{Professional Insight} Preemie Teeth and Dental Hygiene

August 29, 2012

Having a premature baby comes with so many questions and concerns. As a pediatric dentist, I am frequently asked, “What problems can my premature baby have with his or her teeth and oral cavity?”  Fortunately, most of the time, I do not see any differences in the health of preemies’ teeth and mouths. There are, however, some things to watch for as their teeth develop.

Was your baby intubated? There are changes that can take place with the bony structure of the upper portion of your child’s mouth (the hard and soft palate).  The changes that can occur are as a result of the intubation tube and its location. Often, the child will have a high, and more arched, upper palate. This, in turn, causes the upper teeth to be positioned more to the middle of the mouth and changes the occlusion of the teeth. As a result, you will see a posterior crossbite and an anterior openbite. These are both cosmetic, as well as functional concerns, because they can change speech and swallowing patterns. For the most part, these problems can be corrected by orthodontics. Due to the fact that these are skeletal changes – not just changes in tooth positions – your child may need orthodontic treatment at an earlier age, around ages 6-8. Once your child has stopped growing and the suture in the palate has closed, it is much more difficult to correct.


Was your baby born early? Another fairly common problem is a change in the enamel of the teeth (hypoplasia), commonly referred to as “preemie teeth.” Premature babies are four times more likely to have hypoplastic teeth. This mostly affects the baby teeth, not the permanent ones. These teeth are more porous and softer, and as a result can be more prone to cavities. The baby teeth can also have “brown spots” from high bilirubin levels. These teeth are not more prone to cavities and are just a cosmetic concern.

Are your child’s teeth late to come? Premature babies often have delayed eruption of the teeth.  This does not cause any problems at all. The teeth generally erupt just a couple of months later than normal and they still come in the usual order. This delay can actually be an advantage because if the teeth come in the mouth later, they are less likely to have cavities. This is primarily because once you have teeth, you can get cavities. The younger in age the child is, the more often they need to eat and then it’s more often that their teeth are exposed to the carbohydrates that contribute to cavities.

As the parent, how healthy are your teeth? It is also important that parents have healthy teeth and gums.  Recently, a link has been found between periodontitis (gum disease) of the mother and premature birth. In addition, the bacteria that will colonize your child’s mouth come from their caretakers. If a parent has unhealthy teeth and gums, they also have a more virulent and unhealthy strain of bacteria and that can be transfered to the baby.

The best thing you can do for your baby is maintain good oral hygiene habits. These include brushing your baby’s teeth at least twice a day, avoiding napping and sleeping with a bottle and bringing your baby for a first dental visit by his or her first birthday. Preemies often have sensory issues and oral aversions, which make brushing more challenging. But remember, once your child has teeth, he or she can get cavities. Certainly, there are often so many concerns to address that brushing the teeth takes a backseat. But, if a very young child needs dental work done, they most often need to be sedated, and it can be traumatic to both the parent and the child, as well as very expensive. For ideas on how to brush your child’s teeth, you may want to watch this helpful video:

Good oral hygiene and seeing a dentist regularly provides the best opportunity for your child to have a healthy and beautiful smile. Having a premature child brings a great deal of concerns and worries, but know that there are many treatments available and that you have a beautiful gift in your life.

Guest Blogger

Dr. Kelsey Bookmyer, DDS, is a board certified pediatric dentist in Round Rock, Texas.  Her practice sees patients ranging in age from a few months to 18 years.  In addition, Dr. Bookmyer treats special needs patients of all ages.  She received a B.S. in Biology from New Mexico State University. Her D.D.S. degree was obtained from Baylor College of Dentistry in Dallas, where she graduated cum laude.  She then completed a two-year residency in Pediatric Dentistry at the University of Texas Health Science Center in San Antonio. Dr. Bookmyer’s husband is an Oral and Maxillofacial Surgeon who practices in the same building, and together they have one son. Dr. Bookmyer had some of her own struggles with pregnancy; she had several miscarriages and eventually had in-vitro fertilization that resulted in a successful pregnancy. Recently, her sister-in-law gave birth at 33 weeks. Fortunately, the baby is home from the hospital and doing well. Dr. Bookmyer loves her professional career as a pediatric dentist and is blessed with a beautiful family.