Social and biological correlates of localized enamel hypoplasia of the human deciduous canine tooth

Childhood Family Environment and Osteoporosis in a Population-Based Cohort Study of Middle-to Older-Age Americans

Demographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study (N = 5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.69, 0.92), but childhood SES was not (OR = 1.03, 95% CI = 0.94, 1.13). Identifying as Black/African American (OR = 0.56, 95% CI = 0.40, 0.80) was associated with lower odds, and identifying as female (OR = 7.22, 95% CI = 5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Factors and Mechanisms Involved in Acquired Developmental Defects of Enamel: A Scoping Review

BACKGROUND

Developmental Defects of Enamel (DDE) is a pathology of the teeth that can greatly alter the quality of life of patients (hypersensitivity, esthetic issues, loss of function, etc.). The acquired DDE may occur as a result of a wide range of acquired etiological factors and his prevalence of this pathology may reach up to 89.9%. The main objective of this research was to identify and analyze, in current literature, the factors related to acquired DDE, in order to propose a general theory about the mechanisms involved.

METHODS

The search of the primary literature was conducted until [December 31, 2021]. Our search strategy uses the Pubmed/MEDLINE database and was structured around 3 terms ["Development," "Defect," and "Enamel"]. To be included, references had to be primary studies, written in English. Exclusion criteria were reviews, in vitro, animal, genetic or archeology studies, and studies focused on clinical management of DDE. One hundred and twenty three articles were included in this scoping review: 4 Randomized clinical trials, 1 letter, 5 cases reports, 2 fundamentals studies, and 111 observational studies (33 Cross-sectional studies, 68 Cohort study and 10 Case-control study). The quality of evidence was assessed using the PEDro scale for clinical trials, the Newcastle-Ottawa scale for observational studies, and a published tool to assess the quality of case reports and case series.

RESULTS

A scoping review of the literature identified 114 factors potentially involved in acquired DDE. The most frequently encountered pathologies are those causing a disorder of calcium homeostasis or a perturbation of the ARNT pathway in mother or child. The link between the ARNT pathway and metabolism deficiency in uncertain and needs to be defined. Also, the implication of this mechanism in tissue impairment is still unclear and needs to be explored.

CONCLUSIONS

By identifying and grouping the risk factors cited in the literature, this taxonomy and the hypotheses related to the mechanism allow health practitioners to adopt behaviors that limit the risk of developing aDDE and to set up a prevention of dental pathology. In addition, by reviewing the current literature, this work provides guidance for basic research, clinical studies, and literature searches.

Enamel neonatal line thickness in deciduous teeth of Australian children from known maternal health and pregnancy conditions

BACKGROUND

Physiological disruptions to early human development have implications for health and disease in later life. Limited research has explored how prenatal factors influence dental development in children of mothers with known pregnancy conditions. Enamel in human deciduous teeth begins forming in utero and is highly susceptible to physiological upsets experienced perinatally. The moment of birth itself is marked in deciduous enamel by the Neonatal Line (NNL) as a baby transitions from the uterine to external environment. This study evaluates the effect of maternal health factors that include stress and alcohol consumption on NNL in teeth from Australian children.

STUDY DESIGN AND SUBJECTS

Mothers (n = 53) were interviewed about their health during pregnancy and experience of birth. Sixty-five deciduous teeth (incisors, molars, one canine) from their children were donated for histological examination. Neonatal line thickness was measured from thin sections and evaluated against maternal and neonatal factors using statistical analyses, controlling for tooth type and birth number.

RESULTS AND CONCLUSIONS

The only maternal factor of a statistically significant effect on NNL thickness was alcohol consumption. Children of mothers who drank occasionally during pregnancy had a thicker NNL when compared to children of mothers who abstained. These results suggest that maternal lifestyle factors influence NNL formation possibly due to physiological changes that disrupt calcium homeostasis during enamel deposition. We highlight large intra-specific variation in human NNL expression. The potential of dental sampling in identifying children with prenatal exposure to alcohol is suggested.

Crypt fenestration enamel defects and early life stress: Contextual explorations of growth and mortality in Colonial Peru

OBJECTIVES

This study provides a comprehensive analysis of crypt fenestration enamel defects (CFEDs) from the Eten and Mórrope communities, Colonial period (A.D. 1,530-1,750), Lambayeque Valley, Peru. The goal is to help clarify the role of these lesions as reflections of early life environments as well as relationships growth and survival at future ages.

