Evaluation of Dental Radiography and Treatment Needs in 3-19-year-old Swedish Patients: a Retrospective, Controlled Comparison of Extremely Preterm–born and Very Preterm–born With Full Term–born Children and Adolescents

doi:10.21203/rs.3.rs-1441731/v1

Background: Preterm birth has been shown to cause various long-term health issues. Children who were born preterm have also been observed to have more behaviour management problems (BMP) during dental examinations and treatment than children born full term. It is known that dental radiographic examinations can be uncomfortable and cause anxiety in paediatric patients. Our aims were to compare a matched control group of full term-born children and adolescents with preterm–born children and adolescents concerning oral health outcomes, such as prevalence of BMP, missed appointments, caries, treatment needs, including the need for a dental radiographic examination, and experience of orthodontic treatment.

Methods: The present study included 311 patient files: 122 very preterm–born and 33 extremely preterm–born children and adolescents (<32 gestational week). A matched control group of 156 full term–born children and adolescents (≥ 37 gestational week) was analysed for comparison. Various factors, including BMP, missed appointments, dental caries, and radiographic examinations, were retrieved from the dental records for three age intervals: 3–6 years, 7–12 years, and 13–19 years.

Results: Extremely preterm–born children missed significantly more dental appointments and presented with more BMP during dental examinations and treatment than full term–born children in the 3–6-year age group; the same was observed for the very preterm–born in the 7–12-year age groups. No significant differences in BMP during bitewing and periapical examinations or in number of periapical and panoramic radiographs occurred between the groups in any age interval.

Conclusions: The same dental care approach can be used for any child, regardless of gestational age at birth, regarding dental radiography, caries, and treatment needs. However, preterm–born children and adolescents should be given more flexibility in rebooking and receive reminders for scheduled visits with the general dental team.

Children

Dental radiography

Intraoral imaging

Preterm birth

Despite advancements in medicine and technology that have reduced infant and child mortality, preterm birth is worldwide considered to be the principal cause of death in children under the age of 5 years. The effects of a preterm birth, however, may still surface in long-term health issues of various kinds [1]. The most common, long-lasting effects include chronic lung disease, vison and hearing loss, intellectual impairment, and cerebral palsy [1, 2]; risk of impairment increases with neonatal complications and decreasing gestational age and birth weight [3]. Oral health may also be affected as a result of medical health problems, such as a complicated delivery, infections, brain injury, or feeding difficulties in the neonatal period. In the dental context, this may affect general oral health as well as other oral health-related habits [4], including behavioural difficulties related to dental treatment. Behaviour management problems (BMP) are defined as lack of cooperation and disruptive behaviours that may cause a delay in, or even lack of, treatment [5]. During the preschool and school years, it has been shown that preterm–born patients had more BMP during dental examinations and treatment than children born full term [6, 7], as well as a higher number of missed appointments during the preschool years [6]. Nevertheless, preterm–born children did not have a higher risk of developing caries lesions than full term–born children [6]. Other reported oral health problems in preterm–born children (especially in extremely preterm– and very preterm–born children) include disturbances in tooth development, such as smaller teeth, delay in tooth maturation, and more enamel defects compared with full term–born children. High frequencies of temporomandibular disorder pain (TMD pain) during adolescence have also been reported, as well as more malocclusions, and a greater subjective need for orthodontic treatment compared with patients born full term [7–11].

