Erupção dentária em bebês , amamentação e fatores peri e pós-natais : análise de caminhos de fatores diretos e indiretos

Abstract

Tooth Eruption in Infants, Breastfeeding, Perinatal and Postnatal Factors: Path Analysis of Direct and Indirect Effects The eruption of the first primary tooth and the duration of breastfeeding are influenced by biological, socioeconomic, and contextual factors, including birth conditions and neonatal hospitalization. There are gaps in the literature regarding how these factors interrelate, especially in preterm infants. This study had two objectives: (1) to assess, through a cohort study, the direct and indirect factors related to the age at first primary tooth eruption; and (2) to analyze, through a cross-sectional study, the factors associated with the duration of breastfeeding, considering tooth eruption as a possible determinant. The studies included both preterm and full-term infants, followed monthly until the eruption of the first tooth. Clinical and contextual data were collected, including gestational age, birth weight, neonatal intensive care unit (NICU) admission, maternal education and income, pacifier use, type of delivery, and maternal age. Tooth eruption was assessed clinically on a monthly basis, and the date of eruption was confirmed by caregivers. Breastfeeding duration was assessed through a questionnaire administered to the mothers. Statistical analysis was conducted using Mplus 8.6 and SPSS 26.0 software, employing path models as well as descriptive and factorial analyses. A total of 91 infants participated in the study—43 preterm and 48 full-term. Among full-term infants, the mean age of first tooth eruption was 7 months (±1.27). Among preterm infants, the mean chronological age at eruption was 11.37 months (±2.51) (corrected age: 8.95 months ± 2.51). In the longitudinal model, based on chronological age, preterm infants had a higher risk of delayed tooth eruption compared to full-term infants (β = 0.888; p < 0.001). Mothers with poorer socioeconomic conditions (β = 0.297; p = 0.010), who used medication during pregnancy (β = 0.337; p < 0.001), had ≤6 prenatal visits (β = 0.198; p = 0.025), and experienced delivery complications (β = 0.214; p = 0.007) had a higher likelihood of preterm births. Gestational age significantly influenced NICU admission (β = 0.829; p < 0.001) and birth weight (β = 0.935; p < 0.001). Similar results were observed using corrected age, with variations only in the β coefficients. In the cross-sectional analysis, infants with lower gestational age experienced later eruption of the first tooth (β = -0.612; p < 0.001), and delayed eruption was associated with longer breastfeeding duration (β = 0.340; p < 0.001). Infants with lower gestational age were more likely to be admitted to the NICU (β = -0.838; p < 0.001), and those who were hospitalized had shorter breastfeeding duration (β = -0.565; p < 0.001). In conclusion, in Study 1, preterm infants had a higher risk of delayed tooth eruption compared to full-term infants, considering both chronological and corrected age. In Study 2, gestational age showed a direct association with tooth eruption and an indirect association with breastfeeding duration, mediated by maternal and neonatal factors. Keywords: tooth eruption; infant; preterm newborn; cohort study; tooth eruption chronology; breastfeeding; newborn; dental eruption.