Clinical Oral Investigations

, Volume 20, Issue 8, pp 1871–1879 | Cite as

Influence of metabolic-linked early life factors on the eruption timing of the first primary tooth

  • Carolina Un Lam
  • Chin-Ying Stephen HsuEmail author
  • Robert Yee
  • David Koh
  • Yung Seng Lee
  • Mary Foong-Fong Chong
  • Meijin Cai
  • Kenneth Kwek
  • Seang Mei Saw
  • Keith Godfrey
  • Peter Gluckman
  • Yap Seng Chong
Original Article



Early eruption of permanent teeth has been associated with childhood obesity and diabetes mellitus, suggesting links between tooth eruption and metabolic conditions. This longitudinal study aimed to identify pre-, peri- and postnatal factors with metabolic consequences during infancy that may affect the eruption timing of the first primary tooth (ETFT) in children from an ethnically heterogeneous population residing within the same community.

Material and methods

Participants were recruited (n = 1033) through the GUSTO (Growing Up in Singapore Towards healthy Outcomes) birth cohort (n = 1237). Oral examinations were performed at 3-month intervals from 6 to 18 months of age. Crude and adjusted analyses, with generalized linear modelling, were conducted to link ETFT to potential determinants occurring during pregnancy, delivery/birth and early infancy.


Overall mean eruption age of the first primary tooth was 8.5 (SD 2.6) months. Earlier tooth eruption was significantly associated with infant’s rate of weight gain during the first 3 months of life and increased maternal childbearing age. Compared to their Chinese counterparts, Malay and Indian children experienced significantly delayed tooth eruption by 1.2 and 1.7 months, respectively.


Infant weight gain from birth to 3 months, ethnicity and maternal childbearing age were significant determinants of first tooth eruption timing. Early life influences can affect primary tooth development, possibly via metabolic pathways.

Clinical relevance

Timing of tooth eruption is linked to general growth and metabolic function. Therefore, it has potential in forecasting oral and systemic conditions such as caries and obesity.


Pregnancy Birth Infancy Tooth eruption Primary dentition Metabolic links 



This study was funded by Singapore’s National Medical Research Council (NMRC/CIRG/1341/2012: R-221-000-059-511) and supported by the Singapore National Research Foundation under its TCR Flagship Programme on Developmental Pathways to Metabolic Disease (NMRC/TCR/004-NUS/2008 and NMRC/TCR/012-NUHS/2014). A special thanks is extended to the GUSTO sub-domains for their great support; Professor Michael Kramer for his important advice and input; and Pang Wei Wei, Izzuddin Bin Mohd Aris, Tan Pei Ting and Priyangi Alwis for their valuable contributions. The continuous and skilful help of the home visitors and the clinical team from the National University Hospital and the KK Women’s and Children’s Hospital, as well as the database and biostatistics teams, is deeply appreciated.

Compliance with ethical standards

Ethical Approval

All work involving human participants was approved by the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref: 2009/00021) and SingHealth Centralized Institutional Review Board (CIRB Ref: 2009/280/D).

Informed Consent

Written informed consent was obtained from all participants prior to their inclusion in the study.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Carolina Un Lam
    • 1
  • Chin-Ying Stephen Hsu
    • 1
    Email author
  • Robert Yee
    • 1
  • David Koh
    • 2
  • Yung Seng Lee
    • 3
  • Mary Foong-Fong Chong
    • 4
  • Meijin Cai
    • 1
  • Kenneth Kwek
    • 5
  • Seang Mei Saw
    • 1
  • Keith Godfrey
    • 6
  • Peter Gluckman
    • 1
  • Yap Seng Chong
    • 7
  1. 1.Discipline of Oral Sciences, Faculty of DentistryNational University of SingaporeSingaporeSingapore
  2. 2.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  3. 3.Department of Paediatrics, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  4. 4.Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR)Brenner Centre for Molecular MedicineSingaporeSingapore
  5. 5.Department of Maternal Fetal MedicineKK Women’s and Children’s Hospital (KKH)SingaporeSingapore
  6. 6.Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
  7. 7.Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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