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Growth Marks in Teeth May Identify Children at Risk of Mental Health Disorders

Key findings

  • This study evaluated relationships between maternal psychosocial factors and the width of the neonatal line, a potential indicator of developmental disruption, in 70 primary teeth from 70 children ages 5 to 7
  • Children exposed to prenatal maternal depression or anxiety and children of mothers with a history of severe depression or psychiatric problems had wider neonatal lines than unexposed children
  • Early postnatal social support was associated with a narrower neonatal line
  • If these findings are replicated in larger samples, primary teeth could be used to identify children at risk of mental health problems and direct them to an evidence-based early intervention program

It's now accepted that the intrauterine environment influences a child's risk of disease across its life course. A prominent example is that prenatal and perinatal exposure to maternal psychosocial stressors nearly doubles the risk of a mental health disorder.

In Biological Psychiatry, researchers at Massachusetts General Hospital previously proposed using teeth as biomarkers of early-life adversity and subsequent mental health risk. Their TEETH (Teeth Encoding Experiences and Transforming Health) conceptual model holds that developmental disruptions during tooth formation produce "biological imprints" that can be captured objectively.

Rebecca V. Mountain, PhD, a research fellow, and Erin C. Dunn, ScD, MPH, an investigator in the Psychiatric and Neurodevelopmental Genetics Unit, now have evidence for their hypothesis. In JAMA Network Open, they report associations between maternal psychosocial factors and child tooth-based measures that could be useful for guiding early mental health interventions.


The researchers analyzed 70 primary canine teeth from 70 children enrolled in the Avon Longitudinal Study of Parents and Children (ALSPC), a prospective, population-based birth cohort in Bristol, England. The teeth were naturally exfoliated when the children were 5 to 7 years old.

The team examined the neonatal line (NNL), a stress line in teeth that indicates disruption during the development of enamel or dentin. Complicated delivery, longer duration of delivery and preterm births have been associated with wider NNLs. In this study, NNL width was measured at three locations along the length of each tooth.

The ALSPC also involved having women complete questionnaires about psychosocial factors during pregnancy and shortly after delivery. Data used in this study were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021.

Unadjusted Analyses

Exposures to three psychosocial factors were associated with a wider NNL near its intersection with the enamel–dentin junction:

  • Past severe depression (β=3.31; P<0.001)
  • Any lifetime psychiatric problem (β=2.57; P=0.003)
  • Maternal depression or anxiety at 32 weeks gestation (β=2.62; P=0.007)

A fourth factor, high social support at eight weeks post-partum, was associated with a narrower NNL.

Adjusted Analyses

In adjusted analyses, the researchers controlled for three perinatal risk factors associated with NNL width in preliminary analyses: iron supplementation during pregnancy, pre-pregnancy obesity, and gestational age. All significant associations identified in unadjusted analyses persisted.

The Potential for Preclinical Intervention

If these findings are replicated in larger samples, they will have important implications for prevention. Children begin losing primary teeth well before early adolescence, which is when about half of mental health disorders are diagnosed. Analysis of the NNL would be objective, inexpensive, and noninvasive.

Teeth could be collected from pediatricians or dentists during routine checkups and sent to specialized laboratories for analysis, as is commonly done with other biospecimens after annual examinations. Once children at risk of psychiatric symptoms are identified, they could be directed to an evidence-based early intervention program that may have lifelong benefits.

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At least five developmental properties of teeth suggest they could be used to identify individuals at risk of mental health problems following exposure to early-life psychosocial stress.


The relationship between adverse prenatal exposures and psychopathology in childhood is straightforward, Massachusetts General Hospital researchers have found: the greater the number of certain exposures, the greater the risk.