Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon

Association between Short Stature at Grade 1 and Permanent Teeth Caries at Grade 6 in Elementary School Children in Japan: A Population-Based Cohort Study

Short stature in children is a marker of low nutritional status and has been suggested to be associated with dental caries. However, longitudinal studies on this topic are scarce. Data from a longitudinal study of elementary school children in Adachi City, Tokyo, Japan, were analyzed. In 2015, caregivers of children at grade 1 answered questionnaires, and information on dental caries and height measured at school health checkups was merged and followed to grade 6 (N = 3576; follow up rate = 83.3%). The association between short stature at grade 1 (-2.01 standard deviation (SD)--3.00 SD, or <-3.00 SD in height-for-age according to the World Health Organization criteria) and the number of decayed, missing, or filled permanent teeth (DMFT) at grade 6 was examined using multivariable Poisson regression with robust standard error. After adjusting for confounders, children with a short stature at grade 1 had a higher DMFT number at grade 6: the mean ratios (95% confidence interval) were 1.17 (0.89-1.54) and 2.18 (1.03-4.64) for children with a height-for-age -2.01 SD--3.00 SD, and those with a height-for-age < -3.00, respectively. Short stature at grade 1 could be a marker of future dental caries in the permanent teeth at grade 6.

RANTES and developmental defects of enamel in children: A Brazilian prenatal cohort (BRISA)

OBJECTIVE

Little is known about the effect of maternal immunological factors on the etiology of developmental defects of enamel (DDE). RANTES (Regulated on Activation Normal T Cell Expressed and Secreted) is a chemokine produced by fibroblasts, lymphoid and epithelial mucosa cells in response to various external stimuli. Despite its importance for embryogenesis, RANTES expression has been demonstrated in multiple diseases characterized by inflammation, tumor and immune response, and wound healing. We hypothesized that altered levels of RANTES during pregnancy are associated with the immune and inflammatory response in women, which could lead to the occurrence of DDE in utero (DDE-iu), directly or mediated by preterm birth. Therefore, this study aimed to evaluate the direct and indirect effects of serum levels of RANTES in pregnant women in the occurrence of DDE-iu in children.

METHODS

This is a longitudinal case-control study. The mothers and their children (327) were evaluated in three moments: prenatal care, post childbirth, and when the child was between 12.3 and 36 months of age. The analysis was performed with structural equation modeling, estimating the standardized coefficient (SC), adopting α = 5%.

RESULTS

There was a direct and negative effect of RANTES on the outcome (SC = -0.137; p = 0.022). This association was not mediated by preterm birth (SC = 0.007; P = 0.551). When considering the specific types of DDE-iu, RANTES had a direct effect on hypoplasia (SC = -0.190; p = 0.007), but not on opacity (SC = 0.343; p = 0.074).

CONCLUSION

Lower serum levels of RANTES may contribute to a higher number of teeth with DDE-iu, specifically hypoplasia. However, more evidence supported by clinical, laboratory and epidemiological studies is still needed.

Maxillary and dental development in the offspring of protein-restricted female rats

Nutritional restriction during developmental periods impairs organ physiology. Female rats were subjected to protein restriction during pregnancy and lactation to analyze dental and maxillary development. Four exposure groups were considered: normal-protein diet during pregnancy and lactation (NP, 17% casein), low-protein diet during lactation (LP-L, 6% casein), low-protein diet during pregnancy and lactation (LP), and low-protein diet during pregnancy (LP-G). Maxillae from 15-day-old male pups were collected. All protein-restricted groups presented increased dentin thickness and reduced alveolar bone area. When protein restriction was applied during both gestation and lactation (LP), harmful effects were observed in the form of loss of protective OPG (osteoprotegerin) in tooth epithelium-mesenchyme, due to higher RANKL expression, delay in odontoblast maturation, less dental pulp vascularity, reduction in amount of alveolar bone, and less matrix mineralization. In the LP-L group, effects of protein restriction seemed less harmful, and despite less alveolar bone, the enhancement in BMP-7, VEGF, and RANKL seems a compensatory signal to maintain maxillary osteogenesis. In LP-G animals, Dspp expression was higher, suggesting a delay in odontoblast maturation or expression recuperation. In conclusion, maternal protein restriction affects dental and maxillary development. A low-protein diet only in gestation allows for normal development. A low-protein diet during gestation-lactation results in impaired odontogenesis that may increase susceptibility of dental anomalies.

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.

The biological index of frailty: A new index for the assessment of frailty in human skeletal remains

OBJECTIVE

Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals.

MATERIAL AND METHODS

By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals.

RESULTS

The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI).

DISCUSSION

BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

Molar-incisor hypomineralization in quilombola children and adolescents: A study of prevalence and associated factors

OBJECTIVES

This cross-sectional observational study determined the prevalence and factors associated with molar-incisive hypomineralization (MIH) in quilombola children and adolescents in north-eastern Brazil.

