Predictors of Developmental Defects of Enamel in the Primary Maxillary Central Incisors using Bayesian Model Selection

Localized non-inheritable developmental defects of tooth enamel (DDE) are classified as enamel hypoplasia (EH), opacity (OP) and post-eruptive breakdown (PEB) using the Enamel Defects Index. To better understand the etiology of DDE, and in particular possibly modifiable variables, we assessed the linkages amongst exposome variables during the specific time duration of the development of the DDE. In general, the human primary central maxillary incisor teeth develop between 13-14 weeks in utero and 3-4 weeks’ postpartum of a full-term delivery, followed by tooth eruption at about 1 year of age. We utilized existing datasets of mother and child dyad data that encompassed 12 weeks’ gestation through birth and early infancy, and child DDE outcomes from digital images of the erupted primary maxillary central incisor teeth. We applied a Bayesian modeling paradigm to assess the important predictors of EH, OP, and PEB. The results of Gibbs variable selection showed a key set of predictors: mother’s pre-pregnancy body mass index (BMI); maternal serum levels of calcium and phosphorus at gestational week 28; child’s gestational age; and both mother’s and child’s functional vitamin D deficiency (FVDD). In this sample of healthy mothers and children, significant predictors for OP included the child having a gestational period > 36 weeks and FVDD at birth, and for PEB included a mother’s pre-pregnancy BMI < 21.5 and higher serum phosphorus level at week 28.