MATERIALS AND METHODS

CFED absence/presence was recorded in the mandibular canines of 105 individuals and 202 teeth. Defect prevalence was compared between the Eten and Mórrope sites using a proportions test. Femoral growth residuals were compared between CFED present and absent samples. Mortality risk was evaluated using Kaplan-Meier survival analysis.

RESULTS

CFED frequencies at Eten and Mórrope were similar to previous studies. Greater frequencies of CFEDs were found at Eten compared to Mórrope. There was no association between skeletal growth and CFEDs. No differences in mortality were found between CFED present and absent individuals within each site. General survivorship at Eten was significantly greater than Mórrope. However, individuals without CFEDs at Eten had greater survivorship than those with and without CFEDs at Mórrope. Individuals with CFEDs at Eten had greater survivorship than those with CFEDs at Mórrope. These differences begin around 1.7 years.

CONCLUSIONS

CFEDs may be associated with stress experience, but associations with growth and survivorship at later ages is context dependent. CFED prevalence is an ambiguous indicator of stress when used in the absence of mortality data, and even under those circumstances, appears limited by differences in local demography.

DENTAL ENAMEL FORMATION AND IMPLICATIONS FOR ORAL HEALTH AND DISEASE

Dental enamel is the hardest and most mineralized tissue in extinct and extant vertebrate species and provides maximum durability that allows teeth to function as weapons and/or tools as well as for food processing. Enamel development and mineralization is an intricate process tightly regulated by cells of the enamel organ called ameloblasts. These heavily polarized cells form a monolayer around the developing enamel tissue and move as a single forming front in specified directions as they lay down a proteinaceous matrix that serves as a template for crystal growth. Ameloblasts maintain intercellular connections creating a semi-permeable barrier that at one end (basal/proximal) receives nutrients and ions from blood vessels, and at the opposite end (secretory/apical/distal) forms extracellular crystals within specified pH conditions. In this unique environment, ameloblasts orchestrate crystal growth via multiple cellular activities including modulating the transport of minerals and ions, pH regulation, proteolysis, and endocytosis. In many vertebrates, the bulk of the enamel tissue volume is first formed and subsequently mineralized by these same cells as they retransform their morphology and function. Cell death by apoptosis and regression are the fates of many ameloblasts following enamel maturation, and what cells remain of the enamel organ are shed during tooth eruption, or are incorporated into the tooth's epithelial attachment to the oral gingiva. In this review, we examine key aspects of dental enamel formation, from its developmental genesis to the ever-increasing wealth of data on the mechanisms mediating ionic transport, as well as the clinical outcomes resulting from abnormal ameloblast function.

Developing a pig model for crypt fenestration-induced localized hypoplastic enamel defects in humans

Hypoplastic pits on human deciduous canine teeth are attributed to nutritionally induced thinning of the crypt wall prior to eruption, exposing ameloblasts to unspecified physical trauma through the fenestration. Traditionally known as localized hypoplasia of the primary canine (LHPC), this little-understood condition is reported in fields ranging from public health to bioarchaeology. We propose the defect be termed a ‘crypt fenestration hypoplastic enamel defect’ (CFED) to reflect that an analogous lesion is created postnatally on maxillary molars of pigs. Pigs are accepted as a suitable proxy for many studies in human biology. We compare fenestration defects and CFEDs between 50 Sick Pen pigs, who died naturally, and 20 Controls. Observations were made of the presence, number and size of fenestrations in molar crypts. CFEDs were counted on erupted deciduous last molars and permanent first molars. Signs of being underweight and cranio-dental infection at death were recorded. Sick pen pigs show significantly more fenestrations at death and CFEDs acquired before death. These conditions co-occur with infection and poor growth. The deep fibers of temporalis muscle lie adjacent to the crypt wall of maxillary molars. We propose that contraction of this muscle during suckling and chewing creates large compressive forces against fenestrated bony surfaces sufficient to have physiological consequences for physically unprotected ameloblasts. While we conclude that a pig model is appropriate to study fenestration-induced enamel defects, this naturalistic experiment leaves unresolved whether osteopenia in pigs, and by extension in human infants, is due to disease and/or malnutrition.

Is it health or the burial environment: differentiating between hypomineralised and post-mortem stained enamel in an archaeological context

Developmental enamel defects are often used as indicators of general health in past archaeological populations. However, it can be difficult to macroscopically distinguish subtle hypomineralised opacities from post-mortem staining, unrelated to developmental defects. To overcome this difficulty, we have used non-destructive x-ray microtomography to estimate the mineral density of enamel. Using a sample of deciduous teeth from a prehistoric burial site in Northeast Thailand, we demonstrate that it is possible to determine whether observed enamel discolourations were more likely to be true hypomineralised lesions or artefacts occurring as the result of taphonomic effects. The analyses of our sample showed no evidence of hypomineralised areas in teeth with macroscopic discolouration, which had previously been thought, on the basis of macroscopic observation, to be hypomineralisations indicative of growth disruption. Our results demonstrate that x-ray microtomography can be a powerful, non-destructive method for the investigation of the presence and severity of hypomineralisation, and that diagnosis of enamel hypomineralisation based on macroscopic observation of buried teeth should be made with caution. This method makes it possible to identify true dental defects that are indicative of growth disruptions.

