Early Dental Visit Affects Dental Treatment in Korean Preschool Children Born Preterm: A Nationwide Population-Based Study

Early Dental Visit Affects Dental Treatment in Korean Preschool Children Born Preterm: A Nationwide Population-Based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Early Dental Visit Affects Dental Treatment in Korean Preschool Children Born Preterm: A Nationwide Population-Based Study Jin Ah Park, Hye Lim Jun, Myeongjee Lee, Hyung-Jun Choi, In kyung Jung, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4427475/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract This study investigated the effect of early dental visit on subsequent dental treatments in preterm infants and whether there was a significant difference in dental treatment between children born preterm and full-term (FT). National data from the Health Insurance Review and Assessment Service in Korea were analyzed. Prescription codes related to dental treatments were collected. This study included 3,354,662 patients under age 6 years, who were categorized by gestational age: extremely preterm (EPT), very preterm (VPT), and late preterm (LPT). In the preterm group, the percentage of children with no dental visits was 63.87% although the preterm group visited the dentist earlier than the FT group (EPT = 2.84, VPT = 2.78, LPT = 2.52, FT = 3.9 years old). Glass ionomer and 1-visit pulpectomy were significantly higher in the preterm group than in the FT group (p < 0.001). Preschool children who had their first dental visit after age 2 years received any dental treatment earlier than those who visited the dentist before age 1 year (p < 0.001). Early dental visits in infants may delay the timing of dental treatments and reduce their severity, suggesting the importance of early dental screenings for efficient dental management in preterm infants. preterm birth preschool dental visit dental treatment Nationwide Population-Based Study Figures Figure 1 Figure 2 Figure 3 Introduction The World Health Organization defines preterm infants as those born alive before 37 weeks of pregnancy; they can be further subdivided based on gestational age (GA): extremely preterm (EPT, < 28 weeks), very preterm (VPT, ≥ 28–< 32 weeks), and moderate to late preterm (LPT, ≥ 32–< 37 weeks) [ 1 ]. These subdivisions are important because decreasing GA is associated with increased mortality, disability, and intensity of neonatal care required, thus increasing costs [ 2 ]. Approximately 13.4 million newborn infants were born preterm in 2020, a higher number compared to the 13.8 million in 2010 [ 3 ]. In contrast to the overall decreasing birth rate in Korea, the rate of preterm births has increased from 5.9% in 2011 to 8.5% in 2020 [ 4 ], which may be attributed to advanced maternal age and infertility [ 5 , 6 ]. In this context, although preventing preterm births is crucial for both mothers and preterm infants, there is also an emphasis on specialized medical postnatal care for preterm infants and the importance of society’s interests and investments [ 7 ]. Preterm children show significant delays in many areas of physical and psychological growth and development during early childhood [ 8 , 9 ]. Similar to other body tissues, the oral structures are affected by premature birth. Developmental defects of the enamel are one of the most noticeable oral effects of preterm birth. They may classically present as enamel hypoplasia [ 10 ] (i.e., a quantitative loss of enamel) or enamel opacity (i.e., a qualitative change in the translucency of enamel) [ 9 , 11 , 12 ]. In some preterm infants, medical interventions such as laryngoscopy or endotracheal intubation may exert local traumatic forces, potentially leading to dilaceration of the crown and distortions of the palate [ 8 , 13 ]. These factors can make preterm infants vulnerable to dental problems such as dental caries and can have a detrimental impact on dental health. Several studies demonstrate the importance of early dental screening [ 14 – 16 ]. However, previous studies have focused on medical care and support for preterm infants, with limited attention to dental aspects specifically related to preterm infants. To the best of our knowledge, there are no complete reviews of dental checkups and treatments for preterm infants in Korea. Furthermore, no study has classified and stratified preterm infants born at less than 37 weeks gestation according to their GA or comprehensively investigated the timing of the first visit and treatment history. Thus, this study aimed to analyze the types of dental treatment for children based on GA, age at the first dental visit, frequency of dental visits, and types of dental hospitals visited. Further, we investigated how early dental checkups for preterm infants affected subsequent dental treatments and whether there was a significant relationship between age at the first dental visit and the number of treatments or the duration from the first visit to the first treatment. Ultimately, our goal was to demonstrate that early dental visits for preterm infants can delay or simplify dental treatments and prove crucial for the management of oral health in preterm infants. Results Total number of preterm births was 92,497. A total of 3,295,588 patients with 34,909,337 dental prescriptions were evaluated. They comprised 33,423 preterm births and 3,262,165 full-term births. In the preterm groups with dental prescriptions, the EPT, VPT, and LPT groups involved 2,027, 4,785, and 26,611 patients, respectively. The study flow diagram is presented in Fig. 1 . Dental visit and treatment experience The total number of preterm infants with KCD codes related to preterm birth was 92,497, with 33,423 (36.13%) with dental visits and 59,074 (63.87%) with no dental visits. Overall, 2,027 (36.89%); 4,785 (41.84%); and 26,611 (35.22%) preterm infants in the EPT, VPT, and LPT groups, respectively, had dental visit experience. Among the 3,295,588 subjects with dental visit experience, 2,493,624 (75.67%) had dental treatment codes. A total of 1,004 (49.53%); 2,355 (49.22%); 11,189 (42.05%); and 2,479,076 (75.99%) children in the EPT, VPT, LPT, and FT groups had dental treatment experience (Table 1 ). Table 1 Number of patients by gestational age group EPT VPT LPT FT Total Experience of dental visits (only in the preterm group) Yes 2,027 (36.89) 4,785 (41.84) 26,611 (35.22) 33,423 (36.13) No 3,468 (63.11) 6,651 (58.16) 48,955 (64.78) 59,074 (63.87) Total 5,495 (100) 11,436 (100) 75,566 (100) 92,497 (100) Dental treatment code present Yes 1,004 (49.53) 2,355 (49.22) 11,189 (42.05) 2,479,076 (75.99) 2,493,624 (75.67) No 1,023 (50.47) 2,430 (50.78) 15,422 (57.95) 783,089 (24.01) 801,964 (24.33) Total 2,027 (100) 4,785 (100) 26,611 (100) 3,262,165 (100) 3,295,588 (100) Data are presented as numbers (%). GA gestational age; EPT early preterm (GA < 28 weeks); VPT very preterm (GA ≥ 28–< 32 weeks); LPT late preterm (GA ≥ 32–< 37 weeks); FT full term (GA ≥ 37 weeks) In total, 63.11%, 58.16%, and 64.78% of the children in the EPT, VPT, and LPT groups did not receive dental treatment before age 6 years. This proportion was significantly different (p < 0.05), with the VPT group receiving the least amount of dental care. The number of cumulative dental visits over 3 years after birth, as an indicator of the importance of early dental visits, for infants born in 2017 and 2018 was also analyzed. There was no significant difference between the FT and EPT groups, but the VPT and LPT groups showed significantly fewer cumulative visits over 3 years than the FT group (all p < 0.001) (Fig. 2 A). Type of dental institution for the first dental visit according to gestational age For the type of dental institution for the first visit, the rate of visit to general hospitals (including higher-level general tertiary hospitals) was significantly higher in the EPT group than in the other GA groups; the lower the GA, the higher the rate of first-time visits being to higher-level hospitals (Fig. 2 B). For age at the first dental visit, preterm infants visited the clinics, hospital, and general hospital earlier than did FT infants. In all four groups, the average age at the first visit was lower when it was to general hospitals, and age at the first visit decreased in the following order: clinic, hospital, and general hospital. Preterm infants with GA ≥ 32 weeks and < 37 weeks visited the dentist at the earliest (Fig. 2 C). Dental treatment based on gestational age The number of patients receiving dental treatment by gestational age group was shown in Table 2 . Among children aged < 6 years, the most common dental treatment was tooth extraction (n = 1,756,593; 36.81%), followed by glass ionomer restorations (n = 1,590,326; 33.32%;) and 1-visit pulpectomy (n = 708,815; 14.85%). The proportion of children who received glass ionomer treatments was significantly higher in the overall preterm group than in the FT group. In both the VPT and LPT groups, there was a significant increase in the proportion of children receiving 1-visit pulpectomy treatment. When comparing pulpal treatment types, the preterm group included a higher proportion of patients receiving 1-visit pulpectomy than patients receiving multi visit pulpectomy (p < 0.001). Table 2 Number of patients receiving dental treatment by gestational age group Dental treatment EPT n = 2,027 VPT n = 4,785 LPT n = 26,611 FT n = 3,262,165 Total n = 3,295,588 p-value Post hoc test Amalgam 45 (4.48) 116 (4.93) 524 (4.68) 198,386 (8.00) 199,071 (4.17) < 0.001 EPT < VPT, LPT, FT Glass ionomer 671 (66.83) 1,706 (72.44) 8,397 (75.05) 1,579,552 (63.72) 1,590,326 (33.32) < 0.001 FT < EPT, VPT < LPT Pulpotomy 84 (8.37) 181 (7.69) 747 (6.68) 281,144 (11.34) 282,156 (5.91) < 0.001 VPT, LPT < FT 1-Visit pulpectomy 311 (30.98) 780 (33.12) 3,852 (34.43) 703,872 (28.39) 708,815 (14.85) < 0.001 FT < VPT < LPT Multi visit pulpectomy 51 (5.08) 169 (7.18) 718 (6.42) 235,049 (9.48) 235,987 (4.94) < 0.001 LPT < VPT, FT Extraction 544 (54.18) 1,182 (50.19) 4,641 (41.48) 1,750,226 (70.6) 1,756,593 (36.80) < 0.001 LPT < VPT, EPT < FT Data are presented as numbers (%), and the number and proportion of patients receiving dental treatments in the table may include duplicates, as individual patients may undergo multiple dental procedures. 