In dentistry, radiographic investigations are helpful for diagnosing and treating oral disease [12]. However, all radiographic examinations must be adjusted, justified, and optimised for each patient, as exposure to ionizing radiation always carries some amount of risk [13, 14]. Sweden has, since 2018, national regulations, states that the dental records have to include this information [15]. Moreover, because developing tissues are more sensitive to ionizing radiation, children have a higher radiation vulnerability than adults. A small head size also increases the risk that sensitive organs like the thyroid gland may inadvertently become exposed to ionizing radiation [16]. Dental radiographic examinations are one of the most frequent radiographic examinations that paediatric patients take [12], often in combination with periodic dental check-ups for caries detection, dental trauma, and control of disorders in tooth development [17]. Bitewing, periapical, panoramic, and cephalometric images are among the most common dental radiographs made [16]. The panoramic radiograph allows for a wider assessment of the jaws but requires good patient cooperation to obtain acceptable image quality [13, 17]. Brogårdh-Roth et al. [6] observed in their study of 3–6-year-old preterm–born children that fewer dental radiographic examinations were done compared to full term–born children. Intraoral radiographic examinations can be demanding because of the smaller size of the anatomic structures and lack of cooperation [18]. Gagging reflexes due to the detector are relatively common in this population [19]. Moreover, dental radiographic examinations before treatment are often associated with higher anxiety levels in paediatric patients [20]. Brogårdh-Roth S et al. found in another study that adolescent girls, both preterm– and full term–born, were more likely to report pain during dental radiographic examinations than boys [21].

To our knowledge, no previous studies have investigated overall oral health and treatment needs, including for dental radiograph examinations, in extremely preterm– and very preterm–born individuals during both childhood and adolescence. Thus, our aims were to evaluate preterm–born children and adolescents concerning their oral health, such as prevalence of BMP, missed appointments, caries, treatment needs, including the need for a dental radiographic examination, and experience of orthodontic treatment in relation to matched, full term–born children and adolescents. Our hypotheses were that there was no difference between the groups of children and adolescents regarding our aims.

Clinical relevance

The findings of the present investigation will be helpful in the further development of guidelines and strategies for the dental care of various groups of paediatric patients.

Ethics considerations

The present study followed the tenets of the Declaration of Helsinki. The Ethics Committee of the Medical Faculty of Lund University approved all previous studies from which the material for the present study was collected (Dnr [Daybook no.] LU 362-01; Dnr 618/2007) and also the present study (Dnr Etik H15 2013/39). All methods were performed in accordance with the relevant guidelines and regulations.

Written information about the study, including information of full confidentiality and the right to discontinue participation at any time, was posted to the adolescents and their guardians, and a written informed consent form was obtained. All methods were performed in accordance with the relevant guidelines and regulations. The records for ages 3–19 years were reviewed for all who (they and their guardians) had signed an informed-consent form.

Study design and participants

All patient data for the extremely preterm– and very preterm–born patients and the control group of full term–born patients were retrieved from previous studies by Brogårdh-Roth et al. [6, 21]. The sample of dental records included all patients born between 23 and 32 weeks of gestation (n = 192; n = 155 eligible)—that is, the extremely preterm– and very preterm–born groups of adolescents (n = 33 and n = 122 eligible)—during 1994–1996 in the southern Sweden recruitment area of the Lund and Malmö University Hospitals and their matched controls (n = 156). Patients were first identified using the Swedish Medical Birth Registry; data on gestational age, birth weight, and number of siblings were retrieved from the Swedish Board of Health and Welfare. In the present study, the term “preterm” describes children born at 32 weeks of gestation or earlier; “extremely preterm”, children born at 23–28 weeks; and “very preterm”, children born at 29–32 weeks [22, 23]. The full term–born control group comprised children who were born at 37 or more gestational weeks and which previous studies had matched with the patients in the two preterm groups [6, 21]. Each control patient was identified through dental clinics and matched for age, sex, immigrant background (at least one parent born outside the Nordic countries), dental clinic, and dentist [6].

The present study retrieved 311 dental records between 1997 and 2015. Table 1 describes participant characteristics.

Table 1

Characteristics of the preterm–born and the matched full term–born children and adolescents
Characteristics	Preterm–born		Full term–born
	Extremely preterm	Early preterm	Full term–born
Sex
Male	19 (57.6%)	55 (45.1%)	76 (48.7%)
Female	14 (42.4%)	67 (54.9%)	80 (51.3
Twins or triplets	5 (15.2%)	43 (35.2%)	1 (0.6%)
Mean gestational age
weeks	26.6	30.8
range	(24–28)	(29–32)	(37–40)
Mean birth weight
grams	936.1	1604.6	3541.5*
range	615–1470	840–2320	2100–4400*
All data retrieved from Brogårdh-Roth et al. 2009 [24]
Extremely preterm–born, n = 33; very preterm–born, n = 122; and full term–born, n = 156
* n = 128, no data available for n = 28

The inclusion criterion was that dental records for ages 3–19 years were available (Fig. 1). The exclusion criteria were missing dental records during ages 3–19 years and declining to participate (Fig. 1).