Markers of physiological stress in juvenile bonobos (Pan paniscus): are enamel hypoplasia, skeletal development and tooth size interrelated?

A reduction in enamel thickness due to disrupted amelogenesis is referred to as enamel hypoplasia (EH). Linear EH in permanent teeth is a widely accepted marker of systemic physiological stress. An enigmatic, nonlinear form of EH commonly manifest in great ape and human deciduous canines (dc) is known as localized hypoplasia of primary canines (LHPC). The etiology of LHPC and what it signifies-localized traumatic or systemic physiological stress-remains unclear. This report presents frequency data on LHPC, hypostotic cranial traits, and tooth size in a sample of juvenile bonobos, then tests hypotheses of intertrait association that improve knowledge of the etiology and meaning of LHPC. The fenestration hypothesis is tested using hypostotic cranial traits as a proxy for membrane bone ossification, and the relationship between tooth size, LHPC, and hypostosis is investigated. Macroscopic observations of EH, hypostotic traits, and measurements of buccolingual tooth size were conducted according to established standards. LHPC was found in 51.2% of bonobos (n = 86) and in 26% of dc teeth (n = 269). Hypostotic traits were observed in 55.2% of bonobos (n = 96). A test of the association between LHPC and hypostosis yielded nonsignificant results (chi(2) = 2.935; P = 0.0867). Primary canines were larger in specimens with LHPC than in unaffected specimens (paired samples t test; udc, P = 0.011; ldc, P = 0.018), a result consistent with the fenestration hypothesis of LHPC pathogenesis. Hypostosis was not associated with differences in tooth size (P > 0.05). LHPC may be an indirect indicator of physiological stress, resulting from large, buccally displaced primary canines.

Prevalence of enamel hypoplasia in deciduous canines of patients with complete cleft lip and palate

OBJECTIVE

To evaluate the prevalence and type of enamel hypoplasia in deciduous canines of patients with complete unilateral and bilateral cleft lip and palate, as well as its distribution according to gender, dental arch, and side of cleft.

DESIGN

Cross sectional.

SETTING

Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil.

MATERIAL AND METHODS

Three-hundred twelve Caucasian children (193 boys, 119 girls), aged 3 to 10 years, presenting complete unilateral and bilateral cleft lip and palate were included in this study. A single examiner carried out clinical examination under natural light with a dental probe and dental mirror and, after drying of the tooth, by means of a simplified hypoplasia index.

RESULTS

A prevalence of 43.8% was observed for unilateral and 39% for bilateral clefts. Both groups revealed similar distributions regarding the maxillary and mandibular dental arches and gender. Similar distribution was also observed on the cleft and noncleft sides for the unilateral cleft group. The most frequent type and severity was obvious hypoplasia, followed by minimal hypoplasia, both roughly round.

CONCLUSION

The results suggest that the cleft does not influence the occurrence of hypoplasia in deciduous canines.

Environmental stress in the Early Mediaeval Slavic population at Borovce (Slovakia)

Several palaeopathological indicators examined in skeletal samples are caused by stress during childhood and remain visible in adults. In this study, dental enamel hypoplasia was observed in 451 individuals from the Early Mediaeval (8th to beginning of 12th c. AD) Slavic skeletal series at Borovce (Slovakia). The presence of enamel hypoplasia was scored in all types of deciduous and permanent teeth. More than one-fourth (27.2%) of the individuals with preserved permanent teeth showed enamel hypoplasia. No significant differences in the occurrence of the enamel lesions were found between males and females. The age at development of hypoplasias was estimated for 74 individuals by measuring the distance of the defect from the cemento-enamel junction. The hypoplastic defects appeared most frequently between 2.5 and 3.0 years. Following the trends observed in the distribution of age at development of the enamel lesions between subadults and adults, individuals stressed earlier in life had a reduced ability to cope with later insults. High prevalence of enamel hypoplasia, especially among 10-14-year-old growing juveniles, has led to the assumption that the Borovce population lived a considerably long period under conditions of high environmental pathogen load, and probably also suffered from some nutritional deficiencies.