4,772,948 GA gestational age; EPT early preterm (GA < 28 weeks); VPT very preterm (GA ≥ 28–< 32 weeks); LPT late preterm (GA ≥ 32–< 37 weeks); FT full term (GA ≥ 37 weeks) The total number of dental treatments(prescription codes) by gestational age group was shown in Table 3 . Among all the dental treatments, the most common was tooth extractions (n = 4,199,322; 36.20%), and in the preterm groups, the proportion of tooth extractions was higher with shorter GA (EPT: 30.56%, VPT: 26.79%, and LPT: 23.57%; all p < 0.001). Compared to the FT group, the preterm group had a significantly higher proportion of glass ionomer treatments (p < 0.001). The proportion of 1-visit pulpectomy treatment procedures was also significantly higher in both the VPT and LPT groups than in the FT group (p < 0.001 for both). Among all treatments, the number of prescriptions for glass ionomer restorations (5,012,856; 43.21%) was the highest, and the proportion was higher in all preterm group than in the FT group (all p < 0.001). In the preterm group, the proportion of glass ionomer restoration practices significantly increased as the GA increased (p < 0.0111). Amalgam restoration was performed at a significantly lower rate in the overall preterm children (EPT: 2.32%, VPT: 2.81%, LPT: 2.69%) than in the FT children (4.03%) (all p < 0.001). When comparing pulp treatment types, in the preterm group, the proportion of pulpectomy was higher than that of pulpotomy compared to the FT group (p < 0.0186). Table 3 Number of dental treatments by gestational age group Dental treatment EPT VPT LPT FT Total p-value Post hoc test Amalgam 85 (2.32) 267 (2.81) 1,121 (2.69) 464,678 (4.03) 466,151 (4.02) < 0.001 EPT, LPT, VPT < FT Glass ionomer 1,790 (48.92) 5,002 (52.67) 22,711 (54.44) 4,983,353 (43.16) 5,012,856 (43.21) < 0.001 FT < EPT < VPT < LPT Pulpotomy 119 (3.25) 265 (2.79) 1,060 (2.54) 428,768 (3.71) 430,212 (3.70) < 0.001 VPT, LPT < FT 1-Visit pulpectomy 477 (13.04) 1,200 (12.64) 6,001 (14.39) 1,160,036 (10.05) 1,167,714 (10.07) < 0.001 FT < VPT, LPT Multi visit pulpectomy 70 (1.91) 218 (2.30) 988 (2.37) 323,520 (2.80) 324,796 (2.80) < 0.001 VPT, LPT < FT Extraction 1,118 (30.56) 2,544 (26.79) 9,833 (23.57) 4,185,827 (36.25) 4,199,322 (36.20) < 0.001 LPT < VPT < EP < FT Total 3,659 (100) 9,496 (100) 41,714 (100) 11,546,182 (100) 11,601,051 (100) Data are presented as numbers (%). Total means the number of dental treatments in each group. GA gestational age; EPT early preterm (GA < 28 weeks); VPT very preterm (GA ≥ 28–< 32 weeks); LPT late preterm (GA ≥ 32–< 37 weeks); FT full term (GA ≥ 37 weeks) Age at first dental visit Age at the first dental visit was significantly higher in FT infants than in preterm infants (EPT = 2.84, VPT = 2.78, LPT = 2.52, FT = 3.90 years old; Fig. 2 D). The comparison of age at the first dental visit by dental treatment and GA is shown in Table 4 . Age at initial treatment for each procedure was compared, excluding both initial and follow-up dental consultations. Age for the first extraction was lower in the preterm group than in the FT group (4.59 years vs 3.91 years for EPT, 4.19 years for VPT, and 4.14 years old for LPT in the preterm group, all p < 0.001). In the LPT group, ages at the first pulpotomy and 1-visit pulpectomy were 3.55 years and 3.44 years, respectively, and these were significantly lower than those of the other groups (all p < 0.001). Table 4 Age at first dental treatment after first dental visit by gestational age group Dental treatment EPT n = 2,027 VPT n = 4,785 LPT n = 26,611 FT n = 3,262,165 p-value Post hoc test n mean ± SD n mean ± SD n mean ± SD n mean ± SD Amalgam 13 3.92 ± 0.95 44 3.64 ± 0.84 251 3.43 ± 0.86 15,761 3.55 ± 0.88 0.06 Glass ionomer 337 3.44 ± 0.84 914 3.44 ± 0.87 5,535 3.32 ± 0.85 269,192 3.39 ± 0.90 < 0.001 LPT < VPT, FT Pulpotomy 25 4.16 ± 0.62 89 3.81 ± 0.82 357 3.55 ± 0.85 22,740 3.72 ± 0.87 < 0.001 LPT < FT < EPT 1-Visit pulpectomy 134 3.67 ± 0.89 403 3.57 ± 0.89 2,425 3.44 ± 0.84 126,306 3.54 ± 0.88 < 0.001 LPT < FT, VPT, EPT Multi visit pulpectomy 16 3.88 ± 0.72 80 3.85 ± 0.92 356 3.56 ± 0.89 21,931 3.74 ± 0.92 0.0013 LPT < FT, VPT Extraction 105 3.91 ± 1.51 229 4.19 ± 1.34 1,076 4.14 ± 1.29 66,991 4.59 ± 0.76 < 0.001 EPT, VPT, LPT < FT GA gestational age; EPT early preterm (GA < 28 weeks); VPT very preterm (GA ≥ 28–< 32 weeks); LPT late preterm (GA ≥ 32–< 37 weeks); FT full term (GA ≥ 37 weeks) Time-period comparisons from the first dental visit to each dental treatment When comparing the duration from the first dental visit to each treatment, restoration treatment, pulp treatment, and extraction were earlier in the LPT infants than in the FT infants (all p < 0.001). For extraction, compared with FT infants, preterm infants received treatment faster after their first visit to a dentist. The time from the first dental visit to treatment was the shortest for restoration treatment in all groups, followed by that for pulp treatment and extraction (Fig. 2 E). For the time between the first dental visit and pulp treatment (i.e., pulpotomy, 1-visit pulpectomy, and multi visit pulpectomy), it was only significantly different for 1-visit pulpectomy between the LPT group and the FT group (302.73 days vs 335.64 days, p < 0.001; Fig. 2 F). Comparing the number of dental treatments per patient according to GA, glass ionomer restoration and extraction were significantly lower in all PT group compared to the FT group (all p < 0.001). 1-visit pulpectomy was significantly lower in the VPT and LPT groups than in the FT group (p < 0.0172). Figure 3 shows the Kaplan–Meier survival curves of the duration from the first dental visit to each dental treatment for infants born in 2017 and 2018. Of the 716,134 individuals, 323,098 (45.12%) had dental treatment codes, while the remaining 393,036 (54.88%) had codes for initial or follow-up consultations without dental treatment codes. As the patient's visit is delayed, restoration treatment, pulp treatment, and extraction were all performed earlier after the patient’s visit (Fig. 3 A, C, E). Analysis of the graph based on GA revealed that the EPT group received restorative and pulpal treatments later than the FT group (Fig. 3 B, D). In contrast, extraction was performed latest in all the groups (Fig. 3 F). Children who made their first dental visit after the age of 2 years received any dental treatment earlier (Fig. 3 G). There was a significant difference in the time of first receiving any dental treatment by GA (Fig. 3 H, p < 0.001). Discussion Dental checkups and treatments for preterm infants in Korea have not been extensively reviewed. This study found that children born preterm tended to visit the dentist at an earlier age than those born full term. Additionally, children who had their first dental visit at a later age tended to receive dental treatment earlier. The study population was limited to children aged 0–6 years. There may be no diagnoses related to preterm birth during dental visits of elementary school-aged children. Additionally, interpreting dental issues in children aged 7 years and older poses challenges owing to the concurrent presence of deciduous and permanent teeth. Furthermore, dental behavior management problems are significantly more prevalent at age 3 years in children with PT [ 17 ]. They are also more common in children with PT than in the control group among those aged 6 years or younger. However, the difference decreased with increasing age, and there were no longer significant between-group differences during the elementary school years [ 18 ]. At the outset, we hypothesized that infants born at lower GA would have fewer dental visits. There was no trend indicating a higher rate of dental non-attendance with younger GA; however, among the children born preterm, approximately 64% of those aged 6 years or younger had no experience visiting the dentist, comprising a high proportion (over half). To the best of our knowledge, no study has investigated the age at the first dental visit by GA in preterm children. Patterns of pulp treatments were examined by categorizing pulpectomy, 1-visit pulpectomy, and multi visit pulpectomy between the preterm and FT groups. In the preterm group, more patients received a 1-visit pulpectomy than a multi visit pulpectomy. This trend is attributed to lower cognitive abilities [ 19 , 20 ], higher hyperactivity, and the manifestation of externalizing and internalizing problems [ 19 , 21 , 22 ] in preterm children than in FT children. Owing to their diminished cooperation and difficulties in behavioral regulation, dentists tend to aim to complete treatment on the same day [ 23 , 24 ]. Additionally, the higher prevalence of pulpotomies over pulpectomies in the preterm group suggests that dental caries in preterm children was more advanced than those in FT children. The number of patients and the treatment frequency for GI restoration and 1-visit pulpectomy tended to be higher in patients with lower GA, indicating a greater need for restorative treatment and more prevalent carious lesions in patients with lower GA. Preterm infants tended to visit dentists earlier than FT infants. The early dental visits by preterm infants can be for examination and treatment due to poor oral health, concerns that oral health might not be optimal because of other systemic diseases, health issues, and awareness of the importance of early screening through consultations with various medical specialists. In the analysis considering the age-corrected for preterm birth, the age at which the first extraction was performed was significantly lower in all three preterm groups than in the FT group. Additionally, pulpotomy and 1-visit pulpectomy were performed at a younger age in the LPT group. This indicates that preterm children require extraction or pulpal treatment at an earlier age because of their poorer dental conditions. When examining the hospital type at the first dental visit, as the GA decreased, the proportion of visits to general hospitals increased, with the EPT group showing a significantly higher proportion of visits to general hospitals than all other groups. Given that preterm infants with a lower GA often have sequelae of prematurity, such as brain disorders [ 25 – 27 ], lung disorders [ 28 – 30 ], and lack of motor skills [ 31 , 32 ], they are more likely to receive periodic check-ups and treatments at general hospitals. Compared with physicians and general dentists, pediatric dentists are not only more knowledgeable about oral development and issues in infants and toddlers than general dentists or physicians [ 33 , 34 ], but they also provide more proactive interventions and a higher level of expertise in addressing oral problems [ 35 ]. Therefore, there is a higher likelihood of doctors assessing oral health issues early and referring comprehensive oral examinations to pediatric dentists at the same or nearby general hospitals. Early dental visits are anticipated to mitigate future dental risks, resulting in enhanced oral health [ 36 ]. This study found that for all groups, the timing of treatment for restorative, pulp, and extraction procedures accelerated as the patient’s first dental visit was delayed. The group visiting the dentist for the first time after age 2 years received all dental treatments earlier than the other groups. A previous study showed that children who had their first dental visit at age 2–3 years received preventive, restorative, and emergency visits more frequently than those who had their first visit before age 1 year [ 14 ]. Another study reported that early starters who began dental care at age < 4 years had fewer treatments for restorations, crowns, pulpotomies, and extractions than late starters who began dental care at age ≥ 4 years [ 16 ]. Similar to South Korea’s healthcare insurance system, Medicaid in the United States is a healthcare insurance program that supports low-income individuals, disabled individuals, and others to access medical services [ 37 ]. One study on Medicaid-covered dental care reported that children with preexisting conditions who received preventive visits by 18 months received 19–39% fewer treatments [ 15 ]. Another study on Medicaid-enrolled children aged 6 