Dental record review

The Swedish Public Dental Service (Folktandvården), private dental clinics, and the Children’s Dental Clinic at the Faculty of Odontology at Malmö University provided dental records for all participants from 3–19 years.

One author (AV) evaluated all dental records (n = 311). The records were blinded according to patient identity and study group. The 10 first reviews were made with an experienced specialist in paediatric dentistry (SBR). In cases of doubt or disagreement, specialists were consulted until consensus was reached (SBR, KH-H). Table 2 lists the variables retrieved for ages 3–6, 7–12, and 13–19 years.

Table 2

Dental record data retrieved for ages 3–6, 7–12, and 13–19 years
Information retrieved from dental records
Dental visits
Total number of dental care visits
Total number of dental emergency visits
Total number of visits for behaviour shaping (a learning model to prepare the individual for dental treatment)
Missed appointments (no-shows, late cancellations)
Radiographic examination
Total number of bitewing radiograph examinations
Total number of periapical radiograph examinations
Total number of panoramic radiograph examinations
Justification (noted, not noted)
Dental caries at ages 3, 6, 12, and 19 years
Decayed/filled teeth (dft) – primary dentition
Decayed teeth (dt) – primary dentition
Decayed/Filled Teeth (DFT) – permanent dentition
Decayed teeth (DT) – permanent dentition
Medical health problems*
Chronic illness (yes, no)
Daily medication (yes, no)
Behaviour management problems (BMP) [5, 6]
During dental examinations and different treatments, e.g. dental fillings, dental extractions and application of intraoral anaesthetics (yes or no)
During bitewing and periapical radiographic examinations (yes or no)
Sedation during dental treatment
Benzodiazepines (yes, no)
Nitrous oxide (yes, no)
General anaesthesia (yes, no)
Need for referral
To specialist in paediatric dentistry due to BMP (yes or no)
Experience of orthodontic treatment, for example, fixed appliances, removable appliances, or both fixed and removable appliances (yes, no).
* Information gathered from Brogårdh-Roth et al. 2009 [24], and defined according to Westbom & Kornfält [25].

Dental record notes on disruptive behaviour that delayed an examination or treatment, or made dental examinations or treatment impossible, were classified as BMP [5]. One or more examples of disruptive behaviour during the age intervals 3–6, 7–12, and 13–19 years classified a child/adolescent as having BMP [5]. Information regarding chronic illness was obtained from an interview study with the parents [24], since the dental staff does not always note this information in the records and the following definition for chronic illness, from Westbom and Kornfält [25], was used:

(1) A disorder which was disabling and obviously chronic or incurable, or (2) a disorder of at least three months during a one-year period and interfering with daily life functioning and/or needing treatment or special aids during at least three months, or (3) a disorder requiring hospitalization for at least one month or at least three periods during a one-year period.

Statistical analysis

All data were recorded and analysed in Microsoft Office 16 EXCEL (Redmond, Washington, United States) and the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, version 27.0. Armonk, NY: IBM Corp). Frequency analyses were done and cross-tabulations were analysed. Pearson’s chi-square test, Fisher’s Exact test, the ANOVA, and Tukey’s Honestly Significant Difference (HSD) test were used for analysing whether between-group differences were significant. The significance level was set at p ≤ 0.05.

Availability of data

The complete data base can be obtained from the corresponding author (AV).

The present study identified 192 eligible preterm–born adolescents and 192 full term–born controls. Of these, 155 of the preterm–born (80.7%) and 156 of the full term–born (81.3%) adolescents agreed to participate in this study and allow a review of their dental records from ages 3–19 years. During this period, 83.3% of the participating children and adolescents were regular patients at the Swedish Public Dental Service, 3.5% at private clinics, and 1.6% at the Children’s Dental Clinic at Faculty of Odontology at Malmö University. During this period, the remaining 10.9% had a combination of two caregivers, and 9.0% were patients at the Swedish Public Dental Service or a private clinic. Table 1 presents the birth data and sex distribution of the 311 children and adolescents in the study sample.

