The Association Between Prenatal Smoking and Hypodontia 1

The Association Between Prenatal Smoking and Hypodontia

Kaylee Hughes and Linda Morelos

Lamar Institute of Technology

Dental Hygiene Program

The Association Between Prenatal Smoking and Hypodontia 2

Abstract

Hypodontia is one of the most common forms of tooth agenesis that we face in the dental field. It

can cause many problems to the patient’s oral health and self-confidence. There is no known

exact cause of this condition, but several genetic and environmental factors that come together to

cause it. Over the last few years research has been studied to link prenatal smoking to a cause of

hypodontia in their children. This is an important discovery in the dental field because it will

help to better assess and treat our patients. Understanding more about this mysterious, yet

common condition will aid us in potentially reducing the prevalence of hypodontia through

educational measures.
The Association Between Prenatal Smoking and Hypodontia 3

The Association Between Prenatal Smoking and Hypodontia

Hypodontia, a type of tooth agenesis, is known as the absence of 1 to 5 teeth, excluding

the third molars, that never developed in the embryonic stage. Hypodontia affects “2-8% of the

general population” (NORD, 2019), making it a fairly common condition to observe in the dental

field. The exact etiology of hypodontia is still unknown, but researchers do know that genetic

and environmental factors have an impact on this condition. For this research topic, we have

found that researchers have discovered a significant relationship between prenatal smoking and

the prevalence of hypodontia in their children. It is important to remain up to date with all of the

risks associated with your patient’s lifestyle habits to treat your patients efficiently and ethically.

It is beneficial for the clinician to be aware of the increased risk of hypodontia in order to

properly educate expecting mothers and encourage them to stop smoking. As the clinician, we

are building rapport with the patient as we express our concerns for the mother and the baby’s

health. Understanding the link between prenatal smoking and hypodontia will make the clinician

more aware of the risks and they can closely monitor pediatric patients that are at risk. Having

this knowledge, the clinician will be able to better understand and treat their patients who are

diagnosed with hypodontia. The main purpose of this research topic is to raise awareness and

reduce the occurrence of hypodontia in patients through educational measures.

According to research conducted in Koshu, Japan, there has been a significant association

between hypodontia and prenatal smoking. Researchers recruited pregnant mothers and their

children that registered at the Koshu city office between April 2, 1996 and April 1, 1999 and

between April 2, 2000 and April 1, 2003 to participate in the study. When the mothers registered

at the office, they were given a survey to complete asking about their lifestyle habits. The

researchers did a follow up dental exam with the children at the ages of twelve to fifteen years
The Association Between Prenatal Smoking and Hypodontia 4

old. Out of seven hundred and seventy-two children who participated in this study, 6% of the

expecting mothers had reported smoking during pregnancy and 4.9% of the children had missing

teeth. There was a higher number of younger mothers that smoked during pregnancy than older

mothers. “Lower levels of parental education were associated with increased maternal smoking

during pregnancy,” (Nakagawa Kang et al., 2019). This study also reported a relationship

between the number of cigarettes smoked per day and an increased risk of hypodontia in

children. There was an increased prevalence of hypodontia observed in children when expecting

mothers smoked more than six cigarettes per day compared to expecting mothers who smoked

five or less per day.

The exact science of how smoking affects tooth development in the fetus is still

unknown, but there are a few accepted theories. “A plausible explanation is that smoking causes

direct damage to neural crest cells in developing embryos,” states Professor Fallera (Antoun et

al., 2017). Neural crest cells are the source of all facial structures found in the body, such as

bones, nerves, and tissues. Neural crest cells are very sensitive to oxidative stresses, which they

can be exposed to during maternal smoking. If these crest cells are exposed to stresses, this can

lead to a disturbance in tooth development, especially if it occurs during the tooth development

stage. Oxidative stresses can also prevent proper development of neural crest cells, which could

result in other maxillofacial abnormalities developing, such as cleft lip or cleft palate. Another

theory is based on the amount of nicotine absorbed from the mother. Nicotine is known for the

disturbances it can cause to embryonic and fetal development. Nicotine can cause a decreased

supply of oxygen and nutrients to the surrounding tissues, which could ultimately lead to tissue

injury (Nakagawa et al., 2019). A lack of oxygen supplied to the placenta can also slow down the
The Association Between Prenatal Smoking and Hypodontia 5

development of the fetus, resulting in insufficient growth and development of the baby and its

structures.

When regarding hypodontia, there are physical and psychological issues at hand.

Malocclusion is the culprit for many problems associated in the mouth. Missing teeth can affect

your ability to chew, create challenges with speech, and could even result in alveolar bone loss.

If the teeth don’t shift to close in spaces from the missing teeth, the lack of stress on the bone can

result in it being lost. A psychological issue presented with hypodontia is related to the patient’s

self-esteem. In the United States, having good dentition is very important in society. Studies

show that teeth are one of the most noticeable features when meeting someone. Due to social

media and Hollywood standards, many people wish to have a perfect smile. Many of the people

with hypodontia are usually missing their maxillary lateral incisors and mandibular second

premolars. Patients that suffer with hypodontia may or may not have the funds to achieve the

“perfect smile” everyone wishes to achieve. Which in hand may cause low self-esteem, and

depression in these patients. This issue is more susceptible to younger adolescent patients, due to

the fact that adolescents tend to be more brazen with their words, which can result in bullying.

The most traditional way to treat hypodontia is with orthodontics. Depending on the age,

if braces cannot close the gaps other methods such as dentures can be used. Dentures is the

easiest way to replace a missing tooth, however it is not the best for the long-term in teenage

patients. A bridge is a more permanent solution, and is sturdier than a denture, but it is also not

recommended in child or teenage patients since their maxillofacial structures are still growing.

While dentures are not ideal for long-term use, they are recommended as a short-term solution

until the patient is at least eighteen years of age. Once the patient is an adult, the most stable

form of treatment would be the usage of dental implants. The implant is the most permanent
The Association Between Prenatal Smoking and Hypodontia 6

form of solution and will not affect the teeth surrounding the gap, which will help the patient

achieve the most optimum smile.

It is important to be knowledgeable in the potential risks our patients face in order to give

them the best treatment. Although there are genetic factors and environmental factors that we

cannot control, it is our responsibility to prevent health risks our patients may face with proper

education and efficient care. There are many risks already presented with maternal smoking,

which influences us to encourage our patients to stop smoking. The research done in Koshu,

Japan portrays that there is a significant link between prenatal smoking and children with

hypodontia. Exactly how smoking affects tooth development is still unknown, but there are

several well-supported theories that scientists can base their future research on. Stress on the

neural crest cells in the embryo is the main culprit of undeveloped teeth when in relation to

prenatal smoking. We can see the physical and physiological effects that hypodontia can have on

patients with the condition. It is important for us to be able to monitor the risk of hypodontia

with each patient, so that we can catch the condition early enough so the patient’s health is not

impacted drastically.
The Association Between Prenatal Smoking and Hypodontia 7

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