months to 6 years reported that the first oral health examination occurred at age 3 years on average, and as the child’s age at the first oral health examination increased, the risk of dental treatment also increased [ 35 ]. Neglected dental issues deteriorate over time, necessitating more complex and advanced treatments for delayed treatment [ 36 ]. Therefore, this study highlights the importance of early dental screening in preterm children and demonstrates that a delayed initial dental visit correlates with earlier initiation of dental treatment. Furthermore, early screening demonstrates a significant potential for efficiently managing the oral health of preschool children through timely interventions. The EPT group, which was expected to require more and earlier oral interventions owing to the adverse effects of prematurity, did not exhibit this trend when compared to the FT group. By contrast, the FT group tended to receive treatment at an earlier stage. The study findings indicated the earlier timing of the first dental visit in the EPT group allowed for preventive care and timely intervention for oral issues, suggesting that the delay in treatment may not be attributable to prematurity. This result underscores the potential of early oral screening to overcome the disadvantages of oral issues arising from prematurity. This study had some limitations. The HIRA dataset used in this study included only treatments eligible for insurance coverage, such as amalgam and glass-ionomer restorations. Although composite resin and stainless-steel crown restorations of primary teeth are commonly performed in clinical practice, they are not covered by insurance. Therefore, the records of these procedures could not be investigated in this study. Furthermore, the data on extractions did not include tooth numbers. If it is a primary molar extraction, severe decay is likely the cause [ 38 , 39 ]; however, if it is a primary incisor extraction, it can be due to physiological exfoliation [ 39 ] or trauma [ 40 , 41 ]. Therefore, because the process of extraction includes physiological exfoliation, it is difficult to assert that early extraction is always detrimental. In this study, although preterm children were studied over 5 years, the absolute number of cases in the EPT group was relatively lower compared to that in the FL group, leading to statistically insignificant results. Obtaining data over a longer period to ensure an adequate sample size would be beneficial. This study examined prescription details, first-visit age, and visit frequency. However, further research analyzing treatment costs for each GA group is needed to demonstrate the cost-effectiveness of early dental screening in children born preterm. Given the emphasis on the importance of early screening in this study, it is crucial to educate parents and caregivers of children born preterm about the importance of early dental checkups. Furthermore, physicians should be fully knowledgeable in the effectiveness of early dental care for preterm infants, be able to refer them to a dentist for dental care at the appropriate time, be knowledgeable about the medical characteristics and oral features of preterm birth, and be able to actively intervene in their dental care. In conclusion, among children born preterm, multi visit pulpectomy is more common than 1-visit pulpectomy owing to issues with patient cooperation and behavioral regulation. Additionally, the preterm group undergoes more pulpectomy procedures than the pulpotomy group, and there are frequent prescriptions for glass ionomer restorations and extractions, indicating poor oral health status in the preterm group. For the type of institution during the first dental visit, the proportion of visits to general hospitals is significantly higher in the preterm group than in the FT group. In all groups, dental treatment tended to be earlier when the age at the first dental visit was older (i.e., after age 2 years). Early dental screening of preterm infants can help overcome the disadvantages associated with prematurity-related oral issues. Therefore, parents and caregivers of preterm infants, physicians, and dentists should be knowledgeable in the importance and efficacy of early dental checkups for the oral health of preterm infants. Methods Ethics declarations The study protocol was approved by the Institutional Review Board (IRB) of Yonsei University Dental Hospital (IRB No. : 2-2019-0045) and was conducted in accordance with the principles of the Declaration of Helsinki and its later amendments. The IRB of Yonsei University Dental Hospital agreed that the requirement for informed consent was waived owing to the use of de-identified population-based data. Data source Big data on treatment histories recorded from January 1, 2017, to December 31, 2021, in the Health Insurance Review and Assessment Service (HIRA) database in South Korea were analyzed. HIRA also called the National Health Insurance Data, is a repository of claims data collected during the process of reimbursing healthcare providers (HIRA dataset No. M20220701002). The database includes not only diagnostic code data based on the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10), but also data on prescription codes, healthcare institutions, and demographics (including sex and age). Subjects with Korean Statistical Classification of Disease and Related Health Problems (KCD) codes related to preterm birth or dental visits were included in the current study. Only subjects aged 0–6 years during receipt of any dental care were evaluated because they could be assumed to be preschool children in the deciduous dentition period. The KCD codes related to preterm birth and dental prescriptions are summarized in Fig. 1 . The preterm group included all children with KCD codes associated with preterm birth, including those without dental experience. Study variables To compare the dental care history of the preterm and non-preterm infants among the subjects with dental-care-related codes, dental prescriptions were classified into restoration treatment, pulp treatment, extraction, and first or repeat dental visits. Pulp treatment was subdivided into three categories: pulpotomy, 1-visit pulpectomy, and multi visit pulpectomy. Data on the age at which the first dental visit occurred and the total number of dental visits from age 0 years to 6 years were also extracted. To compare the dental care history according to GA, GA was divided into four groups: EPT, VPT, LPT, and FT birth. Amalgam restorations, glass ionomer restorations, pulpotomy, 1-visit pulpectomy, multi visit pulpectomies, and extractions, as representative insurance benefits provided to children, and the number of visits and age at the first dental visit were compared among the four groups. Statistical analyses Categorical variables were summarized as frequencies and percentages and were compared among the GA groups using the chi-square test. Meanwhile, continuous variables were summarized as means and standard deviations (SDs) and were compared among the GA groups using analysis of variance. The occurrence of dental treatment was analyzed using the Kaplan–Meier method. Subjects born in 2017 or 2018 were followed from the first date of the dental visit up to the first date of receiving each dental treatment. Restorative treatment, pulp treatment, and extraction were considered dental treatments. The log-rank test was used to compare the occurrence of each dental treatment according to age at the first oral examination and GA. Bonferroni adjustment was used for multiple comparisons. All statistical analyses were conducted using SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). Statistical significance was defined as a two-sided p-value of < 0.05. Data availability statement The HIRA data underlying this article will be shared on reasonable request to the Big Data Department of HIRA. Researchers who desire to use the database should obtain approvals from both ethical review boards and the HIRA research committee Official application for HIRA studies can be made through the HIRA Bigdata website [ https://opendata.hira.or.kr ]. The data sets used the current study are available from the corresponding authors (Chung-Min Kang) on reasonable request. Declarations Acknowledgment This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2023-00277526, 2020R1G1A1100275) and the 24 Yonsei University College of Dentistry student research grant. Author contributions Concept and design (C.-M.K.), acquisition of data (I.K.J., M.L., C.-M.K.), data collection (I.K.J., M.L., C.-M.K.), quality assessment (J.A.P., H.L.J., C.-M.K.), statistical analysis (I.K.J., M.L.), interpretation of data (J.A.P., H.L.J., H.-J.C., M.L., C.-M.K.), drafting of manuscript (J.A.P., H.L.J., M.L.,C.-M.K.) and critical revision of manuscript (J.A.P., H.L.J., M.L., I.K.J., C.-M.K.). All authors approved the final manuscript and agreed to be accountable for all aspects of the work. Competing interests The authors declare no competing interests. Additional Information Not applicable. References Schneider, N. and C.L. Garcia-Rodenas, Early nutritional interventions for brain and cognitive development in preterm infants: a review of the literature. Nutrients, 2017. 9 (3): p. 187. 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Lawn, J.E., et al., Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon. Reproductive health, 2013. 10 : p. 1-20. Seow, W.K., Effect of preterm birth on oral growth and development. Australian dental journal, 1997. 42 (2): p. 85-91. Park, S.-y., et al., Natal factors affecting developmental defects of enamel in preterm infants: a prospective cohort study. Scientific Reports, 2024. 14 (1): p. 2089. Seow, W.K., et al., A study of primary dental enamel from preterm and full-term children using light and scanning electron microscopy. Pediatric dentistry, 2005. 27 (5): p. 374-379. Bensi, C., et al., Relationship between preterm birth and developmental defects of enamel: A systematic review and meta ‐ analysis. International Journal of Paediatric Dentistry, 2020. 30 (6): p. 676-686. Pinto, G.d.S., et al., Early ‐ life events and developmental defects of enamel in the primary dentition. Community dentistry and oral epidemiology, 2018. 46 (5): p. 511-517. Hohoff, A., et al., Palatal development of preterm and low birthweight infants compared to term infants–What do we know? Part 3: Discussion and Conclusion. Head & face medicine, 2005. 1 : p. 1-7. Savage, M.F., et al., Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics, 2004. 114 (4): p. e418-e423. Beil, H., et al., Effect of early preventive dental visits on subsequent dental treatment and expenditures. Medical care, 2012. 50 (9): p. 749-756. Nowak, A.J., et al., Do early dental visits reduce treatment and treatment costs for children? Pediatric Dentistry, 2014. 36 (7): p. 489-493. BROGÅRDH‐ROTH, S., K. Stjernqvist, and L. Matsson, Dental behavioural management problems and dental caries prevalence in 3 ‐ to 6 ‐ year ‐ old Swedish children born preterm. International Journal of Paediatric Dentistry, 2008. 18 (5): p. 341-347. BROGÅRDH‐ROTH, S., et al., Parental perspectives on preterm children's oral health behaviour and experience of dental care during preschool and early school years. International Journal of Paediatric Dentistry, 2009. 