The two groups of preterm–born children presented with chronic illness more frequently than the full term–born control group. Among the groups, this difference was significant for ages 3–6 years (very preterm and extremely preterm > full term; p’s = 0.001;), 7–12 years (extremely preterm > full term; p = 0.018), and 13–19 years (very preterm and extremely preterm > full term; p = 0.023 and p = 0.001). No significant relations between chronic illness and BMP during dental examination or treatment were found.

Dental Radiographic Examinations

During bitewing and periapical examinations, no significant differences in BMP were found between the three groups for any of the age intervals. The mean number of bitewing examinations in full term–born children was significantly higher (p = 0.026) than in very preterm–born children at 3–6 years. No significant differences occurred in the other age intervals. Moreover, no significant differences in mean number of periapical or panoramic radiographs occurred between the three groups at any age (Table 3). Table 3 also shows when a justification was noted in the dental records for a bitewing, periapical, or panoramic examination.

Table 3

Radiographic examination data from the dental record review
	Age at radiographic examinations
	3–6 years			7–12 years			13–19 years
	BMP (n)	Exams (mean)	Just	BMP (n)	Exams (mean)	Just	BMP (n)	Exams (mean)	Just
	Bitewing radiographs
EPT	3 21.4%	0.59		3 10%	3.68		3 9.7%	4.66
VPT	10 18.9%	0.53		7 6.4%	3.09		5 4.4%	4.59
FT	12 12.8%	0.77		12 7.9%	3.48		7 4.7%	4.83
Total		0.66	1.3%		3.35	3.4%		4.72	8.9%
p-value	0.469	0.026*		0.690	0.087		0.434	0.501
	Periapical radiographs
EPT	0 0%	0.16		1 7.1%	0.90		1 8.3%	0.91
VPT	3 12.5%	0.34		1 1.9%	1.19		0 0%	0.82
FT	2 6.3%	0.28		1 1.3%	1.29		1 2.9%	0.63
Total		0.29	94.8%		1.21	93.7%		0.73	91.8%
p-value	0.749	0.448		0.317	0.558		0.443	0.569
	Panoramic radiographs
EPT		0.00			0.23			0.31
VPT		0.00			0.16			0.20
FT		0.03			0.12			0.17
Total		0.01	50%		0.15	94.3%		0.19	96.4%
p-value		0.272			0.344			0.180
Pearson’s chi-square and Fisher’s exact test; * FT ˃ VPT
Test groups: VPT = very preterm–born (n = 122) and EPT = extremely preterm–born (n = 33); Control group: FT = full term–born (n = 156); BMP = behaviour management problems; Just = justification for the radiograph noted in the dental records

Dental examination and treatment

BMP occurred more frequently in the two groups of preterm–born children than in the full term–born control group during dental examinations and various treatments (Fig. 2). This was significant at 3–6 years (very preterm and extremely preterm > full term; p’s = 0.000) and 7–12 years (very preterm > full term; p = 0.014), but not at 13–19 years (p = 0.198).

Caries prevalence

No significant differences in caries prevalence were found between the three groups for any of the age intervals based on mean dft/DFT and presence of manifest caries.

Other clinical variables

No significant differences could be found between the three groups for sedation, referral to dental paediatric specialist, visits for behaviour shaping, or experience in orthodontic treatment at any age interval (Table 4).

