Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

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© Borgis - New Medicine 3/2020, s. 104-112 | DOI: 10.25121/NewMed.2020.24.3.104
Anna Turska-Szybka1, Paula Piekoszewska-Ziętek1, Dariusz Gozdowski2, *Dorota Olczak-Kowalczyk1
A survey of the oral lesions in newborns and infants: A two-year cross-sectional study
Zmiany błony śluzowej jamy ustnej u niemowląt: dwuletnie badanie przekrojowe
1Department of Paediatric Dentistry, Medical University of Warsaw, Poland
Head of Department: Professor Dorota Olczak-Kowalczyk, PhD, DMD
2Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Science, Poland
Head of Department: Professor Wiesław Mądry
Streszczenie
Wstęp. Zmiany błony śluzowej jamy ustnej u noworodków i niemowląt mogą być manifestacją różnych chorób, często wywołując niepokój u rodziców dzieci.
Cel pracy. Określenie częstości występowania, rodzaju i czynników towarzyszących zmianom błony śluzowej jamy ustnej stwierdzanych u noworodków i niemowląt.
Materiał i metody. Rekrutacja uczestników odbywała się wśród dzieci, które były na wizycie w celu oceny pierwszego ząbkowania. Matki odpowiedziały na pytania dotyczące historii choroby, a dzieci przeszły badanie kliniczne przeprowadzone przez lekarzy pedodontów po przeszkoleniu, kalibracji i badaniu pilotażowym.
Wyniki. W badaniu wzięło udział 248 dzieci w wieku do 12 miesięcy. Średnia liczba zębów (SD) wynosiła 1,96 (2,55). U 1,25% dzieci występowały zęby noworodkowe. Próchnicę zębów stwierdzono u 3,2% dzieci, urazowe uszkodzenia zębów – u 7%, hipoplazję szkliwa – u 1,9%, a zmiany błony śluzowej – u 19,8% pacjentów.
Wnioski. Zmiany w jamie ustnej u niemowląt mogą być związane z ząbkowaniem, zębami i błoną śluzową jamy ustnej. Jedno dziecko na 5 ma zmiany dotyczące błony śluzowej, najczęściej guzki Bohna lub kandydozę. Istnieje znacząca korelacja między częstością występowania zębów noworodkowych a obecnością guzków Bohna.
Summary
Introduction. Oral lesions in newborns and infants represent a wide range of diseases often creating apprehension and anxiety among parents.
Aim. We aimed to assess the type, prevalence and associated factors of oral lesions in newborns and infants.
Material and methods. Participants were recruited during a two-year cross-sectional study among children who had their first teething assessed. The mothers answered medical history questions and the children underwent a clinical examination by paediatric dentists after training, calibration, and pilot study.
Results. Two hundred and forty-eight children aged up to 12 months took part in the study. The mean number of teeth (SD) was 1.96 (2.55). 1.25% of children had natal teeth. Dental caries was observed in 3.2% children; traumatic dental injuries caused by falling in 7%; enamel hypoplasia in 1.9%, and mucosal lesions in 19.8% (Bohn’s nodules, mucocele, candidiasis).
Conclusions. Oral lesions in infants may involve teething, teeth and oral mucosa. One child out of five children has mucosal lesions, most often Bohn’s nodules or candidiasis. There is a significant correlation between the prevalence of natal/neonatal teeth and of Bohn’s nodules.
Introduction
The oral cavity in infants is very specific. Some of its aspects result from physiological characteristics and physical and functional development; others are pathological and require medical interventions (1, 2). Lesions typical for infants were most often caused by teething and included eruptive gingivitis/cysts and traumas (such as Riga-Fede disease and candidiasis). Parents were also worried about early teething, including natal and neonatal teeth (3, 4). Oral lesions prevailed in even 30% of the examined babies (5). That prevalence could result from local, genetic, systemic or environmental factors during pregnancy and after birth (1, 3-6). There were few studies on oral lesions in infants and newborns (1, 4-12). The topic is not often taken up by researchers, so there is a knowledge gap that needs to be filled. The following survey was conducted due to the observation of various changes in the oral cavity among patients reporting for a dental visit.
Aim
The objective of the study was to assess the type, prevalence, and associated factors of oral lesions in newborns and infants.
Material and methods
Participants were recruited in the Department of Paediatric Dentistry, Medical University of Warsaw during a two-year cross-sectional study among children under the age of 12 months. The study was authorised by a Commission for Bioethics of Medical University of Warsaw and has been conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki. Inclusion criteria were as follows: age up to 12 months, residence in Warsaw agglomeration, and written parent consent for participation in the study. Participants were excluded if they had dental and jaw anomalies. Mothers were asked about the medical history and children underwent a dental clinical examination. The medical history included questions about child and parent age, socioeconomic factors (socioeconomic status, education, number of children in the family and cigarette smoking), pregnancy and delivery specifics (pregnancy duration, bad habits, general health problems, delivery type, baby birth weight, complications and feeding), and general health (chronic diseases, medication and eating habits). Participants underwent the clinical examination at the dental clinic according to WHO criteria; the anatomical and physiological oral characteristics of the children were taken into account (13); differential diagnosis was used to assess oral lesions (14). Intraoral examination included mucosa examination and potential lesion type and location. Tongue and upper lip frenal attachments were assessed. Tooth examination included the presence/type of erupted teeth, carious lesions (white spot lesions – WSL, precavitated lesions [d], caries [p]) and traumas. Alveolar ridges were examined for tooth buds and the accompanying symptoms. Clinical examinations were performed by 4 paediatric dentists after calibration (inter- and intraexaminer reliability was assessed by Cohen’s kappa coefficient and in all cases it was above 0.8).