19 (4): p. 243-250. Anderson, P., et al., Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. JAMA, 2003. 289 (24): p. 3264-3272. Casey, P.H., et al., Impact of prenatal and/or postnatal growth problems in low birth weight preterm infants on school-age outcomes: an 8-year longitudinal evaluation. Pediatrics, 2006. 118 (3): p. 1078-1086. Linnet, K.M., et al., Gestational age, birth weight, and the risk of hyperkinetic disorder. Archives of disease in childhood, 2006. 91 (8): p. 655-660. Tso, W.W.Y., et al., Preterm postnatal complications and risk of attention ‐ deficit/hyperactivity disorder. Developmental Medicine & Child Neurology, 2023. 65 (3): p. 358-366. Coll, J.A., et al., Use of non-vital pulp therapies in primary teeth. Pediatric dentistry, 2020. 42 (5): p. 337-349. He, S.-y., et al., Survival analysis and risk factors of pulpectomy among children with severe early childhood caries treated under general anesthesia: a retrospective study. International Journal of Environmental Research and Public Health, 2023. 20 (2): p. 1191. Drommelschmidt, K., et al., Incidence of brain injuries in a large cohort of very preterm and extremely preterm infants at term-equivalent age: results of a single tertiary neonatal care center over 10 years. European Radiology, 2024: p. 1-11. Kvanta, H., et al., Language performance and brain volumes, asymmetry, and cortical thickness in children born extremely preterm. Pediatric research, 2023: p. 1-10. Lee, S., et al., Impact of moderate-to-late preterm birth on neurodevelopmental outcomes in young children: Results from retrospective longitudinal follow-up with nationally representative data. Plos one, 2023. 18 (11): p. e0294435. Harding, C., et al., A descriptive evaluation of early feeding development of infants in a local neonatal unit. Journal of Neonatal Nursing, 2023. 29 (4): p. 681-686. Oza, S., et al., Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013. Bulletin of the World Health Organization, 2014. 93 : p. 19-28. Cheong, J.L., et al., Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s. BMJ Open, 2020. 10 (9): p. e037507. de Kieviet, J.F., et al., Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis. Jama, 2009. 302 (20): p. 2235-2242. Spittle, A.J., et al. Predictors of long-term neurodevelopmental outcomes of children born extremely preterm . in Seminars in perinatology . 2021. Elsevier. McQuistan, M.R., et al., General dentists' referrals of 3-to 5-year-old children to pediatric dentists. The Journal of the American Dental Association, 2006. 137 (5): p. 653-660. Rich III, J.P., L. Straffon, and M.R. Inglehart, General dentists and pediatric dental patients: the role of dental education. Journal of Dental Education, 2006. 70 (12): p. 1308-1315. Ahmed, I., et al., Age of first oral health examination and dental treatment needs of Medicaid-enrolled children. JDR Clinical & Translational Research, 2023. 8 (1): p. 85-92. Lee, J.Y., et al., Examining the cost-effectiveness of early dental visits. Pediatric dentistry, 2006. 28 (2): p. 102-105. Gruber, J., Medicaid , in Means-tested transfer programs in the United States . 2003, University of Chicago Press. p. 15-78. Mukhopadhyay, S. and P. Roy, Extraction of primary teeth in children: An observational study. J Craniomaxillofac Surg, 2015. 4 (1): p. 57-61. Maslak, E., et al., Reasons for primary teeth extraction in children aged 1-14 years: a retrospective study. PalArch's Journal of Archaeology of Egypt/Egyptology, 2020. 17 (6): p. 13947-13964. Flores, M.T., et al., Guidelines for the management of traumatic dental injuries. III. Primary teeth. Dental Traumatology, 2007. 23 (4): p. 196-202. Ranka, M., et al., Trauma to the primary dentition and its sequelae. Dental update, 2013. 40 (7): p. 534-542. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 04 Sep, 2024 Reviews received at journal 25 Aug, 2024 Reviewers agreed at journal 09 Aug, 2024 Reviews received at journal 10 Jun, 2024 Reviewers agreed at journal 26 May, 2024 Reviewers invited by journal 24 May, 2024 Editor assigned by journal 24 May, 2024 Editor invited by journal 20 May, 2024 Submission checks completed at journal 18 May, 2024 First submitted to journal 15 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4427475","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":308297404,"identity":"8ad766fd-7029-442d-a8ec-1233a93d9e62","order_by":0,"name":"Jin Ah Park","email":"","orcid":"","institution":"Yonsei University College of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"Ah","lastName":"Park","suffix":""},{"id":308297405,"identity":"a6e1bbb6-c77f-4bbf-a44b-a48dfa9c3d0f","order_by":1,"name":"Hye Lim Jun","email":"","orcid":"","institution":"Yonsei University College of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Hye","middleName":"Lim","lastName":"Jun","suffix":""},{"id":308297406,"identity":"2a258549-f2bd-49a3-affd-6a34dd6a6609","order_by":2,"name":"Myeongjee Lee","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Myeongjee","middleName":"","lastName":"Lee","suffix":""},{"id":308297407,"identity":"bab0fc4b-a423-4de0-b407-73b02f7b8fee","order_by":3,"name":"Hyung-Jun Choi","email":"","orcid":"","institution":"Yonsei University College of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Hyung-Jun","middleName":"","lastName":"Choi","suffix":""},{"id":308297408,"identity":"4cde0d9d-485a-41ae-b9d2-25f4c217ffad","order_by":4,"name":"In kyung Jung","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"In","middleName":"kyung","lastName":"Jung","suffix":""},{"id":308297409,"identity":"b37f5a07-9895-4520-a247-e77bf523c796","order_by":5,"name":"Chung-Min Kang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACg8M8hh9+ttkwMEgQq8Wwvc9YsvdcGglajHnOmzGz/jtMghYziXwzZsZt5xM33G5/wPCjhggtNhK524BabiduuHPGgLHnGJFarMFabuQwMPA2EOMw+TffpBnbzgG1pD9g/EuMFmOJnDJp1rYDQC0JBsxE2WI4I6dYsrct2XjmjRyDwzLE+MXgRg4oKu1k+26kP3z4hpgQgwFHkJMOkKCBgcGeJNWjYBSMglEwsgAAZs4/aIcB/zgAAAAASUVORK5CYII=","orcid":"","institution":"Yonsei University College of Dentistry","correspondingAuthor":true,"prefix":"","firstName":"Chung-Min","middleName":"","lastName":"Kang","suffix":""}],"badges":[],"createdAt":"2024-05-15 23:01:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4427475/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4427475/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-74809-3","type":"published","date":"2024-10-09T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57727711,"identity":"f1bd9109-5a19-44ad-afde-dcbbeeca4b08","added_by":"auto","created_at":"2024-06-04 21:39:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":247381,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram showing the study period and included patients withKCD codes for preterm birth and dental prescriptions. \u003cem\u003eHIRA\u003c/em\u003e Health Insurance Review and Assessment Service; \u003cem\u003eKCD\u003c/em\u003e Korean Statistical Classification of Disease and Related Health Problems; \u003cem\u003eGA\u003c/em\u003egestational age; Early preterm (GA \u0026lt; 28 weeks); Very preterm (GA ≥ 28–\u0026lt; 32 weeks); Late preterm (GA ≥ 32–\u0026lt; 37 weeks)\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4427475/v1/c0333e7640912c0df808fb5d.png"},{"id":57728614,"identity":"d95fc697-156b-483a-b2d0-9a333ae94b59","added_by":"auto","created_at":"2024-06-04 21:47:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":175999,"visible":true,"origin":"","legend":"\u003cp\u003eExperiences of dental care, first dental visit age, and first dental clinic visited based on gestational age (GA). (A) The number of cumulative dental clinic visits according to GA. (B) The type of first visited dental clinic according to GA. (C) Age at first visit by dental clinic visited according to GA. (D) Age at first dental visit by GA group. (E) Duration from first dental visit to restorative treatment, pulp treatment, and extraction. (F) Duration from first dental visit to three pulp treatment. EPT early preterm (GA \u0026lt; 28 weeks); VPT very preterm (GA ≥ 28–\u0026lt; 32 weeks); LPT late preterm (GA ≥ 32–\u0026lt; 37 weeks); FT full term (GA ≥ 37 weeks)\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4427475/v1/63aa6660cf549e239058d824.png"},{"id":57727712,"identity":"8bd2cd8f-3d11-4369-87d3-f321688b5ff7","added_by":"auto","created_at":"2024-06-04 21:39:40","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":578978,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier survival analysis of dental caries and age at first oral health examination (n = 3,354,662, 2017–2021). Survival probability: The probability that the child does not require treatment for the period under observation. Survival (years): Years under observation. The observation period is up to 5 years.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4427475/v1/4a50d5d106d247907e98e064.png"},{"id":66597378,"identity":"77c0d783-1ad5-4593-b884-c92eb3c7052e","added_by":"auto","created_at":"2024-10-14 16:10:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1701116,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4427475/v1/4cd03ab9-c92d-4bee-9988-aa2e58d2292d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early Dental Visit Affects Dental Treatment in Korean Preschool Children Born Preterm: A Nationwide Population-Based Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization defines preterm infants as those born alive before 37 weeks of pregnancy; they can be further subdivided based on gestational age (GA): extremely preterm (EPT, \u0026lt; 28 weeks), very preterm (VPT, \u0026ge; 28\u0026ndash;\u0026lt; 32 weeks), and moderate to late preterm (LPT, \u0026ge; 32\u0026ndash;\u0026lt; 37 weeks) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These subdivisions are important because decreasing GA is associated with increased mortality, disability, and intensity of neonatal care required, thus increasing costs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Approximately 13.4\u0026nbsp;million newborn infants were born preterm in 2020, a higher number compared to the 13.8\u0026nbsp;million in 2010 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In contrast to the overall decreasing birth rate in Korea, the rate of preterm births has increased from 5.9% in 2011 to 8.5% in 2020 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], which may be attributed to advanced maternal age and infertility [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In this context, although preventing preterm births is crucial for both mothers and preterm infants, there is also an emphasis on specialized medical postnatal care for preterm infants and the importance of society\u0026rsquo;s interests and investments [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePreterm children show significant delays in many areas of physical and psychological growth and development during early childhood [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Similar to other body tissues, the oral structures are affected by premature birth. Developmental defects of the enamel are one of the most noticeable oral effects of preterm birth. They may classically present as enamel hypoplasia [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] (i.e., a quantitative loss of enamel) or enamel opacity (i.e., a qualitative change in the translucency of enamel) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In some preterm infants, medical interventions such as laryngoscopy or endotracheal intubation may exert local traumatic forces, potentially leading to dilaceration of the crown and distortions of the palate [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These factors can make preterm infants vulnerable to dental problems such as dental caries and can have a detrimental impact on dental health.