Table 4

Sedation during treatment, referral to paediatric dental specialist for BMP, and orthodontic treatment
	Age interval
	3–6 years		7–12 years		13–19 years
	n	%	n	%	n	%
	Benzodiazepines
EPT	4	12.5	0	0	0	0
VPT	6	5	4	3.4	0	0
FT	6	3.9	0	0	0	0
p-value	0.128		0.051		-
	Nitrous oxide
EPT	1	3.1	3	9.7	0	0
VPT	3	2.5	8	6.8	4	3.4
FT	3	1.9	5	3.3	0	0
p-value	0.864		0.188		0.054
	General anaesthesia
EPT	0	0	0	0	1	3.1
VPT	2	1.7	0	0	0	0
FT	1	0.6	0	0	1	0.7
p-value	0.700		-		0.204
	Referral to a paediatric dental specialist
EPT	2	6.3	2	6.5	1	3.1
VPT	9	7.6	3	2.6	0	0
FT	8	5.2	1	0.7	1	0.7
p-value	0.694		0.074		0.204
	Orthodontic treatment experience
EPT	0	0	1	3.2	13	40.6
VPT	0	0	13	11.2	34	29.1
FT	0	0	11	7.2	32	21.3
p-value	-		0.323		0.057
Pearson’s chi-square and Fisher’s exact test
Test groups: VPT = very preterm–born (n = 122) and EPT = extremely preterm–born (n = 33); Control group: FT = full term–born (n = 156)

Visits and missed appointments

No significant difference in mean number of dental care visits was found between the control and experimental groups at any age interval (Table 5). Extremely preterm–born missed significantly more dental appointments than full term–born controls at 3–6 years (p = 0.001) while very preterm–born children missed significantly more appointments than the controls at 7–12 years (p = 0.003). However, no significant differences were found at 13–19 years (p = 0.206; Table 5). Neither were any significant differences at any age interval found in mean number of dental emergency visits between the three groups (Table 5).

Table 5

Mean numbers and ranges of dental care and emergency visits, and missed appointments.
Group	Mean number and range
	Dental care visits			Missed appointments			Dental emergency visits
	ages			ages			ages
	3–6	7–12	13–19	3–6	7–12	13–19	3–6	7–12	13–19
VPT n = 122	5.44 (1–18)	10.21 (1–36)	9.57 (1–32)	2.17 (0–14)	3.24 (0–17)	3.59 (0–24)	0.36 (0–3)	0.58 (0–8)	0.61 (0–7)
EPT n = 33	5.41 (1–15)	10 (3–27)	12.25 (2–30)	3.27 (0–13)	3.13 (0–14)	3.22 (0–12)	0.19 (0–1)	0.81 (0–4)	0.63 (0–6)
FT n = 156	5.65 (1–25)	9.86 (1–38)	9.89 (2–26)	1.54 (0–9)	1.97 (0–13)	2.79 (0–19)	0.36 (0–3)	0.55 (0–7)	0.51 (0–5)
p-value	0.835	0.906	0.033*	0.001^ⴕ	0.003^ǂ	0.206	0.343	0.438	0.716
test groups: VPT = very preterm–born (n = 122) and EPT = extremely preterm–born (n = 33)
control group: FT = full term–born (n = 156)
ANOVA and Tukey’s HSD test; * = EPT > VPT; ^ⴕ = EPT > FT; ^ǂ = VPT > FT

The present retrospective study of dental records for 3–19-year-old extremely preterm–, very preterm–, and full term–born children and adolescents supported our hypotheses for many of the investigated variables. At younger ages, 3–6 years and 7–12 years, preterm children missed significantly more dental appointments and had more notes on BMP in their check-up and treatment records than their full term–born counterparts. Overall, the present study has yielded valuable information for future considerations in the dental care of preterm–born adults; one main result is that both preterm– and full term–born children can be offered the same dental care, which is a welcome result from both patient and care provider perspectives.

Ghanei et al. found that, in general, 19.3% of the time, children experience pain and 17.7% of the time, discomfort during dental radiographic examinations [26]. The findings of the present study show that premature birth does not seem to be an important factor in BMP during radiographic examinations, although they can be painful and uncomfortable. Other findings support this. Our study sample had also participated in a previous questionnaire survey at age 17–19 years [21]; 34% of the extremely and very preterm–born respondents claimed experiencing pain (a rating of ≥ 50 on a Visual Analog Scale [VAS] scale) in dental radiography examinations compared with 37% of the full term–born respondents. This study of Brogårdh-Roth et al., however, did document a significant gender difference in both preterm groups as well as in the control group and revealed that 17–19-year-old adolescents who had been extremely preterm at birth reported pain during dental radiography more frequently than the very preterm–born adolescents [21]. The Brogårdh-Roth et al. study [21] also reflected that the views and experiences of the adolescents themselves are important; Marshman et al. have similarly stated that it is necessary for dental research to acquire the adolescent perspective in future evaluations of treatment [27].

