Prenatal growth acceleration in maxillary deciduous canines of children with Down syndrome: Histological and chemical composition study

Previous studies have reported that the abnormal development of the second deciduous molar in Down syndrome and cerebral palsy begins before birth. In view of these results we have turned our attention to the earlier stages of dental development in utero, represented by the primary canine, in order to see if we can identify more precisely the origin and timing of developmental insults in these conditions. The study was carried out on exfoliated or extracted maxillary primary canines of children with Down syndrome (DS) and cerebral palsy (CP) and they were compared to a control group of children with no adverse medical history. Thin sections were made through the mid-sagittal bucco-palatinal axis. Using a light microscope, the width of prenatal enamel and postnatal enamel, defined by the neonatal line was measured on each section at a standardized location. The chemical composition of the enamel was then measured at three different locations using an energy dispersive spectrophotometer (ESR) in a high vacuum mode. The total enamel width in DS and controls was similar and greater than that of CP canines. Significantly more enamel was laid down prenatally in DS teeth than in controls or CP and it was more highly mineralized. These results for DS canines differ from those previously published for the later developing second primary molars. They support the hypothesis of accelerated growth in the early stages of intra-uterine development, prior to the establishment of reduced growth trajectories in the later stages. The results for CP teeth showed that more prenatal enamel was laid down prenatally than in controls. Mineralization in CP was poor during the first two trimesters and improved significantly during the last trimester. While this approach is retrospective, we propose that it may aid in identifying the onset of developmental anomalies of unknown etiology that are expressed in later life.