\u003c/p\u003e \u003cp\u003eSeveral studies demonstrate the importance of early dental screening [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, previous studies have focused on medical care and support for preterm infants, with limited attention to dental aspects specifically related to preterm infants. To the best of our knowledge, there are no complete reviews of dental checkups and treatments for preterm infants in Korea. Furthermore, no study has classified and stratified preterm infants born at less than 37 weeks gestation according to their GA or comprehensively investigated the timing of the first visit and treatment history.\u003c/p\u003e \u003cp\u003eThus, this study aimed to analyze the types of dental treatment for children based on GA, age at the first dental visit, frequency of dental visits, and types of dental hospitals visited. Further, we investigated how early dental checkups for preterm infants affected subsequent dental treatments and whether there was a significant relationship between age at the first dental visit and the number of treatments or the duration from the first visit to the first treatment. Ultimately, our goal was to demonstrate that early dental visits for preterm infants can delay or simplify dental treatments and prove crucial for the management of oral health in preterm infants.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTotal number of preterm births was 92,497. A total of 3,295,588 patients with 34,909,337 dental prescriptions were evaluated. They comprised 33,423 preterm births and 3,262,165 full-term births. In the preterm groups with dental prescriptions, the EPT, VPT, and LPT groups involved 2,027, 4,785, and 26,611 patients, respectively. The study flow diagram is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDental visit and treatment experience\u003c/h2\u003e \u003cp\u003eThe total number of preterm infants with KCD codes related to preterm birth was 92,497, with 33,423 (36.13%) with dental visits and 59,074 (63.87%) with no dental visits. Overall, 2,027 (36.89%); 4,785 (41.84%); and 26,611 (35.22%) preterm infants in the EPT, VPT, and LPT groups, respectively, had dental visit experience. Among the 3,295,588 subjects with dental visit experience, 2,493,624 (75.67%) had dental treatment codes. A total of 1,004 (49.53%); 2,355 (49.22%); 11,189 (42.05%); and 2,479,076 (75.99%) children in the EPT, VPT, LPT, and FT groups had dental treatment experience (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of patients by gestational age group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEPT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVPT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLPT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eExperience of dental visits (only in the preterm group)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,027 (36.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,785 (41.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26,611 (35.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33,423 (36.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,468 (63.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,651 (58.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48,955 (64.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59,074 (63.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,495 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,436 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75,566 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92,497 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eDental treatment code present\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,004 (49.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,355 (49.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11,189 (42.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,479,076 (75.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,493,624 (75.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,023 (50.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,430 (50.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,422 (57.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e783,089 (24.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e801,964 (24.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,027 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,785 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26,611 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,262,165 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,295,588 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eData are presented as numbers (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eGA\u003c/em\u003e gestational age; \u003cem\u003eEPT\u003c/em\u003e early preterm (GA\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks); \u003cem\u003eVPT\u003c/em\u003e very preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;28\u0026ndash;\u0026lt; 32 weeks); \u003cem\u003eLPT\u003c/em\u003e late preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;32\u0026ndash;\u0026lt; 37 weeks); \u003cem\u003eFT\u003c/em\u003e full term (GA\u0026thinsp;\u0026ge;\u0026thinsp;37 weeks)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn total, 63.11%, 58.16%, and 64.78% of the children in the EPT, VPT, and LPT groups did not receive dental treatment before age 6 years. This proportion was significantly different (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the VPT group receiving the least amount of dental care. The number of cumulative dental visits over 3 years after birth, as an indicator of the importance of early dental visits, for infants born in 2017 and 2018 was also analyzed. There was no significant difference between the FT and EPT groups, but the VPT and LPT groups showed significantly fewer cumulative visits over 3 years than the FT group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eType of dental institution for the first dental visit according to gestational age\u003c/h2\u003e \u003cp\u003eFor the type of dental institution for the first visit, the rate of visit to general hospitals (including higher-level general tertiary hospitals) was significantly higher in the EPT group than in the other GA groups; the lower the GA, the higher the rate of first-time visits being to higher-level hospitals (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). For age at the first dental visit, preterm infants visited the clinics, hospital, and general hospital earlier than did FT infants. In all four groups, the average age at the first visit was lower when it was to general hospitals, and age at the first visit decreased in the following order: clinic, hospital, and general hospital. Preterm infants with GA\u0026thinsp;\u0026ge;\u0026thinsp;32 weeks and \u0026lt;\u0026thinsp;37 weeks visited the dentist at the earliest (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDental treatment based on gestational age\u003c/h2\u003e \u003cp\u003eThe number of patients receiving dental treatment by gestational age group was shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among children aged\u0026thinsp;\u0026lt;\u0026thinsp;6 years, the most common dental treatment was tooth extraction (n\u0026thinsp;=\u0026thinsp;1,756,593; 36.81%), followed by glass ionomer restorations (n\u0026thinsp;=\u0026thinsp;1,590,326; 33.32%;) and 1-visit pulpectomy (n\u0026thinsp;=\u0026thinsp;708,815; 14.85%). The proportion of children who received glass ionomer treatments was significantly higher in the overall preterm group than in the FT group. In both the VPT and LPT groups, there was a significant increase in the proportion of children receiving 1-visit pulpectomy treatment. When comparing pulpal treatment types, the preterm group included a higher proportion of patients receiving 1-visit pulpectomy than patients receiving multi visit pulpectomy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of patients receiving dental treatment by gestational age group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEPT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;2,027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVPT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;4,785\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLPT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;26,611\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;3,262,165\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;3,295,588\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost hoc test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmalgam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (4.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116 (4.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e524 (4.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e198,386 (8.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e199,071 (4.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEPT\u0026thinsp;\u0026lt;\u0026thinsp;VPT, LPT, FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlass ionomer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e671 (66.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,706 (72.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,397 (75.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,579,552 (63.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,590,326 (33.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFT\u0026thinsp;\u0026lt;\u0026thinsp;EPT, VPT\u0026thinsp;\u0026lt;\u0026thinsp;LPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulpotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (8.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181 (7.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e747 (6.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e281,144 (11.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e282,156 (5.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVPT, LPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-Visit pulpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e311 (30.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e780 (33.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,852 (34.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e703,872 (28.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e708,815 (14.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFT\u0026thinsp;\u0026lt;\u0026thinsp;VPT\u0026thinsp;\u0026lt;\u0026thinsp;LPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMulti visit pulpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (5.