Localized hypoplasia of the primary canine in bonobos, orangutans, and gibbons

This paper extends observations by Lukacs ([1999] Am. J. Phys. Anthropol. 110:351-363; [2001] Am. J. Phys. Anthropol. 116:199-208) of localized hypoplasia of the primary canine (LHPC) among large apes to gibbons, bonobos, and orangutans. LHPC is a roughly circular area of deficient enamel on the labial surface of primary canine teeth which, on current evidence from humans, forms several months after birth due to malnutrition-induced craniofacial osteopenia, leading to crypt fenestration that exposes the dental follicle and more deep-sited ameloblasts to minor physical traumata during normal motor infant development. Our goal was to determine the prevalence of LHPC among a variety of apes which differ in body mass and socioecology, with a view to elucidating the etiology of the defect. We examined juvenile dentitions from 122 animals from three taxa: 8 Hylobates lar, 75 Pongo pygmaeus from Borneo and Sumatra, and 39 Pan paniscus from central Africa. Reported variables include taxon, sex, arcade, side, and tooth size. Presence/absence and ordinal severity of defect expression were recorded by description, microphotography, and scanning electron microscopy. Molds were taken in high-resolution dental impression materials and cast in epoxy resin. There are clear taxonomic, but no sex, differences. Prevalence ranged from 0.0% in gibbons to 61.5% in bonobos and 85.3% in orangutans. The result for orangutans is similar to that reported by Lukacs ([1999] Am. J. Phys. Anthropol. 110:351-363), while bonobos are much more affected than were the common chimpanzees (22%) described by Lukacs ([1999] Am. J. Phys. Anthropol. 110:351-363). There are no significant antimeric differences, but the lower canine is much more affected than the upper by LHPC. We show that larger teeth are more affected by LHPC and have more severe defects. Also, we encountered several instances of patent or healing canine crypt fenestrations, occasionally in direct association with LHPC. Location of the defect indicates that LHPC may occur perinatally but more usually several months postnatally. Histological examination showing the neonatal line and LHPC is required to resolve the issue of timing. We concur with Lukacs ([1999] Am. J. Phys. Anthropol. 110:351-363) that taxonomic, anatomical, and environmental variables combine to determine the occurrence and appearance of LHPC. Nevertheless, we conclude that LHPC probably reflects deficient growth of the arcades in infant apes and humans.

Epidemiology of enamel hypoplasia in deciduous teeth: explaining variation in prevalence in western India

This study is based on seven samples of school children (n = 516) from rural (five groups) and urban (two groups) settings in western Maharashtra, India. Height and weight were recorded for each subject. Intra-oral observation of the labial surface of maxillary and mandibular anterior teeth was conducted with a low power (3x) illuminated hand lens. Presence of enamel hypoplasia was recorded on a dental chart by drawing the size and location of the defect on the affected tooth. Data analysis was conducted in two stages: 1) Enamel hypoplasia (EH) prevalence was analyzed by percentage of teeth and by percentage of individuals affected for the composite sample and independently for each study group and 2) an assessment of the relationship between anthropometric variables (height and weight), socio-economic status (SES), and localized hypoplasia of primary canines (LHPC; Skinner, 1986) was evaluated using multiple linear regression analysis. EH was observed less often in deciduous incisors (0.2% in di(2) to 2.5% in di(2)) than in deciduous canines (dc). Mandibular dc were affected with the greatest frequency (23.1%, tooth count). The overall individual count prevalence of dc hypoplasia (LHPC) is 26.2% (134/511) for all village samples and sexes combined. Difference in LHPC frequency by sex is non-significant, with males (24.7%, 70/284) and females (28.2%, 64/227) exhibiting nearly equal values. Significant inter-group variation in LHPC prevalence was documented among the seven groups, and the range of LHPC prevalence the among living groups exceeds variability in LHPC among four prehistoric Chalcolithic skeletal series of the Deccan Plateau. Multiple regression analysis revealed no significant relationship between height-for-age or weight-for-age in four school samples (two urban/two rural), but a significant association between stature and LHPC was found for three rural endogamous groups. Children with LHPC were significantly shorter by 1.5 cm than children who lacked the defect after controlling for differences in age. While the association between low birth weight and EH is strong and well documented clinically, the association between childhood stature and LHPC is more variable across groups and may reflect inter-group variation in the duration and intensity of environmental stress.