The overall aim of the present study, however, was a longitudinal overview of the dental care given to preterm– and full term–born patients during their growing up years without focusing on the patient perspective. At all age intervals, preterm–born children and adolescents with a history of oft-reported chronic illness need to be identified in order to determine suitable pain management strategies, which was also highlighted by Hatfield et al. [28]. Johnson and Marlow concur, for the reason that cognitive deficits are often reported in extremely and very preterm–born individuals [29]. Pierro et al. found that age is significantly related to behaviour during radiographic examinations because cooperation increases with age [30], which agrees with our findings.

Regarding the documentation of dental radiographs in the dental records, this study found that almost no dental professional documented why bitewing radiographs were necessary. This is most likely because Sweden had no national regulations for recording justifications for use of ionizing radiation at the time of our study. Regulations were introduced first in 2018 [15]. Justification of periapical and panoramic radiographs, however, was usually documented. This might be a consequence of the situation during which these dental radiographs were taken or that they served as an answer to a specific clinical problem.

Our study found no significant differences in mean numbers of periapical and panoramic radiographs between preterm–born and full term–born children at any age interval. Nevertheless, the mean number of bitewing examinations was significantly higher in full term-born children than in very preterm-born children. This could be due to the fact that before, in Sweden, children were examined in groups. Bitewing radiographs were exposed regularly on every child. Probably, some of the preterm-born children were not included in this type of screening. Preterm–born children still appear to have undergone the same radiographic examination procedures as full term–born children, with similar exposures to radiation. However, from 3–6 years of age, both the very preterm– and extremely preterm–born presented with more BMP during dental examinations and various treatments compared to the full term–born controls; furthermore, during ages 7–12 years, the very preterm–born patients also presented with more BMP than the controls. Yet, this did not occur during dental radiographic examinations compared to full term–born children.

Reports of preterm–born children having more behavioural and emotional problems than full term–born, as Johnson and Marlow have observed [29], may help explain why the two preterm groups in our study presented with more BMP during dental examinations and treatments at ages 3–6 and 7–12 years. This difference disappeared at 13–19 years, which may be due to the adolescent phase being a time of greater maturity and, thus, the preterm–born adolescent being able to adjust to dental care situations better; several studies on preterm–born adolescents have reported similar observations [4, 6, 21, 24].

Behaviour in the dental situation, however, may be linked to behaviour in everyday situations, and there are reports that preterm–born children have problems with social and behavioural functioning that manifest when they reach school age and adolescence; Rogers and Hintz have noted that these include hyperactivity, anxiety, and difficulties focusing [31]. Brogårdh-Roth et al. found in one study that negative experiences are an important factor in the development of dental fear and anxiety; this was not a factor, however, for the same participants at ages 17–19 years. In this follow-up study, dental fear and anxiety in the preterm–born adolescents were comparable to in the full term–born control group [21].

Klaassen et al. showed that the most common reason for referral to a paediatric dental specialist was uncooperative behaviour [32]. Our study found no significant differences between preterm– and full term–born children in number of referrals to paediatric dental specialists, which indicates that although preterm–born children may present with more BMP during dental examination and treatment, general-practicing dentists are still able to manage these patients. The lack of a significant difference in mean number of visits for behaviour shaping between our experimental and control groups supports this.

In line with many other studies, we found no significant difference in caries prevalence between preterm– and full term–born children [7, 33, 34, 35, 36]. Also in line with Johnson and Marlow, however, are the findings in our study that extremely preterm– and very preterm–born children and adolescents have more chronic illnesses than full term–born children and adolescents at all age intervals [29]. The Brogårdh-Roth et al. study on the same participants as in our study found that about 50% of the preterm– and full term–born adolescents reported consuming sweets and sugary drinks between meals several days per week at 17–19 years of age [21]. As Hasselkvist et al. have noted, this frequent consumption of sweets and soft drinks may be a risk factor for developing caries and, later in life, dental erosion [37]. Further, Sharafi et al. have shown that this less-than-healthy lifestyle throughout young adulthood increases cardiovascular disease in young adults born preterm [38]; thus, there is risk of problems in adulthood.