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169 (7.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e718 (6.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e235,049 (9.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e235,987 (4.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;VPT, FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e544 (54.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,182 (50.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,641 (41.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,750,226 (70.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,756,593 (36.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;VPT, EPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eData are presented as numbers (%), and the number and proportion of patients receiving dental treatments in the table may include duplicates, as individual patients may undergo multiple dental procedures. 4,772,948\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eGA\u003c/em\u003e gestational age; \u003cem\u003eEPT\u003c/em\u003e early preterm (GA\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks); \u003cem\u003eVPT\u003c/em\u003e very preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;28\u0026ndash;\u0026lt; 32 weeks); \u003cem\u003eLPT\u003c/em\u003e late preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;32\u0026ndash;\u0026lt; 37 weeks); \u003cem\u003eFT\u003c/em\u003e full term (GA\u0026thinsp;\u0026ge;\u0026thinsp;37 weeks)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe total number of dental treatments(prescription codes) by gestational age group was shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Among all the dental treatments, the most common was tooth extractions (n\u0026thinsp;=\u0026thinsp;4,199,322; 36.20%), and in the preterm groups, the proportion of tooth extractions was higher with shorter GA (EPT: 30.56%, VPT: 26.79%, and LPT: 23.57%; all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Compared to the FT group, the preterm group had a significantly higher proportion of glass ionomer treatments (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The proportion of 1-visit pulpectomy treatment procedures was also significantly higher in both the VPT and LPT groups than in the FT group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both). Among all treatments, the number of prescriptions for glass ionomer restorations (5,012,856; 43.21%) was the highest, and the proportion was higher in all preterm group than in the FT group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the preterm group, the proportion of glass ionomer restoration practices significantly increased as the GA increased (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0111). Amalgam restoration was performed at a significantly lower rate in the overall preterm children (EPT: 2.32%, VPT: 2.81%, LPT: 2.69%) than in the FT children (4.03%) (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When comparing pulp treatment types, in the preterm group, the proportion of pulpectomy was higher than that of pulpotomy compared to the FT group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0186).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumber of dental treatments by gestational age group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEPT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVPT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLPT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost hoc test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmalgam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (2.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,121 (2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e464,678 (4.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e466,151 (4.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEPT, LPT, VPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlass ionomer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,790 (48.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,002 (52.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22,711 (54.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,983,353 (43.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5,012,856 (43.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFT\u0026thinsp;\u0026lt;\u0026thinsp;EPT\u0026thinsp;\u0026lt;\u0026thinsp;VPT\u0026thinsp;\u0026lt;\u0026thinsp;LPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulpotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (3.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265 (2.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,060 (2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e428,768 (3.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e430,212 (3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVPT, LPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-Visit pulpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e477 (13.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,200 (12.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,001 (14.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,160,036 (10.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,167,714 (10.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFT\u0026thinsp;\u0026lt;\u0026thinsp;VPT, LPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMulti visit pulpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218 (2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e988 (2.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e323,520 (2.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e324,796 (2.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVPT, LPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,118 (30.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,544 (26.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,833 (23.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,185,827 (36.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4,199,322 (36.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;VPT\u0026thinsp;\u0026lt;\u0026thinsp;EP\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,659 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,496 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41,714 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11,546,182 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11,601,051 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eData are presented as numbers (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eTotal means the number of dental treatments in each group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eGA\u003c/em\u003e gestational age; \u003cem\u003eEPT\u003c/em\u003e early preterm (GA\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks); \u003cem\u003eVPT\u003c/em\u003e very preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;28\u0026ndash;\u0026lt; 32 weeks); \u003cem\u003eLPT\u003c/em\u003e late preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;32\u0026ndash;\u0026lt; 37 weeks); \u003cem\u003eFT\u003c/em\u003e full term (GA\u0026thinsp;\u0026ge;\u0026thinsp;37 weeks)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAge at first dental visit\u003c/h2\u003e \u003cp\u003eAge at the first dental visit was significantly higher in FT infants than in preterm infants (EPT\u0026thinsp;=\u0026thinsp;2.84, VPT\u0026thinsp;=\u0026thinsp;2.78, LPT\u0026thinsp;=\u0026thinsp;2.52, FT\u0026thinsp;=\u0026thinsp;3.90 years old; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). The comparison of age at the first dental visit by dental treatment and GA is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Age at initial treatment for each procedure was compared, excluding both initial and follow-up dental consultations. Age for the first extraction was lower in the preterm group than in the FT group (4.59 years vs 3.91 years for EPT, 4.19 years for VPT, and 4.14 years old for LPT in the preterm group, all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the LPT group, ages at the first pulpotomy and 1-visit pulpectomy were 3.55 years and 3.44 years, respectively, and these were significantly lower than those of the other groups (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge at first dental treatment after first dental visit by gestational age group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDental treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEPT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;2,027\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eVPT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;4,785\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eLPT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;26,611\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eFT\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;3,262,165\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePost hoc test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmalgam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e3.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15,761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlass ionomer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5,535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e269,192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;VPT, FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulpotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e22,740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u0026thinsp;\u0026lt;\u0026thinsp;EPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-Visit pulpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2,425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e126,306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;FT, VPT, EPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMulti visit pulpectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e21,931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.0013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eLPT\u0026thinsp;\u0026lt;\u0026thinsp;FT, VPT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e66,991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eEPT, VPT, LPT\u0026thinsp;\u0026lt;\u0026thinsp;FT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003cem\u003eGA\u003c/em\u003e gestational age; \u003cem\u003eEPT\u003c/em\u003e early preterm (GA\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks); \u003cem\u003eVPT\u003c/em\u003e very preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;28\u0026ndash;\u0026lt; 32 weeks); \u003cem\u003eLPT\u003c/em\u003e late preterm (GA\u0026thinsp;\u0026ge;\u0026thinsp;32\u0026ndash;\u0026lt; 37 weeks); \u003cem\u003eFT\u003c/em\u003e full term (GA\u0026thinsp;\u0026ge;\u0026thinsp;37 weeks)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTime-period comparisons from the first dental visit to each dental treatment\u003c/h2\u003e \u003cp\u003eWhen comparing the duration from the first dental visit to each treatment, restoration treatment, pulp treatment, and extraction were earlier in the LPT infants than in the FT infants (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For extraction, compared with FT infants, preterm infants received treatment faster after their first visit to a dentist. The time from the first dental visit to treatment was the shortest for restoration treatment in all groups, followed by that for pulp treatment and extraction (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE). For the time between the first dental visit and pulp treatment (i.e., pulpotomy, 1-visit pulpectomy, and multi visit pulpectomy), it was only significantly different for 1-visit pulpectomy between the LPT group and the FT group (302.73 days vs 335.64 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF). Comparing the number of dental treatments per patient according to GA, glass ionomer restoration and extraction were significantly lower in all PT group compared to the FT group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). 