Enamel hypoplasia in the deciduous teeth of early Miocene catarrhines: evidence of perinatal physiological stress

Enamel hypoplasia (EH) is a deficiency in enamel thickness due to physiological insults that compromise ameloblast function during the secretory phase of amelogenesis. The prevalence of EH in the deciduous teeth of nonhuman primates is largely unknown. One exception is the recent discovery of EH in the deciduous teeth of extant great apes which exhibit significant differences in prevalence between genera (Lukacs, 1999 a, 2000 a, Am. J. phys. Anthrop.110, 351-363). EH in deciduous teeth of other primates, living and fossil, remain undocumented. This communication describes a "plane form" type of EH known as localized hypoplasia of primary canines (LHPC) (Skinner, 1986 a, Am. J. phys. Anthrop.69, 59-69) in early Miocene catarrhines from Kenya. Specimens were examined macroscopically, with a 10x hand lens and with a variable power (10-30x) binocular microscope. Fédération Dentaire International (FDI)/Defects of Dental Enamel (DDE) standards were employed in recognition and recording of enamel defects (Fédération Dentaire International, 1982, Int. Dent. J.32, 159-167; Clarkson, 1989, Adv. Dental Res.3, 104-109). Size, shape and location of defects were measured and recorded on an outline drawing of the tooth crown. The Kenya National Museum study sample includes six genera of early Miocene catarrhines (n=66 specimens, with n=80 teeth). Seven deciduous teeth were afflicted with EH, yielding an overall prevalence of 8.75%. Two taxa, Kalepithecus (n=1 deciduous canine) and Proconsul (n=3 deciduous canines), were affected with LHPC. Expression of LHPC in fossil catarrhines is consistent with the expression of EH observed in skeletal samples of extant great apes. This report establishes an approximately 17-23 Ma antiquity for EH among early catarrhines and suggests that the neonatal stage of ontogenetic development was sufficiently stressful physiologically to produce disruption in amelogenesis. These physiological stresses impacted neonates of fossil taxa with a wide range of adult body sizes, from large-bodied Proconsul major ( approximately 75 kg) to one of the smaller-bodied catarrhines, Kalepithecus ( approximately 5 kg).

Interpreting sex differences in enamel hypoplasia in human and non-human primates: Developmental, environmental, and cultural considerations

The purpose of this review is to provide a synoptic, critical evaluation of the evidence of, and potential etiological factors contributing to, sex differences in the expression of enamel hypoplasia (EH). Specifically, this review considers theoretical expectations and empirical evidence bearing on two central issues. The first of these is the impact of a theorized inherent male vulnerability to physiological stress on sex differences in EH. The second issue is the potential contribution to sex differences in EH of intrinsic differences in male and female enamel composition and development. To address this first issue, EH frequencies by sex are examined in samples subject to a high degree of physiological stress. Based on the concept of inherent male vulnerability (or female buffering), males in stressful environments would be expected to exhibit higher EH frequencies than females. This expectation is evaluated in light of cultural practices of sex-biased investment that mediate the relationship between environmental stress and EH expression. Defects forming prenatally afford an opportunity to study this relationship without the confounding effects of sex-biased postnatal investment. Data bearing on this issue derive from previously conducted studies of EH in permanent and deciduous teeth in both modern and archaeological samples as well as from new data on Indian schoolchildren. To address the second issue, fundamental male-female enamel differences are evaluated for their potential impact on EH expression. A large sex difference in the duration of canine crown formation in non-human primates suggests that male canines may have greater opportunity to record stress events than those of females. This expectation is examined in great apes, whose canines often record multiple episodes of stress and are sexually dimorphic in crown formation times. With respect to the first issue, in most studies, sex differences in EH prevalence are statistically nonsignificant. However, when sex differences are significant, there is a slight trend for them to be greater in males than in females, suggesting a weak influence of greater male vulnerability. Cultural practices of sex-biased investment in children appear to have greater impact on EH expression than does male vulnerability/female buffering. With respect to the second issue, sex differences in the composition and development of enamel were reviewed and determined to have limited or unknown impact on EH expression. Of these factors, only the duration of crown formation was expected to affect EH expression by sex within the great apes. The data support an association between higher defect counts in the canines of great ape males relative to those of females that may be the result of longer crown formation times in the canines of great ape males. This review concludes with an assessment of the nature of the evidence currently available to examine these issues and suggests future avenues for research focused on elucidating them.

'Ilko dacowo:' canine enucleation and dental sequelae in Somali children

OBJECTIVE

To assess the prevalence of primary canine enucleation and associated dental sequelae in Somali children resident in Sheffield.

DESIGN

Cross-sectional survey.

SETTING

Somali religious education classes and homework groups, selected primary and secondary schools, and the Charles Clifford Dental Hospital, Sheffield (1998-99).