Statistics
The comparison of proportions (percentages) was conducted using Fisher exact test. The analyses were performed in version 12 of Statistica (StatSoft, Tulsa, OK). Significance level was set at 0.05.
Results
Two hundred and forty-eight children under the age of 12 months, including 55.2% of boys, took part in the study. Ninety children (54.4% of boys) were less than six months old; 158 (55.7% of boys) were more than six months old. Table 1 presents the characteristics of the examined children at different ages. The average birth weight (± standard deviation [SD]) equalled 3202.1 (± 674.4) grams. The average pregnancy (± SD) lasted 38.5 (± 3.8) weeks.
Tab. 1. Characteristics of the examined children at different ages
 Total
(n = 248)
n (%)
Child age (months)
0-6
n = 90
n (%)
> 6-12
n = 158
n (%)
Age in months (mean [SD])  7.38 (2.9)4.33 (1.23)9.11 (2.0)
     
     
     
Birth at < 37 weeks of gestation 27 (10.9)4 (4.4)23 (14.6)
     
     
Complications at birth oxygen deprivation17 (6.9)4 (4.4)13 (8.2)
infection requiring antibiotic therapy 20 (8.1)7 (7.8)13 (8.2)
     
Child chronic diseases    
acid reflux11 (4.4)3 (3.3)8 (5.1)
malabsorptions8 (3.2)4 (4.4)4 (2.5)
congenital anomalies of urinary tract 2 (0.8)0 (0)2 (1.3)
heart defects 6 (2.4)2 (2.2)4 (2.5)
calcium and phosphate metabolism disorders6 (2.4)3 (3.3)3 (1.9)
anaemia 2 (0.8)1 (1.1)1 (0.6)
diabetes 2 (0.8)1 (1.1)1 (0.6)
Eight mothers smoked and two mothers consumed alcohol during pregnancy. Ninety-three women (37.5%) reported general health problems during pregnancy as follows:, 32 (34.4%) anaemia, 24 (25.8%) respiratory tract infections, 19 (20.4%) diabetes, and 18 (19.4%) urinary tract infections. Table 2 presents the parent and family characteristics of the examined children.
Tab. 2. Parent and family characteristics of the examined children
 Mother
n (%)
Father
n (%)
Age of parents (in years) ≤ 2536 (14.5)23 (9.5)
26-3075 (30.2)57 (23.7)
31-3587 (35.1)99 (41.1)
36-4042 (17)48 (19.9)
> 40 8 (3.2)14 (5.8)
Educationprimary school7 (2.8)4 (1.7)
secondary school 88 (35.5)75 (31.1)
higher then secondary school153 (61.7)162 (67.2)
Family socio-economic statuslow4 (1.6)
 average 82 (33.1)
 good 162 (65.3)
Number of children in a family (mean [SD])1.7 (0.85)
Cigarette smoking at home 61 (24.6)
In 39 children (15.7%), five under six months of age and 34 over six months of age, the incisal edge or the cusp of a tooth was possible to detect through the oral mucosa. One child had swollen gums and 16 had red gums around the erupting tooth. Five children over six months of age had an eruption cyst and one child over six months of age presented with an abscess. Table 3 presents the dental status of the examined children and figure 1 presents the type of erupted teeth. Six children (1.25%) had natal teeth, one child (0.4%) had neonatal tooth and one child (0.4%) had a mesiodens.