1-visit pulpectomy was significantly lower in the VPT and LPT groups than in the FT group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0172).\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the Kaplan\u0026ndash;Meier survival curves of the duration from the first dental visit to each dental treatment for infants born in 2017 and 2018. Of the 716,134 individuals, 323,098 (45.12%) had dental treatment codes, while the remaining 393,036 (54.88%) had codes for initial or follow-up consultations without dental treatment codes. As the patient's visit is delayed, restoration treatment, pulp treatment, and extraction were all performed earlier after the patient\u0026rsquo;s visit (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, C, E). Analysis of the graph based on GA revealed that the EPT group received restorative and pulpal treatments later than the FT group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB, D). In contrast, extraction was performed latest in all the groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eF). Children who made their first dental visit after the age of 2 years received any dental treatment earlier (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eG). There was a significant difference in the time of first receiving any dental treatment by GA (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eH, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDental checkups and treatments for preterm infants in Korea have not been extensively reviewed. This study found that children born preterm tended to visit the dentist at an earlier age than those born full term. Additionally, children who had their first dental visit at a later age tended to receive dental treatment earlier.\u003c/p\u003e \u003cp\u003eThe study population was limited to children aged 0\u0026ndash;6 years. There may be no diagnoses related to preterm birth during dental visits of elementary school-aged children. Additionally, interpreting dental issues in children aged 7 years and older poses challenges owing to the concurrent presence of deciduous and permanent teeth. Furthermore, dental behavior management problems are significantly more prevalent at age 3 years in children with PT [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. They are also more common in children with PT than in the control group among those aged 6 years or younger. However, the difference decreased with increasing age, and there were no longer significant between-group differences during the elementary school years [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the outset, we hypothesized that infants born at lower GA would have fewer dental visits. There was no trend indicating a higher rate of dental non-attendance with younger GA; however, among the children born preterm, approximately 64% of those aged 6 years or younger had no experience visiting the dentist, comprising a high proportion (over half). To the best of our knowledge, no study has investigated the age at the first dental visit by GA in preterm children.\u003c/p\u003e \u003cp\u003ePatterns of pulp treatments were examined by categorizing pulpectomy, 1-visit pulpectomy, and multi visit pulpectomy between the preterm and FT groups. In the preterm group, more patients received a 1-visit pulpectomy than a multi visit pulpectomy. This trend is attributed to lower cognitive abilities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], higher hyperactivity, and the manifestation of externalizing and internalizing problems [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] in preterm children than in FT children. Owing to their diminished cooperation and difficulties in behavioral regulation, dentists tend to aim to complete treatment on the same day [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, the higher prevalence of pulpotomies over pulpectomies in the preterm group suggests that dental caries in preterm children was more advanced than those in FT children. The number of patients and the treatment frequency for GI restoration and 1-visit pulpectomy tended to be higher in patients with lower GA, indicating a greater need for restorative treatment and more prevalent carious lesions in patients with lower GA.\u003c/p\u003e \u003cp\u003ePreterm infants tended to visit dentists earlier than FT infants. The early dental visits by preterm infants can be for examination and treatment due to poor oral health, concerns that oral health might not be optimal because of other systemic diseases, health issues, and awareness of the importance of early screening through consultations with various medical specialists. In the analysis considering the age-corrected for preterm birth, the age at which the first extraction was performed was significantly lower in all three preterm groups than in the FT group. Additionally, pulpotomy and 1-visit pulpectomy were performed at a younger age in the LPT group. This indicates that preterm children require extraction or pulpal treatment at an earlier age because of their poorer dental conditions.\u003c/p\u003e \u003cp\u003eWhen examining the hospital type at the first dental visit, as the GA decreased, the proportion of visits to general hospitals increased, with the EPT group showing a significantly higher proportion of visits to general hospitals than all other groups. Given that preterm infants with a lower GA often have sequelae of prematurity, such as brain disorders [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], lung disorders [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and lack of motor skills [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], they are more likely to receive periodic check-ups and treatments at general hospitals. Compared with physicians and general dentists, pediatric dentists are not only more knowledgeable about oral development and issues in infants and toddlers than general dentists or physicians [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], but they also provide more proactive interventions and a higher level of expertise in addressing oral problems [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Therefore, there is a higher likelihood of doctors assessing oral health issues early and referring comprehensive oral examinations to pediatric dentists at the same or nearby general hospitals.\u003c/p\u003e \u003cp\u003eEarly dental visits are anticipated to mitigate future dental risks, resulting in enhanced oral health [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This study found that for all groups, the timing of treatment for restorative, pulp, and extraction procedures accelerated as the patient\u0026rsquo;s first dental visit was delayed. The group visiting the dentist for the first time after age 2 years received all dental treatments earlier than the other groups. A previous study showed that children who had their first dental visit at age 2\u0026ndash;3 years received preventive, restorative, and emergency visits more frequently than those who had their first visit before age 1 year [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Another study reported that early starters who began dental care at age\u0026thinsp;\u0026lt;\u0026thinsp;4 years had fewer treatments for restorations, crowns, pulpotomies, and extractions than late starters who began dental care at age\u0026thinsp;\u0026ge;\u0026thinsp;4 years [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilar to South Korea\u0026rsquo;s healthcare insurance system, Medicaid in the United States is a healthcare insurance program that supports low-income individuals, disabled individuals, and others to access medical services [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. One study on Medicaid-covered dental care reported that children with preexisting conditions who received preventive visits by 18 months received 19\u0026ndash;39% fewer treatments [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Another study on Medicaid-enrolled children aged 6 months to 6 years reported that the first oral health examination occurred at age 3 years on average, and as the child\u0026rsquo;s age at the first oral health examination increased, the risk of dental treatment also increased [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNeglected dental issues deteriorate over time, necessitating more complex and advanced treatments for delayed treatment [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, this study highlights the importance of early dental screening in preterm children and demonstrates that a delayed initial dental visit correlates with earlier initiation of dental treatment. Furthermore, early screening demonstrates a significant potential for efficiently managing the oral health of preschool children through timely interventions. The EPT group, which was expected to require more and earlier oral interventions owing to the adverse effects of prematurity, did not exhibit this trend when compared to the FT group. By contrast, the FT group tended to receive treatment at an earlier stage. The study findings indicated the earlier timing of the first dental visit in the EPT group allowed for preventive care and timely intervention for oral issues, suggesting that the delay in treatment may not be attributable to prematurity. This result underscores the potential of early oral screening to overcome the disadvantages of oral issues arising from prematurity.\u003c/p\u003e \u003cp\u003eThis study had some limitations. The HIRA dataset used in this study included only treatments eligible for insurance coverage, such as amalgam and glass-ionomer restorations. Although composite resin and stainless-steel crown restorations of primary teeth are commonly performed in clinical practice, they are not covered by insurance. Therefore, the records of these procedures could not be investigated in this study. Furthermore, the data on extractions did not include tooth numbers. If it is a primary molar extraction, severe decay is likely the cause [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]; however, if it is a primary incisor extraction, it can be due to physiological exfoliation [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] or trauma [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Therefore, because the process of extraction includes physiological exfoliation, it is difficult to assert that early extraction is always detrimental.