SUBJECTS AND METHODS

The target population were all Somali children aged between 4 and 17 years. Subjects were interviewed to obtain background sociodemographic data and an oral examination was performed. The status of the canine in each quadrant was noted, in addition to the presence of any dental anomalies in adjacent teeth. Features indicative of a history of attempted canine enucleation included: absence of primary canines, localized developmental defects affecting primary or permanent canines and lower lateral permanent incisors, and retention of lower primary lateral incisors with distal eruption of permanent lateral incisors.

RESULTS

A total of 260 children were included in the study, comprising 56.5% of the target population. The mean age of the subjects was 9.7 years with an equal male and female distribution. According to the criteria devised, 82 (31.5%) of the subjects were considered to exhibit one or more of the dental features suggestive of a previous history of canine enucleation. There was no significant difference in prevalence according to gender or birthplace (UK, Somalia or another country), but a positive history was greater in subjects whose mother did not speak English. In addition to anomalies involving canines, lower permanent incisors were commonly missing (5.0% of children aged over 9 years).

CONCLUSION

The suspected continuation of canine enucleation in UK-born Somali children raises important oral health issues. Culturally sensitive education is indicated to discourage this harmful ritual practice.

Localised enamel hypoplasia of human deciduous canines: genotype or environment?

A discrete area of defective enamel formation that appears on the labial surface of the crowns of deciduous canine teeth has been described in both recent and prehistoric human populations, with reported frequencies varying from 1 to 45 per cent. Suggestions about the aetiology of this localized hypoplasia range from genotypic factors to environmental conditions and systemic effects. The major aims of this study were to describe the frequency of occurrence and pattern of expression of the lesion in Australian Aboriginal and Caucasian ethnic groups, and to clarify the role of genetic factors by examining a sample of twins. The study sample consisted of dental casts of 181 pairs of Australian Caucasian twins, 215 Aborigines and 122 Caucasian singletons, together with 253 extracted deciduous canines. Examination of dental casts and extracted teeth was undertaken under 2x magnification with emphasis being placed upon location and expression of the lesion. The defect was observed in 49 per cent of twins and 44 per cent of Aborigines, but only 36 per cent of singletons. The percentages of affected teeth in each group were: 18 per cent in twins, 17 per cent in Aborigines and 13 per cent in Caucasians. A significant proportion of the defects occurred on the mesial aspect of the labial surface, in the middle area incisocervically, with the majority in the lower jaw. A number of significant differences in frequency were observed between groups, sexes, arches and sides. The results confirm some of the findings of previous studies, but also suggest that none of environmental, genetic or systemic factors can be ruled out as being involved in aetiology of the defect. The higher incidence of the lesion occurring on the mesial aspect of the labial surface is suggestive of physical trauma. Also, the vulnerability of the prominent developing mandibular canine, with its thin or missing labial covering of bone, would be expected to lead to higher prevalence of the lesion in the lower jaw. Although not definitive, the results of concordance analyses in twins were suggestive of a possible genetic predisposition in the formation of the lesion. Further research with a greater clinical orientation and emphasis on determining specific aetiological factors within any given environment in different ethnic groups may provide better insight into the ambiguous aetiology of the hypoplastic enamel defect.

Enamel hypoplasia in deciduous teeth of great apes: do differences in defect prevalence imply differential levels of physiological stress?

This paper presents new data on enamel hypoplasia in the deciduous canine teeth of great apes. The enamel defect under consideration is known as localized hypoplasia of primary canines (LHPC), and is characterized by an area of thin or missing enamel on the labial surface of deciduous canine teeth (Skinner [1986a] Am. J. Phys. Anthropol. 69:59-69). Goals of this study are: 1) to determine if significant differences in the frequency of LHPC occur among three genera of great apes, and 2) to evaluate variation in LHPC prevalence among great apes as evidence of differential physiological stress. Infant and juvenile apes with deciduous teeth were examined at the Cleveland Museum of Natural History (n = 100) and at the Smithsonian Institution, National Museum of Natural History (n = 36). Deciduous teeth were observed under oblique incandescent light, with the naked eye and with a 10x hand lens. Enamel hypoplasia was scored using Federation Dentaire International (FDI)-Defects of Dental Enamel (DDE) standards. Hypoplasias were recorded by drawing defect location and size on a dental chart, and by measuring defect size and location with Helios needlepoint dial calipers. The prevalence of LHPC is reported by genus and sex, using two approaches: 1) the frequency of affected individuals-those having one or more deciduous canine teeth scored positive for LHPC; and 2) the number of canine teeth scored positive for LHPC as a percentage of all canine teeth observed. Variation in defect size and location will be described elsewhere. Localized hypoplasia of primary canine teeth was found in 62.5% of 128 individual apes, and in 45.5% of 398 great ape deciduous canines. As in humans, LHPC is the most common form of enamel hypoplasia in deciduous teeth of great apes, while LEH is rare or absent. The distribution and pattern of expression of LHPC in great apes is similar to that described in humans: side differences are not significant, but mandibular canines exhibit the defect two to five times more often than maxillary canine teeth. Differences in LHPC prevalence by sex are small and not significant. Intergeneric differences are large and non-random: chimpanzees (Pan) exhibit a significantly lower frequency of LHPC (22%, n = 50) by individual count, than either the orangutan (Pongo, 88.0%, n = 25) or the gorilla (Gorilla, 88.7%, n = 53). Tooth count prevalences exhibit a similar pattern of variation and are also statistically significant. These findings suggest that large bodied great apes (gorilla and orangutan) may be under greater physiological stress during perinatal and early postnatal development than the chimpanzee. The size, position, and timing of LHPC lesions are currently under analysis and may yield more insight into the etiological origin of this enamel defect.