In our study, extremely preterm–born children was the group that missed most appointments at ages 3–6 years while very preterm–born children missed most appointments at ages 7–12 years. Preterm–born children have more medical appointments than full term–born children, which may explain this difference. By ages 13–19 years, however, the difference had disappeared, probably because the need for medical care is less as the adolescent matures.

In line with the study of Brogårdh-Roth et al., which found that preterm–born children are not more exposed to traumatic dental injuries than full term–born children, we found no difference in mean number of dental emergency visits between our experimental and control groups [39]. We also found no differences in orthodontic treatment experience, although Paulsson et al. have reported a higher treatment need in preterm–born children than full term–born children [40]. Nonetheless, Paulsson et al. showed in another study that extremely preterm–born children can experience delayed tooth development, which the general practicing dentist should note [41].

Study limitations

Deciphering handwritten dental records can be challenging. How and when the records are written, whether at the end of the day, or during the patient visit, as well as which dental care professional who writes them, may lead to an inaccurate portrayal of the actual problems, especially of BMP. Further, statistical comparisons between the two preterm groups should be interpreted with caution as the extremely preterm–born group had only 33 participants; the group size, however, was in line with official Swedish statistics concerning prevalence of birth between 23 and 28 weeks of gestation.

Study strengths

Our study followed the same groups of preterm– and full term–born children and adolescents over a long period (3–19 years of age), which can be considered a strength. Further, the original preterm study population included all adolescents born at ≤ 32 gestational weeks in the catchment area of Malmö and Lund in southern Sweden from 1994 to 1996. Participation was relatively high; thus, the data could be helpful in determining population norms.

Another strength of the study was that one examiner (AV) retrieved all notes from the dental records in collaboration with a specialist in paediatric dentistry (SBR) and a specialist in Oral and Maxillofacial Radiology (KH-H). Well-defined, standardized methods were used in the dental record review.

The same dental care approach can be used for any child, regardless of gestational age at birth, regarding dental radiography, caries management, and treatment needs. However, preterm–born children and adolescents should be given more flexibility in rebooking and receive reminders for scheduled visits with the general dental team.

BMP: Behaviour management problems

EPT: Extremely preterm-born (gestational weeks 23-28)

VPT: Very preterm-born (gestational weeks 29-32)

Ethics approval and consent to participate

The present study followed the tenets of the Declaration of Helsinki. The Ethics Committee of the Medical Faculty of Lund University approved all previous studies from which the material for the present study was collected (Dnr [Daybook no.] LU 362-01; Dnr 618/2007) and also the present study (Dnr Etik H15 2013/39). A written informed consent form was obtained from all the adolescents and their guardians.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analysed in the present study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare no competing interests.

Funding

This study was supported by research funds for Oral Health Related Research by Region Skåne, Sweden.

Authors' contributions

All authors (AV, LA, A-PW, MB, XQ-S, KH-H, SBR): Study conception and design. LA, SBR: Material collection from the Swedish Public Dental Service, private dental clinics, and the Children’s Dental Clinic at the Faculty of Odontology at Malmö University. AV, LA, XQ-S, KHH, SBR: Material preparation and data set collection. AV, XQ-S, KHH, SBR: data analysis. All authors were included in the writing of the manuscript.

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No competing interests reported.

Evaluation of Dental Radiography and Treatment Needs in 3-19-year-old Swedish Patients: a Retrospective, Controlled Comparison of Extremely Preterm–born and Very Preterm–born With Full Term–born Children and Adolescents

Status:

Version 1

Abstract

Figures

Background

Clinical relevance

Materials And Methods

Ethics considerations

Study design and participants

Dental record review

Statistical analysis

Availability of data

Results

Dental Radiographic Examinations

Dental examination and treatment

Caries prevalence

Other clinical variables

Visits and missed appointments

Discussion

Study limitations

Study strengths

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1