\u003c/p\u003e \u003cp\u003eIn this study, although preterm children were studied over 5 years, the absolute number of cases in the EPT group was relatively lower compared to that in the FL group, leading to statistically insignificant results. Obtaining data over a longer period to ensure an adequate sample size would be beneficial. This study examined prescription details, first-visit age, and visit frequency. However, further research analyzing treatment costs for each GA group is needed to demonstrate the cost-effectiveness of early dental screening in children born preterm. Given the emphasis on the importance of early screening in this study, it is crucial to educate parents and caregivers of children born preterm about the importance of early dental checkups. Furthermore, physicians should be fully knowledgeable in the effectiveness of early dental care for preterm infants, be able to refer them to a dentist for dental care at the appropriate time, be knowledgeable about the medical characteristics and oral features of preterm birth, and be able to actively intervene in their dental care.\u003c/p\u003e \u003cp\u003eIn conclusion, among children born preterm, multi visit pulpectomy is more common than 1-visit pulpectomy owing to issues with patient cooperation and behavioral regulation. Additionally, the preterm group undergoes more pulpectomy procedures than the pulpotomy group, and there are frequent prescriptions for glass ionomer restorations and extractions, indicating poor oral health status in the preterm group. For the type of institution during the first dental visit, the proportion of visits to general hospitals is significantly higher in the preterm group than in the FT group. In all groups, dental treatment tended to be earlier when the age at the first dental visit was older (i.e., after age 2 years). Early dental screening of preterm infants can help overcome the disadvantages associated with prematurity-related oral issues. Therefore, parents and caregivers of preterm infants, physicians, and dentists should be knowledgeable in the importance and efficacy of early dental checkups for the oral health of preterm infants.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEthics declarations\u003c/h2\u003e \u003cp\u003eThe study protocol was approved by the Institutional Review Board (IRB) of Yonsei University Dental Hospital (IRB No. : 2-2019-0045) and was conducted in accordance with the principles of the Declaration of Helsinki and its later amendments. The IRB of Yonsei University Dental Hospital agreed that the requirement for informed consent was waived owing to the use of de-identified population-based data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData source\u003c/h2\u003e \u003cp\u003eBig data on treatment histories recorded from January 1, 2017, to December 31, 2021, in the Health Insurance Review and Assessment Service (HIRA) database in South Korea were analyzed. HIRA also called the National Health Insurance Data, is a repository of claims data collected during the process of reimbursing healthcare providers (HIRA dataset No. M20220701002). The database includes not only diagnostic code data based on the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10), but also data on prescription codes, healthcare institutions, and demographics (including sex and age).\u003c/p\u003e \u003cp\u003eSubjects with Korean Statistical Classification of Disease and Related Health Problems (KCD) codes related to preterm birth or dental visits were included in the current study. Only subjects aged 0\u0026ndash;6 years during receipt of any dental care were evaluated because they could be assumed to be preschool children in the deciduous dentition period. The KCD codes related to preterm birth and dental prescriptions are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The preterm group included all children with KCD codes associated with preterm birth, including those without dental experience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003eTo compare the dental care history of the preterm and non-preterm infants among the subjects with dental-care-related codes, dental prescriptions were classified into restoration treatment, pulp treatment, extraction, and first or repeat dental visits. Pulp treatment was subdivided into three categories: pulpotomy, 1-visit pulpectomy, and multi visit pulpectomy. Data on the age at which the first dental visit occurred and the total number of dental visits from age 0 years to 6 years were also extracted. To compare the dental care history according to GA, GA was divided into four groups: EPT, VPT, LPT, and FT birth. Amalgam restorations, glass ionomer restorations, pulpotomy, 1-visit pulpectomy, multi visit pulpectomies, and extractions, as representative insurance benefits provided to children, and the number of visits and age at the first dental visit were compared among the four groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eCategorical variables were summarized as frequencies and percentages and were compared among the GA groups using the chi-square test. Meanwhile, continuous variables were summarized as means and standard deviations (SDs) and were compared among the GA groups using analysis of variance. The occurrence of dental treatment was analyzed using the Kaplan\u0026ndash;Meier method. Subjects born in 2017 or 2018 were followed from the first date of the dental visit up to the first date of receiving each dental treatment. Restorative treatment, pulp treatment, and extraction were considered dental treatments. The log-rank test was used to compare the occurrence of each dental treatment according to age at the first oral examination and GA. Bonferroni adjustment was used for multiple comparisons. All statistical analyses were conducted using SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). Statistical significance was defined as a two-sided p-value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData availability statement\u003c/h2\u003e \u003cp\u003eThe HIRA data underlying this article will be shared on reasonable request to the Big Data Department of HIRA. Researchers who desire to use the database should obtain approvals from both ethical review boards and the HIRA research committee Official application for HIRA studies can be made through the HIRA Bigdata website [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://opendata.hira.or.kr\u003c/span\u003e\u003cspan address=\"https://opendata.hira.or.kr\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e]. The data sets used the current study are available from the corresponding authors (Chung-Min Kang) on reasonable request.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2023-00277526, 2020R1G1A1100275) and the 24 Yonsei University College of Dentistry student research grant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcept and design (C.-M.K.), acquisition of data (I.K.J., M.L., C.-M.K.), data collection (I.K.J., M.L., C.-M.K.), quality assessment (J.A.P., H.L.J., C.-M.K.), statistical analysis (I.K.J., M.L.), interpretation of data (J.A.P., H.L.J., H.-J.C., M.L., C.-M.K.), drafting of manuscript (J.A.P., H.L.J., M.L.,C.-M.K.) and critical revision of manuscript (J.A.P., H.L.J., M.L., I.K.J., C.-M.K.). All authors approved the final manuscript and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchneider, N. and C.L. 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Primary teeth.\u003c/em\u003e Dental Traumatology, 2007. \u003cstrong\u003e23\u003c/strong\u003e(4): p. 196-202.\u003c/li\u003e\n\u003cli\u003eRanka, M., et al., \u003cem\u003eTrauma to the primary dentition and its sequelae.\u003c/em\u003e Dental update, 2013. \u003cstrong\u003e40\u003c/strong\u003e(7): p. 534-542.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"preterm birth, preschool, dental visit, dental treatment, Nationwide Population-Based Study","lastPublishedDoi":"10.21203/rs.3.rs-4427475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4427475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study investigated the effect of early dental visit on subsequent dental treatments in preterm infants and whether there was a significant difference in dental treatment between children born preterm and full-term (FT). National data from the Health Insurance Review and Assessment Service in Korea were analyzed. Prescription codes related to dental treatments were collected. This study included 3,354,662 patients under age 6 years, who were categorized by gestational age: extremely preterm (EPT), very preterm (VPT), and late preterm (LPT). In the preterm group, the percentage of children with no dental visits was 63.87% although the preterm group visited the dentist earlier than the FT group (EPT\u0026thinsp;=\u0026thinsp;2.84, VPT\u0026thinsp;=\u0026thinsp;2.78, LPT\u0026thinsp;=\u0026thinsp;2.52, FT\u0026thinsp;=\u0026thinsp;3.9 years old). Glass ionomer and 1-visit pulpectomy were significantly higher in the preterm group than in the FT group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Preschool children who had their first dental visit after age 2 years received any dental treatment earlier than those who visited the dentist before age 1 year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Early dental visits in infants may delay the timing of dental treatments and reduce their severity, suggesting the importance of early dental screenings for efficient dental management in preterm infants.\u003c/p\u003e","manuscriptTitle":"Early Dental Visit Affects Dental Treatment in Korean Preschool Children Born Preterm: A Nationwide Population-Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 21:39:35","doi":"10.21203/rs.3.rs-4427475/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-04T06:35:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-25T09:51:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207900792441733519893665348894134598446","date":"2024-08-09T10:49:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-10T09:17:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278299475339276261775574099745688979866","date":"2024-05-26T15:59:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-24T15:30:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-24T15:22:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-20T19:45:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-18T06:17:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-15T23:00:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1cb84ef4-e0e7-43b4-82a5-e4bd1ff75ad6","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:05:21+00:00","versionOfRecord":{"articleIdentity":"rs-4427475","link":"https://doi.org/10.1038/s41598-024-74809-3","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-10-09 15:57:38","publishedOnDateReadable":"October 9th, 2024"},"versionCreatedAt":"2024-06-04 21:39:35","video":"","vorDoi":"10.1038/s41598-024-74809-3","vorDoiUrl":"https://doi.org/10.1038/s41598-024-74809-3","workflowStages":[]},"version":"v1","identity":"rs-4427475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4427475","identity":"rs-4427475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}