Interproximal contact hypoplasia in primary teeth: A new enamel defect with anthropological and clinical relevance

This study reports the prevalence, distribution, and expression of enamel defects in a sample of primary teeth (n = 225) from a prehistoric site in western India (1400-700 BC). Five enamel surfaces of individual, isolated primary teeth were observed for surface defects using a binocular stereomicroscope with variable power of magnification (8-20x). Standards for evaluating dental enamel defects (DDE) recommended by the Fédération Dentaire International (FDI) were employed. Details of defect expression were also recorded, including size, shape, and surface of tooth crown affected. Hypoplastic enamel defects were observed in 28% of teeth, but the distribution and expression of defects was not random. More than 50% of canine teeth had hypoplastic defects (HD); incisors and molar teeth exhibited far fewer HD. The buccal surface of canines was the most commonly affected crown surface. Areas of missing enamel were also common on the mesial and distal surfaces of canines and incisors and on the mesial surface of molar teeth. The high frequency of enamel defects found on interproximal crown surfaces warrants a label, and the name interproximal contact hypoplasia (IPCH) is proposed. Linear enamel hypoplasia (LEH) was absent from this primary dental sample. IPCH is more frequent in mandibular than in maxillary teeth, but no side preference was detected. In canine teeth, buccal hypoplasias (localized hypoplasia of primary canines; LHPC) were not positively correlated with interproximal hypoplastic defects. The etiology of IPCH may involve mesial compaction of developing teeth due to slow longitudinal growth of the jaws. Episodic bone remodeling results in ephemeral fenestrae in the mesial and distal walls of the dental crypt permitting tooth-tooth contact and disruption of amelogenesis. IPCH prevalence decreases across the subsistence transition from sedentary Early Jorwe agriculturalists to seminomadic Late Jorwe hunters and foragers, but the difference is not statistically significant. This may be due to underrepresentation of mandibular teeth in the sample. Am. J. Hum. Biol. 11:718-734, 1999. Copyright 1999 Wiley-Liss, Inc.

Patterns of dental enamel defects at ancient Mendes, Egypt

The dental remains of 88 individuals from Old Kingdom, First Intermediate, and Greco-Roman periods at the ancient Egyptian site of Mendes (Tell er-Rub(c)a) were examined for dental enamel hypoplasia, and the results reported here provide some of the first comparative data on enamel defects in ancient Egypt. Overall, 48% of the individuals in the sample have one or more teeth with hypoplasia, with 17% of permanent teeth and 8% of deciduous teeth affected. The permanent teeth account for 87% of the total number of affected teeth, a prevalence over deciduous teeth that is significant at alpha = 0.05. Permanent and deciduous teeth display different patterns of hypoplasia, with the former exhibiting both discrete pitting and linear furrowing, and the latter exhibiting only pits. Teeth with linear defects significantly outnumber those with pits by a factor of more than three to one. Only permanent canines display more than one lesion on a tooth, with a mean of 1.4 defects per affected tooth. Although calculation of the age of insult from lesion position is imprecise, it appears that stress episodes occurred most commonly between approximately 3-5 years of age. The presence of pits in the deciduous dentition, however, suggests that physiological stresses began in utero. There is no statistically significant difference in the frequency of enamel defects between males and females. An observed decrease in the frequency of defects from the Old Kingdom period to the subsequent First Intermediate and Greco-Roman periods is not significant at alpha = 0.05, although such a decrease is expected given epigraphic and other data that refer to prolonged drought and malnutrition in the late Old Kingdom. The calculated chi(2) value of 3.83 is significant at the 0.10 level, however, and since our sample is rather small and the magnitude of the chi-square statistic is a function of sample size, we recommend that future research investigate further the relationship between the frequency of enamel defects and the time period in which they occur.