METHODS

The sample consisted of 251 children and adolescents (8 to 14 years old) living in the rural quilombola community Lagoas in São Raimundo Nonato, Piauí (census population). Sociodemographic and health-related data were collected from pre-, peri- and post-natal health records and a clinical examination for MIH diagnosis was performed by four previously trained and calibrated examiners. Descriptive data analysis and Poisson regression were performed. The magnitude of the association was determined by adjusted prevalence ratio (PR) and confidence intervals (95% CI).

RESULTS

The prevalence of MIH was 46.6%. The presence of MIH was associated with gestational diabetes (PR = 2.49, 95% CI 2.08-2.99; p <0.001) and acute foetal distress (PR = 1.39; 95% CI 1.04-1.86; p = 0.025).

CONCLUSION

It was concluded that the prevalence of MIH in the quilombola community was high and associated with gestational diabetes and acute foetal distress.

Evaluating life history trade-offs through the presence of linear enamel hypoplasia at Pueblo Bonito and Hawikku: A biocultural study of early life stress and survival in the Ancestral Pueblo Southwest

OBJECTIVES

Due to the indelible nature of enamel, bioarchaeologists use linear enamel hypoplasia (LEH) to detect early investments in surviving stress and have identified an association between LEH presence and constraints in growth and maintenance as well as an increased susceptibility to future stress events. This study evaluates heterogenous frailty and susceptibility to death in relation to episodes of early life stress, as reflected by LEH presence, in the Ancestral Pueblo Southwest. This study hypothesizes that LEH presence will be associated with decreased survivorship and an increased likelihood of mortality in both samples.

MATERIALS AND METHODS

This study uses two samples, one from Pueblo Bonito (A.D. 800-1200; n = 28) and the second from Hawikku (A.D. 1300-1680; n = 103). Kaplan-Meier survival analysis with a log-rank test was used to evaluate the effect of LEH presence on survivorship for the two samples.

RESULTS

Survival analysis reveals statistically significant differences in mortality risk between individuals with and without LEH for the Hawikku sample, but no significant differences for the Pueblo Bonito sample.

CONCLUSION

The results demonstrate differences in the response to early life stress at the Hawikku and Pueblo Bonito sites, likely reflecting context. The Pueblo Bonito sample represents a high-status group, and survival following LEH may be the result of cultural buffering. Hawikku dates to a period associated with increased levels of disease and malnutrition as well as Spanish colonization. This environment may have exacerbated mortality risk for individuals in the region who survived early life stress and signifies the consequences of European colonialism in the New World.

Exploring the association of predisposing factors of Cerebral Palsy and developmental defects of enamel: a case-control study

AIM

To evaluate the occurrence of developmental defects of enamel (DDE) in children and adolescents with Cerebral Palsy (CP) and to analyze the effect of common factors in the etiology of CP on the occurrence of DDE.

METHODS

A case-control study was carried out using the modified DDE index to classify enamel defects. The study group (SG) consisted of 45 participants with CP aged between three and 14 years. The control group (CG) consisted of 88 normotypical schoolchildren, paired by gender and age group. Caregivers answered a questionnaire on their socioeconomic status and medical history. The Chi-square tests, bivariate and multivariate analysis were performed (level significance < 0.05).

RESULTS

The occurrence of DDE in SG and CG was 60% and 64.8%, respectively (p value = 0.726). The most frequent defect observed in SG was diffuse opacity (44.4%), followed by demarcated opacity (26.7%) and enamel hypoplasia (2.2%). No difference was observed in the defect's distribution among both groups (p value = 0.083). For SG, the bivariate analysis revealed a statically significant association between the presence of DDE and age group 7-14 years old and maternal schooling below 11 years. After adjusting for confounding variables, age, family income and maternal schooling were not associated with DDE.

CONCLUSION

In conclusion, the occurrence of DDE was high and similar in both groups. The pre, peri or post-natal factors associated with CP were not significant for the presence of DDE.

Malnutrition, enamel defects, and early childhood caries in preschool children in a sub-urban Nigeria population

Objectives

The study tried to determine if malnutrition (underweight, stunting, wasting, overweight) and enamel defects (enamel hypoplasia, hypomineralized second molar, amelogenesis imperfecta, fluorosis) were associated with early childhood caries (ECC). The study also examined whether malnutrition was associated with the presence of enamel defects in 0-5-year-old children.

Methods

The study was a secondary analysis of primary data of a cross-sectional study assessing the association between maternal psychosocial health and ECC in sub-urban Nigerian population collected in December 2018 and January 2019. One hundred and fifty nine children were recruited. Exploratory variables were malnutrition and enamel defects. The outcome variables were the prevalence of ECC in 0-2-year-old, 3-5-year-old, and 0-5-year-old children. Multivariable Poisson regression analysis was used to determine the associations, and socioeconomic status, oral hygiene status, and frequency of in-between-meals sugar consumption were adjusted for. The adjusted prevalence ratios, 95% confidence intervals, and p values were calculated.

