic inequalities were responsible for 62.9 million prevalent cases of decayed deciduous teeth, representing 12.1% of the global incidence of caries in children’s primary teeth. Research consistently links socioeconomic status (SES) to dental caries, as individuals from lower SES backgrounds typically face barriers to oral health services, poor oral hygiene, and a higher intake of sugary foods. However, the relationship between prolonged breastfeeding and tooth decay remains uncertain, with some studies suggesting that breastfeeding beyond 12 or 24 months may increase the risk of early childhood caries, though the evidence remains of low quality and high variability.
Additionally, limited research has explored the role of minor psychiatric disorders (MPD) in mothers—such as anxiety, stress, and depression—and their potential influence on the oral health of their children, particularly in the primary dentition.
Developmental defects of enamel (DDE) have been identified as a key factor that increases a child’s susceptibility to dental caries. Prenatal factors such as maternal use of alcohol, cigarettes, and drugs have also been linked to the development of DDE, which can lead to enamel defects that retain biofilm and harbor cariogenic bacteria, ultimately raising the risk for tooth decay.
Dental caries arises from a complex combination of factors, with the potential for these risk factors to persist across generations. However, no studies have yet explored the combined impact of maternal substance use, stressful events, SES, breastfeeding, and DDE on the development of dental caries in children.
Substance use during pregnancy (SUDP) has been steadily increasing and poses significant risks to both women and children. Alcohol and tobacco are the most commonly consumed substances among pregnant women, with illicit substances such as cocaine, opioids, and marijuana also prevalent. A study from Brazil reported that 6.1% of pregnant women smoked cigarettes, while 31.1% consumed either alcohol or tobacco, or both. Substance use during pregnancy has been associated with various adverse health outcomes, including poor oral health, yet there is a lack of epidemiological studies examining the direct consequences of SUDP on children’s oral health.
Fetal alcohol syndrome, often linked to maternal alcohol consumption, has been connected with increased instances of facial asymmetry, crossbites, DDE, and higher rates of dental decay. Despite these findings, many studies suffer from small sample sizes, inadequate adjustments for confounding factors, and a focus on mixed dentition, potentially skewing the results. Nevertheless, it is likely that substances used during pregnancy cross the placental barrier and affect fetal development, including the amelogenesis process that begins around the 11th week of pregnancy. As a result, the child may experience tooth decay or other dental issues.
This study aimed to examine the potential impact of SUDP on the development of dental caries in children aged 12 to 36 months, analyzing both direct and indirect effects. Two main hypotheses were proposed: (1) the Tooth Development Hypothesis, suggesting that SUDP affects dental amelogenesis during pregnancy, leading to DDE and increased tooth decay in children, and (2) the Behavioral Hypothesis, proposing that mothers who use drugs may neglect proper oral hygiene and nutrition for their children, fostering conditions conducive to dental caries. The study adjusted for a range of variables, including SES, maternal mental health, maternal age, feeding history, DDE, and gingival bleeding during brushing (GBoB), to determine the total, direct, and indirect effects of SUDP on children’s dental health.
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