Patterns of dental caries severity in Chinese kindergarten children

The dental caries status of a population group is traditionally described by mean values of decayed, missing and filled teeth or surfaces (DMFT or S). Because of the limitations of the DMF values alone, additional measures of dental caries become important. A system of describing the pattern of dental caries attack hierarchically according to severity of caries was suggested by Poulsen & Horowitz (Community Dent Oral Epidemiol 1974;2:7-11). The purpose of the present study was to analyze caries data from a group of 3-6-year-old Chinese kindergarten children according to this hierarchical system, assess the hierarchical assumptions of the system with deciduous teeth and evaluate its usefulness as an additional caries description for a kindergarten population. As part of a longitudinal field trial, baseline caries data were collected from 452 children. Caries was registered by tooth surface without the use of radiographs. Each child was assigned to one of six mutually exclusive zones of increasing caries severity, from zone 0=caries free through zone 5, the most severe, assuming that once a child was classified into a given zone it automatically belonged to all zones of lesser severity (except zone 0). On the basis of the original six zones, 61% of the children were classified correctly according to the hierarchical concept, but different alternative models which merged one or more zones together demonstrated varying percentages of correct classification, the cariologically most acceptable one placing 83% correctly. For each age group there was a close correlation between mean dmfs and increasing severity. The hierarchical model provides a valuable additional description of the caries status in deciduous teeth and is consistent with professional and epidemiological knowledge of caries attack patterns.

Prevalence and distribution of developmental enamel defects in primary dentition of Chinese children 3-5 years old

A total of 1344 children, 3-5 yr old, from two rural counties, Haidian and Miyun, close to Beijing, China, were examined in 1992. A modified DDE Index was employed in this study, and a pre-designed formula was used to calculate an enamel defect score (EDS) for each individual in the study. Oral examination was performed by one dentist under natural light using a standard mouth mirror and dental probe. Developmental enamel lesions were diagnosed without drying or cleaning the teeth prior to examination. Results from this study showed that primary teeth with defective enamel were seen in 23.9% of the children examined, opacity in 1.6%, and hypoplasia in 22.2%. Among the teeth, maxillary central and lateral incisors were affected by enamel hypoplasia most often (40.8% and 39.2%), followed by maxillary canines (25.7%), maxillary 1st molars (22.1%), and mandibular 1st molars (18.5%). The enamel defects occurred more frequently on the buccal surfaces of teeth than on any other surface. The study did not find a significant association of the children's age, family socioeconomic status, and anthropometric measurements with the distribution of enamel defects. However, there was a significantly higher prevalence of teeth with defects in males compared to females (P < 0.001), as well as mean tooth surfaces with defects (P < 0.05), and mean EDS (P < 0.05). Children born prematurely were shown to have four times more enamel lesions than children who were full term (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Hypovitaminosis A: A model for sudden infant death syndrome

The cause of sudden infant death syndrome (SIDS) is unknown. It is the leading cause of death from age one month to one year in North America. The purpose of this essay is to generate some testable hypotheses as to the cause of SIDS by drawing attention to distinct epidemiological parallels between SIDS and a newly recognized form of enamel hypoplasia, termed localized hypoplasia of the primary canine tooth (LHPC), which has been attributed to vitamin A deficiency. LHPC and SIDS share a common epidemiological profile: winter seasonality, occurrence at 3-5 months, and affecting apparently healthy children, but with increased incidence in socio economically disadvantaged families particularly racial/ethnic minorities (except Hispanics who show a reduced incidence), previously compromised infant health, less prenatal counselling, and less breastfeeding. Vitamin A has pervasive functions throughout the body including bone growth and maintenance of epithelial membranes. It is proposed that SIDS is due in part to hypovitaminosis A through one of several mechanisms: imbalanced basicranial growth producing mechanical constriction on the respiratory nerves passing through the jugular foramen; or through compromised myelination and/or maturation of the brain stem and cranial nerves involved in respiration; or through pharyngeal collapse due to mandibular undergrowth; or dysfunction of hypoxia-sensitive epithelial cells in the trachea. It is recommended that assay of hypoxia-sensitive epithelial cells in the trachea. It is recommended that assay of the retinyl ester content of the liver of SIDS victims be included in autopsy protocol. © 1995 Wiley-Liss, Inc.