Fig. 1. Percentage of the type of erupted teeth in the examined infants
Tab. 3. Dental status of the examined children in different age
  Children age, months
TeethTotal
n (%)
0-6
n (%)
> 6-12
n (%)
Examined children248 (100)90 (100)158 (100)
Children with at least one erupted tooth*157 (63.3)28 (31.1)129 (81.6)
Number of erupted teeth in each children (mean [SD])1.96 (2.55)0.41 (0.89)2.82 (2.79)
Traumatic dental injuries**11 (7)2 (2.2)9 (7.6)
Dental caries (d + p > 0)**5 (3.2)05 (3.9)
Enamel hypoplasia**3 (1.2)03 (1.9)
*As a percent of examined children
**As a percent of children with at least one erupted tooth
Mandibular central incisors were generally the first to erupt, followed by maxillary central incisors. Tooth 71 erupted on average (95% confidence interval) at 7.51 (6.96-8.06) months, tooth 81 at 7.97 (7.41-8.52) months, tooth 51 at 9.81 (9.39-10.23) months, and tooth 61 at 10.10 (9.66-10.54) months. Five among the 33 children (15.2%), who had four erupted maxillary incisors, had caries on their labial surfaces. Two children, aged 8.8 and 10.4 months, had only white spot lesions (d = 1 and d = 4, respectively); three children, aged 10.4, 12, and 12 months had caries (p = 4). Eleven maxillary central incisors and two mandibular central incisors in 11 children underwent traumatic injuries, including partial tooth luxation (n = 7) and crown fracture involving both enamel and dentin (n = 2), and tooth luxation (n = 4). Falling caused all traumas (tab. 4).
Tab. 4. Prevalence of various characteristics/lesions of oral mucosa
Oral mucosaTotal
n (%)
Child age, months 
0-6
n (%)
> 6-12
n (%)
P
Examined children248 (100)90 (100)158(100)
Upper lip frenal attachment
mucosal25 (10.1)13 (14.4)12 (7.6)0.123
gingival88 (35.5)27 (30.0)61 (38.6) 0.214
papillary83 (33.5)31 (34.4)52 (32.9)0.889
incisive papilla penetrating 52 (21.0)19 (21.1)33 (20.9)1.000
Short lingual frenulum 37 (14.9)14 (15.5)23 (14.6)0.832
Mucosal lesions 49 (19.8)24 (26.6)25 (15.8)0.560
Bohn’s nodules24 (9.7)10 (11.1) 14 (8.9)0.656
mucocele 7 (2.8)5 (5.6)2 (1.3)0.103
oral candidiasis 5 (2)5 (5.6)0 (0.0)0.006*
aphthous stomatitis4 (1.6)1 (1.1)3 (1.9)1.000
primary oral herpes 3 (1.2)1 (1.1)2 (1.3)1.000
fibroma3 (1.2)1(1.1)2 (1.3)1.000
Epstein’s pearls 2 (0.8)1 (1.1)1 (0.6)1.000
epulis 1 (0.4)0 (0.0)1(0.6)1.000
p-values are based on Fisher exact test for comparisons of children in various age
*statistical significance at p < 0.05

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otrzymano: 2020-07-20
zaakceptowano do druku: 2020-08-10

Adres do korespondencji:
*Dorota Olczak-Kowalczyk
Zakład Stomatologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-097 Warszawa
tel.: +48 (22) 116-64-24
dorota.olczak-kowalczyk@wum.edu.pl

New Medicine 3/2020
Strona internetowa czasopisma New Medicine