Results

The prevalence of ECC was 2.1% in 0-2-year-old children and 4.9% in 3-5-year-old children. In adjusted models, underweight, stunting, and wasting/overweight were not significant risk indicators for ECC in either age group. 0-2-year-old children who had amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 3-5-year-old children who had hypoplasia (p = 0.004), amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 0-5-year-old children with hypoplasia (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. There were significant associations between various types of malnutrition and various types of enamel defects.

Conclusion

Although different types of malnutrition were associated with enamel defects, and enamel defects were associated with ECC, malnutrition was not associated with ECC. Further studies are needed to clarify the association between malnutrition and genetically and toxin-induced enamel defects.

Pre-term birth and asthma is associated with hypomineralized second primary molars in pre-schoolers: A population-based study

BACKGROUND

Hypomineralized second primary molar (HSPM) is a developmental enamel defect that represents a caries-risk factor. There are few studies about HSPM epidemiology in representative populations.

AIM

To determine the prevalence and factors associated with HSPM in pre-schoolers.

DESIGN

This is a cross-sectional population-based study of 5-year-old pre-schoolers from Teresina, Brazil. The sample was randomly selected and stratified by geographic region of the city, type of school (public and private), and sex of the pre-schoolers (n = 811). Sociodemographic status and pre-, peri-, and post-natal conditions were collected by structured questionnaires. Two calibrated examiners diagnosed HSPM using the criteria of the European Academy of Paediatric Dentistry for molar-incisor hypomineralization. Severity, colour, location, and extent of lesions were also evaluated. Descriptive analysis of the data and a Poisson regression analysis were performed (P < .05).

RESULTS

The prevalence of HSPM was 14.9. Demarcated opacities (75.6%) and white/cream colour were the most prevalent (71.4%). Pre-term pre-schoolers had 66% (PR = 1.66, 95% CI = 1.07-2.58), and those who reported asthma in the first year of life had 69% (PR = 1.69, 95% CI = 1.01-2.85) higher prevalence of HSPM.

CONCLUSIONS

Pre-term birth and reported asthma in the first year of life were associated with HSPM. The prevalence of HSPM in pre-schoolers aged 5 years old in Teresina was high.

Early Childhood Caries in Peru

Early Childhood Caries (ECC) is a global oral health problem, and Peru may be one of the countries with high prevalence of untreated ECC in South America. In this study, we constructed an epidemiologic profile of ECC in Peru through a comprehensive review of published data. The prevalence of ECC, risk factors for it, its impact on child development, and public oral health interventions on ECC have been included. The study revealed extremely high rates of ECC in Peru and significant oral-health disparities. Risk factors for ECC were poverty, high sugar consumption, and low oral health literacy. However, the number of studies is limited and their quality questionable. Oral health has not received high public-health priority in Peru. However, in recent years, new regulations and evidence-based documents (the first Clinical Practice Guideline for the Prevention, Diagnosis, and Management of Caries in Children; the Guideline for Children's healthy Growth and Development; the Law on Healthy Diet; and the Manual on Food Advertising) give hope for the future of infants' oral health in the nation.

Quilombola children and adolescents show high prevalence of developmental defects of enamel

Teeth with developmental defects of enamel (DDE) have porous and/or uneven enamel, making them more susceptible to the build-up of oral biofilm and development of caries and periodontal diseases. The aim of this cross-sectional study was to determine the prevalence of DDE and associated factors among children and adolescents living in a Quilombola community in the Northeast of Brazil. The study population was census-based and comprised individuals aged three to 14 years. The children's parents/guardians answered a questionnaire devised to collect information on socioeconomic and demographic characteristics, health problems during pregnancy and illnesses during early childhood. DDE was diagnosed using the modified DDE index. The data were analyzed using descriptive statistics and Poisson regression with robust standard errors (p<0.05). A total of 406 individuals were examined. DDE prevalence was 80.5%: 42.2% in deciduous teeth and 61.1% in permanent teeth. There was an association between presence of DDE and age (PR=1.09, 95% CI=1.01-1.17), use of antibiotics during pregnancy (PR=1.14, 95% CI=1.07-1.22) and reported malnutrition during early childhood (PR=1.12; 95% CI=1.03-1.22). The findings reveal high prevalence of DDE among children and adolescents living in the Quilombola community. Associated factors were older age, use of antibiotics during pregnancy and malnutrition during early childhood.

Dental enamel defects predict adolescent health indicators: A cohort study among the Tsimane' of Bolivia

OBJECTIVES

Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents.

METHODS

This cohort study of 349 Amerindian adolescents (10-17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log-binomial regression and receiver operating characteristics (ROCs).

RESULTS

Greater extent of defective enamel formation on the tooth surface was associated with shorter height (-1.35 cm, 95% CI: -2.17, -0.53), lower weight (-0.98 kg, 95% CI: -1.70, -0.26), lower hemoglobin (-0.36 g/dL, 95% CI: -0.59, -0.13), lower glycated hemoglobin (-0.04 %A1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 109 /L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health.

CONCLUSIONS

Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes.