Developmental enamel defects in the primary dentition: aetiology and clinical management

Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders

AIMS

Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period.

METHODS AND RESULTS

In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD = 2.7) to 2.04 (SD = 3.6), while GVPI was reduced significantly from 1.8 (SD = 0.9) to 1.4 (SD = 0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p < .001) while older maternal age (OR = 1.38, 95%CI = 1.057-1.808) and consumption of more than three sugary snacks/day (OR = 0.005, 95%CI = 0-0.0794) were significantly correlated with dental caries.

CONCLUSION

The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.

Are low serum levels of Vitamin D associated with dental developmental defects in primary teeth? A systematic review

OBJECTIVE

To identify, qualify and synthesize all studies that assessed if low serum level of 25(OH)D (<50 nmol/L) is associated with dental developmental defects (DDD) in primary teeth.

MATERIALS AND METHODS

Observational studies or clinical trials were included if measured 25(OH)D serum levels in pregnant women and/or in their children (up to 3 years old) and evaluated the occurrence of DDD in the primary dentition of offspring associated with the low 25(OH)D levels. Literature reviews, case reports, laboratory and/or animals' studies, conference abstracts, letters to the editor, book chapters and clinical protocols were excluded. Searches were carried out in 6 electronic databases and in the gray literature until March 2023, without restrictions. The study quality was assessed by the Newcastle-Ottawa Scale and the certainty of the evidence by GRADE. Data were descriptively synthesized considering the association between DDD and 25(OH)D levels.

RESULTS

Seven studies were included. Only developmental enamel defects (DED) were observed after examination of 6651 children. The incidence of DED ranged from 8.9% to 66%. Six studies found no association between low levels of 25(OH)D and DED. However, one reported correlation between hypomineralization of the primary second molar (HSMD) and low levels of 25(OH)D at birth. Methodological flaws were observed in all studies and the certainty of the evidence was very low.

CONCLUSION

Although HSMD was the only DDD associated with low levels of 25(OH)D in children, the available evidence is still not conclusive. More robust studies are needed to endorse the biological plausibility of DDD in primary teeth due to low serum levels of 25(OH)D in pregnant women or in their children. FAPERJ financed this study, which was registered in PROSPERO (CRD42022357511).

Comprehensive Oral Diagnosis and Management for Women with Turner Syndrome

Turner Syndrome (TS) is a rare genetic disorder that affects females when one of the X chromosomes is partially or completely missing. Due to high genetic and phenotypic variability, TS diagnosis is challenging and is often delayed until adolescence, resulting in poor clinical management. Numerous oral, dental and craniofacial anomalies have been associated with TS, yet a comprehensive description is still lacking. This study addresses this gap through a detailed analysis of oral health and craniofacial characteristics in a cohort of 15 females with TS and their first-degree relatives. Subjects with TS ranged from 3 to 48 years old, none showed evidence of periodontal disease and only the youngest was in mixed dentition. Using the Multifunction System, we identified an aggregation of multiple signs and symptoms in each TS subject, including tooth anomalies (supernumerary molars, agenesis, microdontia, enamel defects, alterations in eruption patterns -advanced and delayed for chronological age-, crowding, rotations and transpositions), malocclusion (class II/1 and II/2) and Class II facial profile, while relatives exhibited fewer manifestations. The early detection of these signs and symptoms is crucial for appropriate referral and the optimal clinical management of TS, especially during the critical period of 9 to 10 years when congenital dental anomalies appear. The use of an established taxonomy to describe these phenotypic features is essential for early detection. Multidisciplinary teams are required to ensure holistic care management in rare diseases like TS.

Prenatal exposure to environmental toxins and comprehensive dental findings in a population cohort of children

Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.

Natal factors affecting developmental defects of enamel in preterm infants: a prospective cohort study

This study investigated natal factors influencing developmental defects of enamel (DDE) in premature infants using a newly refined preterm developmental defects of enamel (PDDE) index. Dental examinations were conducted on a cohort of 118 preterm infants (average age 3.5 ± 1.4 years) to record PDDE scores, while reviewing their medical records to examine natal factors. According to the logistic regression analysis, factors related to DDE prevalence were advanced maternal age, gestational age < 28 weeks, birth weight < 1000 g, 1 min APGAR score < 7, and hospitalization period > 2 months, which were significantly higher by 2.91, 5.53, 7.63, 10.02, and 4.0 times, respectively. According to regression analysis with generalized linear models, the PDDE scores were approximately 7.65, 4.96, and 15.0 points higher in premature children diagnosed with bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis, respectively. When endotracheal intubation was performed, the PDDE score was 5.06 points higher. The prevalence of PDDE was primarily observed bilaterally in the maxillary anterior teeth. Extremely preterm infants showed significantly delayed tooth eruption, suggesting that the influence of gestational age on dental development rates. Identifying the factors related to DDE in premature children can inform early dental interventions to support the oral health of high-risk children.

Developmental Defects of Enamel: A Bibliometric Analysis of the Top 100 Most-Cited Papers

BACKGROUND

Developmental defects of enamel (DDE) are a result of disturbances during formation and maturation of the enamel. Evaluating the most-cited DDE papers can provide important tools that point to the gaps and strengths of this important topic in dentistry.

SUMMARY

This bibliometric study analyzed the 100 most-cited papers on DDE. Using a combined keyword search strategy, the 100 most-cited papers were selected in the Web of Science Core Collection. Papers that addressed any type of DDE were included. The extracted data were title, number of citations, study theme, authorship, journal, type of DDE, type of dentition (primary or permanent), type of diagnosis, study design, year, and country of publication. The bibliometric networks were generated through VOSviewer software. The 100 papers had a range from 78 to 459 citations. The main themes of studies were etiopathogenesis (53%), prevalence and incidence (22%), and diagnosis (8%). The authors with the highest number of citations were Goodman AH and Rose JC (459 citations). Most articles were published in dental journals (47%). The most studied types of DDE were fluorosis and amelogenesis imperfecta in the permanent dentition (47%). Observational (24%) and non-systematic reviews (24%) were the most common study designs and ranged from 1977 to 2019. The country with the highest number of publications was the USA (41%).

KEY MESSAGES

Most of the top 100 DDE papers were about fluorosis and amelogenesis imperfecta, with top papers from three continents with English as the native language. This topic is of great importance in dentistry, and the need for further studies is highlighted, especially regarding the diagnosis and treatment of some DDEs.

Gestational Serum Retinol Deficiency Is Associated with Enamel Hypoplasia

Enamel hypoplasia (EH) is a prevalent developmental defect of teeth that can result from various insults, including prenatal nutrient deficiencies. This study aimed to evaluate the association between prenatal serum retinol deficiency and EH in the deciduous teeth of offspring at 2-y of age. A cohort of 1,450 pregnant women was enrolled, and their prenatal nutritional status was assessed between 12 and 14 wk of gestation. Maternal serum retinol, serum 25-hydroxyvitamin D (25OHD), hemoglobin, body mass index, and birth outcomes, infant feeding practices, family socioeconomic status, and demographic information were recorded. Oral health examinations were conducted for the children semiannually, and EH was diagnosed using the Modified DDE index on all the surfaces of erupted teeth. A modified Poisson regression analysis was used to assess the cumulative risk of EH over a period of 2-y. A total of 920 (63.4%) mother-child pairs completed the study, and the cumulative EH prevalence among offspring after 2-y of follow-up was 16.5% (N = 152; 87/1,114 children in the first year and 132/920 in the second year, with 20/920 having EH only in the first year). After adjusting for potential confounders, maternal serum retinol deficiency significantly increased the risk of deciduous EH (risk ratio [RR], 2.0; 95% confidence interval [CI], 1.1-3.7). In addition, deficient serum 25OHD (RR, 6.5; 95% CI, 4.0-10.7), caesarean delivery (RR, 1.6; 95% CI, 1.0-2.4), Muslim (RR, 2.9; 95% CI, 2.0-4.1) and Christian (RR, 2.4; 95% CI, 1.6-3.5) versus Hindu religions, and very preterm birth (RR, 1.7; 95% CI, 1.1-2.9) increased the risk of EH. Children presenting with EH had 2 or more teeth affected, and the maxillary incisors were the most frequently affected, followed by the first primary molars and canines. In conclusion, maternal serum retinol deficiency during the 12 to 14 wk of gestation may increase the risk of deciduous EH, besides the well-established 25OHD deficiency.

Maternal methylmercury exposure during early-life periods adversely affects mature enamel structure of offspring rats at human exposure levels: a concern for oral health

Although there are many studies on the health effects of methylmercury (MeHg) toxicity during in utero and early development, little is known about its effects on mineralized tissues present in the oral cavity, such as enamel structure. Therefore, this study evaluated the effects of MeHg exposure on the physico-chemical, ultrastructural and functional properties of mature tooth enamel. Specifically, we studied offspring of mothers exposed to MeHg during the prenatal and postnatal periods which are the developmental stages associated with tooth enamel formation. Female rats were exposed to MeHg at a dose of 40 μg/kg/day for 42 days of pregnancy and lactation. The enamel of offspring was analyzed by (1) Fourier Transform Infrared Spectroscopy and Raman to assess physicochemical composition, (2) Scanning Electron Microscopy for ultrastructural evaluation, (3) Transmitted Polarizing Light Microscopy for analysis of the enamel extracellular matrix, and (4) resistance and hardness were evaluated by microhardness. The results showed that MeHg exposure during this sensitive enamel formation period induced changes in inorganic and organic content and enamel prisms ultrastructure alterations and disturbed the organic extracellular matrix due to a decreased enamel strength. These novel findings establish for the first time that maternal exposure to MeHg pre and postnatal promoted relevant changes in mature enamel of their offspring rats.

Pre-treatment oral microbiome analysis and salivary Stephan curve kinetics in white spot lesion development in orthodontic patients wearing fixed appliances. A pilot study

BACKGROUND

White spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome.

METHODS

In this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of "good" that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics.

RESULTS

50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis.

CONCLUSIONS

While there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development.

Lückenschluss nach Extraktion von Sechsjahrmolaren mit Molaren-Inzisiven-Hypomineralisation unterstützt durch das myofunktionell-kieferorthopädische Therapiekonzept „mykie“ – Ein Fallbericht

Die Molaren-Inzisiven-Hypomineralisation (MIH) stellt den behandelnden Zahnarzt und Kieferorthopäden vor schwierige Therapieentscheidungen. Einerseits stellt der Zahnerhalt die höchste Priorität dar, ist aber bei einer großflächigen Zerstörung des Zahnes, oft begleitet mit ausgeprägten Hypersensitivitäten, nicht immer zu gewährleisten. Der vorliegende Patientenfall skizziert einen Therapieansatz, bei dem die vier Sechsjahrmolaren aufgrund von MIH sehr frühzeitig im Alter von 8,9 Jahren extrahiert wurden. Der hier durchgeführte Lückenschluss wurde mit dem kombiniert myofunktionell-kieferorthopädischen Behandlungskonzept mykie (= myofunktionelle Kieferorthopädie) unterstützt.

Space Closure After Extraction of Permanent First Molars with molar incisor hypomineralization Supported by the Myofunctional-Orthodontic Therapy Concept mykie – A Case Report

Dental and Dental Hygiene Students' Knowledge and Capacity to Discriminate the Developmental Defects of Enamel: A Self-Submitted Questionnaire Survey

Background: A prompt and accurate diagnosis of developmental defects of enamel (DDE) is mandatory for proper treatment management. This cross-sectional survey, designed and carried out using anonymous self-administered questionnaires, aimed to assess dental and dental hygiene students’ knowledge and their capability to identify different enamel development defects. Methods: The questionnaire consisted of twenty-eight closed-ended questions. Two different samples of undergraduate students were selected and enrolled: a group of dental hygiene (GDH) students and a group of dental (GD) students. A multivariate logistic regression was performed by adopting the correct answers as explanatory variables to assess the difference between the two groups. Results: Overall, 301 completed questionnaires were analyzed: 157 from the GDH and 144 from the GD. The dental student group showed better knowledge than the GDH of enamel hypomineralization and hypoplasia (p = 0.03 for both). A quarter (25.25%) of the total sample correctly identified the period of development of dental fluorosis with a statistically significant difference between the groups (p < 0.01). Amelogenesis imperfecta (AI) was identified as a genetic disease by 64.45% of the sample, with a better performance from the GD (p = 0.01), while no statistical differences were found between the groups regarding molar incisor hypomineralization. Multivariate analysis showed that AI (OR = 0.40, [0.23;0.69], p < 0.01) and caries lesion (OR = 0.58, [0.34;0.94], p = 0.03) were better recognized by the GD. Conclusions: Disparities exist in the knowledge and management of DDE among dental and dental hygiene students in Italy; however, significant knowledge gaps were found in both groups. Education on the diagnosis and treatment of DDE during the training for dental and dental hygiene students needs to be strongly implemented.

Enamel biomineralization under the effects of indomethacin and celecoxib non-steroidal anti-inflammatory drugs

The aim of this study was to explore the effects of nonsteroidal anti-inflammatory drugs on biomineralization of enamel. Sixty C57Bl6 male mice were used, which were assigned into three groups: celecoxib (n = 20) or indomethacin (n = 20) treatment for a period of 28 days or received no medication (control group, n = 20). Visual inspection and microcomputed tomography were used to analyze enamel morphology. Scanning electron microscopy–Energy dispersive X-ray and Knoop microhardness test were used to quantify chemical element content (Ca, P, C, O) and enamel microhardness, respectively. Tissues were collected to investigate the synthesis, activity or nuclear translocation of metalloproteinase-20, transcription factor Runx2, dentin sialoprotein and cyclooxygenase-2 enzyme by means of immunohistochemistry, in situ zymography and indirect immunofluorescence. Treatment with indomethacin and celecoxib reduced the Ca and P content, microhardness and mineral density in enamel. Treatment with nonsteroidal anti-inflammatory drugs caused an accumulation of metalloproteinase-20 and overall increased enzymatic activity in enamel matrix, while the synthesis of the transcription factor Runx2 was inhibited by these drugs. Interestingly, indomethacin inhibited Runx2 translocation to the nucleus whereas celecoxib did not. Those findings show that non-steroidal anti-inflammatory drugs impact the enamel biomineralization and could be involved in the etiology tooth enamel defects if used during the period of tooth formation and mineralization.

Etiology Study of Acquired Developmental Defects of Enamel and Their Association with Dental Caries in Children between 3 and 19 Years Old from Dolj County, Romania

Background: Developmental defects of enamel (DDE) are frequently encountered in primary and permanent teeth, yet their etiology is not completely known. Enamel hypoplasia is considered a predisposing factor for early caries. The objective of this study was the evaluation of several risk factors potentially causing DDE and the possible association between DDE and dental caries. Methods: This study was performed on a group of 213 rural children from Romania. It combined a thorough dental examination for all children, and a questionnaire filled in by their mothers, regarding the evolution of their pregnancy and the child’s health status in the first years of life. Results: There was no statistically significant association between DDE presence and data regarding the evolution of pregnancy, mothers’ health status or children’s conditions during early childhood. There was a significant association between the use of amoxicillin, ibuprofen, and cephalosporin during the period of formation of permanent teeth, and one environmental factor (water source), and the presence of DDE (Chi Square, p < 0.05). Also, DDEs were associated with the presence of caries (Fisher, p = 0.001). Conclusions: Children who consumed water from private wells and children who received medication during early childhood developed more enamel defects, presenting a higher risk of caries development.

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS

This systematic review aimed to investigate the risk predictors of caries in primary teeth and evaluate their association with the increment of Early Childhood Caries (ECC) among preschool children. This systematic review included only cohort or case-control studies of at least 2 years duration, over 300 participants and with English full-text. Potentially eligible studies were retrieved from 4 electronic databases (Ovid Embase, Ovid MEDLINE; PubMed, Web of Science) from inception to March 1, 2021. Independent screening and data extraction by 2 reviewers to identify factors associated with ECC increment, including family and socioeconomic factors, dietary and oral health-related habits, and clinical parameters. A total of 18 studies from 163 potential reports were included, involving 1,159,226 preschool children. Lower parental education attainment was found associated with ECC increment (WMD:0.87; 95% CI 0.52, 1.21); whereas immigration status (WMD:-0.38; 95% CI -1.09, 0.34), gender (WMD:-0.02; 95% CI -0.28, 0.24), and dental service utilization (WMD:0.35; 95% CI -0.10, 0.79) were not significant factors for ECC increment. All included studies consistently suggested positive correlations between ECC increment and baseline caries experience, plaque level, cariogenic microorganisms, and prenatal and passive smoking, while mixed findings were detected between ECC increment with dietary and oral hygiene practices. Preschool children whose parents have low education level are more likely to have greater increment of ECC over 2 years. Existing caries lesions, increased dental plaque level, cariogenic microorganisms, prenatal or passive smoking were also consistently identified as risk factors for ECC in all reviewed studies. This systematic review highlights specific risk factors to target for the prevention of ECC and supports implementing more oral health promotion for preschool children with parents of lower educational attainment.

Tooth Wear and Tribological Investigations in Dentistry

Dental or tooth wear is a physiological process in the life cycle of teeth. Loss of the occlusal surface may cause excessive tooth wear. Several factors may contribute to tooth wear with different intensities and duration in the oral cavity. The oral cavity is generally compared to a tribological system to determine the various types of wear between teeth and restorative materials and assess the amount of dental wear. However, it is challenging to investigate in vitro and in vivo wear owing to the complexity of tooth wear; thus, a clear correlation between in vitro and in vivo data could not be established. This review is aimed at providing an insight into the etiology of tooth wear and tribological investigations in dentistry.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine’s recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Impact of hypomineralised second primary molar on preschoolers' oral health-related quality of life-A hierarchical approach

BACKGROUND

Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries.

AIM

To evaluate the impact of HSPM on oral health-related quality of life (OHRQoL) in preschoolers through hierarchical analysis.

DESIGN

This population-based cross-sectional study assessed 834 5-year-old preschoolers, in Teresina, Piauí, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P < .05).

RESULTS

Severe HSPM was associated with OHRQoL in bivariate analysis (P < .05). In adjusted final multivariate analysis (model 1), the presence of dental caries with or without clinical consequences was associated with worse OHRQoL (P < .05). In model 2, after the removal of dental caries, preschoolers with severe HSPM had greater probability of having a negative impact on OHRQoL in the child impact section (RR = 2.14; 95% CI = 1.26-3.65), family impact section (RR = 1.99; 95% CI = 1.16-3.42), and total score (RR = 2.09; 95% CI = 1.25-3.49) of the ECOHIS.

CONCLUSION

Severe HSPM had a negative impact on the OHRQoL of preschoolers and their families, but the presence of dental caries neutralised this impact.

Novel KLK4 Mutations Cause Hypomaturation Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) is a group of rare genetic diseases affecting the tooth enamel. AI is characterized by an inadequate quantity and/or quality of tooth enamel and can be divided into three major categories: hypoplastic, hypocalcified and hypomaturation types. Even though there are some overlapping phenotypes, hypomaturation AI enamel typically has a yellow to brown discoloration with a dull appearance but a normal thickness indicating a less mineralized enamel matrix. In this study, we recruited four Turkish families with hypomaturation AI and performed mutational analysis using whole exome sequencing. These analyses revealed two novel homozygous mutations in the KLK4 gene: a nonsense mutation in exon 3 (NM_004917.4:c.170C>A, p.(Ser57*)) was found in families 1, 2 and 3 and a missense mutation in exon 6 (c.637T>C, p.(Cys213Arg)) in family 4. Functional analysis showed that the missense mutation transcript could not translate the mutant protein efficiently or generated an unstable protein that lacked functional activity. The two novel inactivating KLK4 mutations we identified caused a hypomaturation AI phenotype similar to those caused by the four previously described KLK4 nonsense and frameshift mutations. This study improves our understanding of the normal and pathologic mechanisms of enamel formation.

Nutritional reconstruction in an early modern population: Searching for a relationship between dental microwear and bone element composition

BACKGROUND

Observing the microwear patterns of the dental crowns enamel surface can provide information on the ingredients and structure of the food consumed, but also on eating habits and lifestyle. Major role in reconstructing the diet and lifestyle of past populations is played by the analysis of alkaline earth metals, such as strontium, barium, zinc and calcium. Ba and Sr are indicators of the consumption of vegetables, plants (cereals and legumes) and marine organisms. This study aims to assess dietary diversity and identify its components based on microscopic techniques and chemical analyses of material from early modern archaeological sites in Wrocław, Poland.

METHODS

The material consisted of 36 permanent molars and the intrasternal parts of 122 first ribs, collected from 6 Wroclaw early modern cemeteries. Tooth microwear was evaluated on Scanning electron microscopy images, with Microwear 4.02 software. Bone chemical composition (Ca, P, Ba, Sr content) was evaluated with mass spectrometry.

RESULTS

Most lines were present on the teeth from St. Mary Magdalene Cemetery, with the lowest average number of lines observed on the teeth from St. Barbara Cemetery. The Ca/P ratios calculated for different sites formed two clusters that allows to distinguish two groups of archaeological sites with different bone preservation status. Number of differences in Ba/Sr, Sr/Ca, Ba/Ca ratios was found between disctinct archaeological sites. A number of correlations were found between the concentration of the chemical elements, but no statistically significant correlation was found between the microwear characteristics and the proportion of the elements studied. Some strong correlations were found between microwear features and the Ca/P ratio.

CONCLUSIONS

the different values of Sr/Ca, Ba/Ca and Ba/Sr ratios indicate different diets in the different communities. The data obtained indicate a mixed diet, with a relatively high proportion of animal products throughout Wrocław. Conclusions should be treated with caution due to secondary diagenesis. The lack of interdependence between microwear and chemical composition characteristics suggests that the two methods should be considered complementary and not overlapping, as they provide different insights into the diets of past populations. The comparison of microwear between different sites should always take into account secondary diagenesis and the burial environment, as these influence the characteristics of microwear.

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.

Relationship between preterm, low birth weight, and development defects of enamel in the primary dentition: A meta-analysis

BACKGROUND

This study aimed to systematically analyze the relationship between preterm (PT), low birth weight (LBW), and developmental defects of enamel (DDE) in the primary dentition.

METHODS

Following the retrieval of the databases, case-control studies, cross-sectional studies, and cohort studies on the relationship between PT, LBW and DDE, which had been published in English or Chinese up to January 2022 were included. The data about odds ratio (OR) and 95% confidence interval (95% CI) were extracted and calculated using STATA 12.0 Software. Case-control studies were evaluated using the Newcastle-Ottawa Scale (NOS), while cross-sectional studies and cohort studies were evaluated using the JBI scale. The heterogeneity of each study was evaluated using the Q test.

RESULTS

A total of 15 studies were included, of which 8 studied the relationship between PT and DDE, and 13 explored the relationship between LBW and DDE including three about the relationship between very low birth weight (VLBW) and DDE. Seven studies explored the relationship between PT, LBW, and DDE. The results of this meta-analysis showed that both PT and LBW especially VLBW (OR= 7.19, 95% CI: 4.98-10.38) were risk factors for DDE in the primary dentition (OR= 2.33, 95% CI: 1.55-3.51) (OR= 1.67, 95% CI: 1.08-2.59). The subgroup results showed that PT and LBW were both associated with the occurrence of enamel hypoplasia (EHP) (OR= 6.89, 95% CI: 3.33-14.34; OR= 2.78, 95% CI: 2.10-3.68) rather than enamel opacity (OR= 0.94, 95% CI: 0.55-1.61; OR= 1.03, 95% CI: 0.66-1.61). There was no publication bias about the included studies (P = 0.75 > 0.05; P = 0.47 > 0.05).

CONCLUSION

This meta-analysis demonstrated that both PT and LBW especially VLBW are associated with a higher risk of DDE in the primary dentition. PT and LBW are both related to the occurrence of EHP. However, the relationship between PT, LBW, and enamel opacity has not been verified.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier: CRD42021262761.

Oral manifestations of congenital Zika virus infection in children with microcephaly: 18-month follow-up case series

AIMS

To describe oral manifestations in children born with microcephaly attributed to congenital Zika virus syndrome (CZS).

METHODS

Data was collected in semiannual intervals from 2017 to 2019, by oral exams of the children and interview with caregivers at a Public Dental Center in Rio de Janeiro, Brazil. A single calibrated examiner performed clinical examinations.

RESULTS

Of 38 eligible children, 34 were followed-up from 12 to 30 months of age, 20 boys and 14 girls. The mean age of emergence of their first primary tooth was 12.4 months (SD = 2.9). By 30 months of age only 14.7% (n = 5) had complete primary dentition. Alteration in the sequence of tooth emergence was observed in 41.1% (n = 14). Radiographic examination demonstrated dental agenesis (14.7% n = 5). Dental developmental alterations (38.2%, n = 13), enamel defects (14.7%, n = 5), eruption cysts/hematoma (23.5%, n = 8), gingival bleeding (55.8%, n = 19), narrow palate, and bruxism (64.7%, n = 22) were also observed. No child had dental caries.

CONCLUSION

Children with microcephaly attributed to CZS presented oral manifestations early in life.

Knowledge of dental enamel defects amongst undergraduate dental students-a cross-sectional survey

INTRODUCTION/OBJECTIVES

Enamel defects are disturbances in the quantity or quality of enamel, due to disruption or damage to the enamel organ during amelogenesis. The correct diagnosis of enamel defects is critical as diverse management options could be required for different conditions. Difficulties in diagnosis can happen, because these defects may have similar clinical presentations. This study evaluated the diagnostic skills in enamel defects of dental students of a prominent Australasian school.

METHODS

A questionnaire consisting of clinical photographs of the affected teeth/dentition in multiple views and four standardised questions for each case of enamel defect were given to Year 4 and Year 5 students.

RESULTS

Localised/Chronological Hypoplasia had the lowest percentage of correct diagnosis (20.5%), whilst Enamel White Spot Lesions (EWSLs) had the highest (85%). Localised/Chronological Hypoplasia had the lowest aetiology score (20.5%), and the highest was obtained for EWSLs (85%). In regard to which question to ask to gain insight into the conditions, Enamel Hypomineralisation/MIH had the lowest score for both Year 4 and Year 5 respondents (35.4% and 21.3%). Most respondents agreed more teaching in this topic was needed, with further clinical sessions to observe the enamel defects, workshops/seminars, lectures and student-driven presentations suggested.

CONCLUSION

Final-year dental students showed variable knowledge in diagnosis, aetiology and clinical management of enamel defects. Further didactic and clinical teaching should be incorporated in the undergraduate curriculum on this topic .

Oral health in children with chronic kidney disease

The review summarizes the current understanding of dental health in children with chronic kidney disease (CKD). Oral conditions associated with CKD and its medical and surgical management have been described in cohort studies. Children with CKD may present with severe developmental defects of enamel (DDE) including discoloration, pitting, and reduced hardness leading to extensive tooth wear with normal function. The alkaline oral pH resulting from the uremia of CKD inhibits cariogenic bacteria, reduces dental caries risk, and increases accumulation of dental calculus. The malnutrition, acidosis, growth hormone resistance, anemia, and renal osteodystrophy in CKD provide multiple mechanisms for abnormal craniofacial growth and delayed tooth eruption. Following successful kidney transplant, caries risk increases due to normalization of oral pH in the presence of DDE; optimized diet and oral hygiene become critical in caries control. Post-transplant medications including cyclosporine A and calcium channel blockers may cause gingival overgrowth which in severe cases requires gingival surgery to allow tooth eruption, improve appearance, or permit orthodontic treatment. Immune suppression with sirolimus or everolimus may cause severe debilitating oral ulcerations. Long-term immune suppression increases the risk for development of oral candidiasis and oral cancers. Dental examinations and treatment are recommended for children with all stages of CKD to mitigate adverse oral outcomes of the disease and its management.

PER2-mediated ameloblast differentiation via PPARγ/AKT1/β-catenin axis

Circadian rhythm is involved in the development and diseases of many tissues. However, as an essential environmental regulating factor, its effect on amelogenesis has not been fully elucidated. The present study aims to investigate the correlation between circadian rhythm and ameloblast differentiation and to explore the mechanism by which circadian genes regulate ameloblast differentiation. Circadian disruption models were constructed in mice for in vivo experiments. An ameloblast-lineage cell (ALC) line was used for in vitro studies. As essential molecules of the circadian system, Bmal1 and Per2 exhibited circadian expression in ALCs. Circadian disruption mice showed reduced amelogenin (AMELX) expression and enamel matrix secretion and downregulated expression of BMAL1, PER2, PPARγ, phosphorylated AKT1 and β-catenin, cytokeratin-14 and F-actin in ameloblasts. According to previous findings and our study, BMAL1 positively regulated PER2. Therefore, the present study focused on PER2-mediated ameloblast differentiation and enamel formation. Per2 knockdown decreased the expression of AMELX, PPARγ, phosphorylated AKT1 and β-catenin, promoted nuclear β-catenin accumulation, inhibited mineralization and altered the subcellular localization of E-cadherin in ALCs. Overexpression of PPARγ partially reversed the above results in Per2-knockdown ALCs. Furthermore, in in vivo experiments, the length of incisor eruption was significantly decreased in the circadian disturbance group compared to that in the control group, which was rescued by using a PPARγ agonist in circadian disturbance mice. In conclusion, through regulation of the PPARγ/AKT1/β-catenin signalling axis, PER2 played roles in amelogenin expression, cell junctions and arrangement, enamel matrix secretion and mineralization during ameloblast differentiation, which exert effects on enamel formation.

Influence of tenofovir exposure in utero on primary dentition

Tenofovir disoxoproxil fumarate (TDF) is recommended for antiretroviral treatment for pregnant women living with HIV. As a comparative method to study bone density, we investigated the influence of in utero tenofovir exposure on the prevalence and distribution of developmental defects of enamel (DDE) in the primary dentition, as the mineralization process in teeth is higher and more complex and thus more vulnerable. HIV-exposed children with in utero exposition to tenofovir were included in this prospective observational single-center study. Dental status and enamel defects were assessed by an experienced dentist following a standardized protocol. Further information was collected using a standardized questionnaire, available in German and English. The prevalence of developmental defects in children with intrauterine tenofovir exposure was compared with literature data from a recent study of 377 healthy children in Germany and literature data from a study of 1221 healthy African children. Thirty-one children (mean age 2.1 ± 0.3 years; 41.9% female) were included. Median tenofovir exposure in utero was 28 weeks (mean ± 10.52 SD). Prevalence of developmental defects in the primary dentition in tenofovir-exposed children was similar compared to data of unexposed children (16.1% vs. 5.3%, p = 0.051 (compared to German cohort); 16.1% vs. 33.3%, p = 0.068 (compared to African cohort)).Conclusion: HIV-uninfected infants with in utero exposure to TDF showed no significant differences in the prevalence of DDE in comparison to cross-sectional data of HIV- and TDF-unexposed children; thus, the in utero exposure to TDF did not negatively influence the prevalence or distribution of DDE. What is Known: • There are no data available on the prevalence of developmental defects of enamel (DDE) in the primary dentition in intrauterine HIV- and tenofovir-exposed children. • Conclusions can be drawn from intrauterine milk tooth development to bone development and mineralization. What is New: • Prevalence of developmental defects in the primary dentition in tenofovir-exposed children was similar compared to data of unexposed children. • Preterm birth and hospitalization did not show a significant association on the prevalence of developmental defects in the primary dentition.

Prenatal smoking and the risk of early childhood caries: A prospective cohort study

Introduction

Dental caries is a chronic complex disease of multifactorial etiology that affects a quarter of U.S. children. This study evaluated the association between prenatal smoking and offspring caries experience and used a negative control exposure analysis to assess if the association is causal.

Methods

Data from 1429 mother-offspring participants of the 1991/92 Avon Longitudinal Study of Parents and Children conducted in Bristol, England were analyzed. Prenatal smoking (yes v. no) and quantity smoked (none, <half pack, ≥half pack) were self-reported while offspring caries experience was determined by clinical oral examinations at 3 time points. Discrete time hazards regression estimated hazard odds of first occurrence of offspring caries, and substituted partner smoking for prenatal smoking in a negative control exposure analysis.

Results

Overall, 22% smoked during pregnancy while 36% of partners smoked. The adjusted hazard odds of first occurrence of caries experience in the offsprings of prenatal smokers compared to the offsprings of non-smokers was 1.42 (95% CI: 1.08, 1.86). Relative to non-smoking, smoking <half pack/day and ≥half pack/day during pregnancy were associated with higher adjusted hazard odds of offspring caries experience: 1.10 (95% CI: 0.79, 1.54) and 1.38 (0.98, 1.95) respectively. Partner smoking was associated with 33% (95% CI: 1.07, 1.65) higher adjusted hazard odds of first offspring caries experience occurrence.

Conclusions

Prenatal and partner smoking appear associated with greater offspring caries experience. The positive association with partner smoking suggests either a shared genetic predisposition or unmeasured common environmental factors with the mother as opposed to a direct biological effect of the intrauterine environment.

General and oral health status of preterm one-year-old very low and extremely low birthweight infants (a cross - sectional study)

AIMS

The aim of the present study was to evaluate the general and oral health status of a group of preterm one-year-old very low (VLBW) and extremely low birthweight (ELBW) infants and make a comparison with full-term one-year-old normal birthweight infants (NBW).

METHODS

A cross-sectional study was conducted in 102 one-year-old preterm VLBW and ELBW infants, and the data obtained were compared to 87 one-year-old full-term NBW infants. The infants' medical histories were obtained from hospital records and interviews with the mothers. The oral cavities of all infants were examined under the same conditions. The chi-square test, Pearson's chi-square test of independence and Mann-Whitney test were used for the statistical evaluation, with P < 0.05 considered statistically significant. Relative risk (RR) and 95% confidence interval (CI) estimates for variables significantly associated with oral findings were calculated.

RESULTS

Both perinatal variables (gestational age, mode of delivery, birthweight, Apgar score, resuscitation, orotracheal intubation and presence of intraoral pathology) and neonatal variables (antibiotic treatment and infections) had a significant association with prematurity, VLBW and ELBW. The one-year-old preterm VLBW and ELBW infants frequently suffered from general diseases, frequently received regular medication and had fewer erupted primary teeth; they also had a higher prevalence of developmental defects of the enamel and deformations of the hard palate.

CONCLUSION

This study confirmed anamnestic, medical and oral differences between one-year-old preterm VLBW and ELBW and full-term NBW infants.

Teeth as Potential New Tools to Measure Early-Life Adversity and Subsequent Mental Health Risk: An Interdisciplinary Review and Conceptual Model

Early-life adversity affects nearly half of all youths in the United States and is a known risk factor for psychiatric disorders across the life course. One strategy to prevent mental illness may be to target interventions toward children who are exposed to adversity, particularly during sensitive periods when these adversities may have even more enduring effects. However, a major obstacle impeding progress in this area is the lack of tools to reliably and validly measure the existence and timing of early-life adversity. In this review, we summarize empirical work across dentistry, anthropology, and archaeology on human tooth development and discuss how teeth preserve a time-resolved record of our life experiences. Specifically, we articulate how teeth have been examined in these fields as biological fossils in which the history of an individual's early-life experiences is permanently imprinted; this area of research is related to, but distinct from, studies of oral health. We then integrate these insights with knowledge about the role of psychosocial adversity in shaping psychopathology risk to present a working conceptual model, which proposes that teeth may be an understudied yet suggestive new tool to identify individuals at risk for mental health problems following early-life psychosocial stress exposure. We end by presenting a research agenda and discussion of future directions for rigorously testing this possibility and with a call to action for interdisciplinary research to meet the urgent need for new biomarkers of adversity and psychiatric outcomes.

Infantile hemangioma of the upper lip and enamel hypoplasia: Two case reports

Segmental infantile hemangiomas related to PHACE syndrome have recently been associated with enamel hypoplasia. We present two cases of solitary, localized upper lip infantile hemangioma with enamel hypoplasia of deciduous teeth.

Toward Preventing Enamel Hypoplasia: Modeling Maternal and Neonatal Biomarkers of Human Calcium Homeostasis

AIM

The aim of this study was to assess biomarkers of calcium homeostasis and tooth development, in mothers during pregnancy and their children at birth, for enamel hypoplasia (EH) in the primary maxillary central incisor teeth.

METHODS

Bayesian methodology was used for secondary data analyses from a randomized, controlled trial of prenatal vitamin D3 supplementation in healthy mothers (N = 350) and a follow-up study of a subset of the children. The biomarkers were serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), total circulating 25-dihydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH)2D). The maternal biomarkers were assayed monthly during pregnancy, and the child's biomarkers were derived from cord blood. Digital images of the child's 2 teeth were scored for EH using Enamel Defects Index criteria for each of the incisal, middle, and cervical regions for an EH extent score.

RESULTS

The child EH prevalence was 41% (60/145), with most defects present in the incisal and middle tooth regions. Cord blood iPTH and 1,25(OH)2D levels were significantly associated with EH extent after controlling for maternal factors. For every 1 pg/mL increase in cord blood iPTH, the EH extent decreased by approximately 6%. For every 10 pg/mL increase in cord blood 1,25(OH)2D, the EH extent increased by almost 30% (holding all other terms constant and adjusting for subject-level heterogeneity). The relationship between maternal 25(OH)D and maternal mean iPTH varied significantly by EH extent.

CONCLUSION

The results suggest possible modifiable relationships of maternal and neonatal factors of calcium homeostasis during pregnancy and at birth for EH, contributing to the frontier of knowledge regarding sound tooth development for dental caries prevention.

Oral alterations in patients with cystinosis

Cystinosis is a rare autosomal recessive lysosomal storage disorder, which leads to abnormal accumulation of cysteine in various organs, including progressive dysfunction of kidneys. The most severe and frequent form, affecting ∼95% of patients, is termed infantile nephropathic cystinosis (NC) (OMIM 219800). We have reported oral findings in two patients with NC and described esthetic and functional rehabilitation in one of them. The first case describes a 16-year-old male patient, who was diagnosed with NC when he was 1-year-old. The patient exhibited generalized enamel hypoplasia, grade 1 drug-induced gingival overgrowth, caries lesion in molar tooth and supernumerary tooth (ie, distomolar). The second case describes a 14-year-old male patient diagnosed with NC at 3 years old. Clinical examination revealed generalized enamel hypoplasia and grade 1 drug-induced gingival overgrowth. Radiographic examination showed supernumerary tooth (mesiodens). The treatment included gingivoplasty and restoration with direct composite resin. The severity of hypoplasia highlights the importance of a dental rehabilitation treatment, as proposed here. Direct restoration with composite resin allowed harmony, function, and esthetics to be restored, in addition to being a rapid and low-cost technique.

Factors associated with the development of dental defects acquired in the extrauterine environment

This study aimed to analyze the association of sociodemographic, child health, healthcare service, and access indicators with developmental defects of enamel (DDE) acquired outside the uterus, based on gestational factors. A cohort of births was carried out, and 982 children aged 12 to 30 months were examined. A total of 1,500 women were followed up as of the 5th month of gestation, and the child's gestational age was evaluated at follow-up. The clinical examination was performed as recommended by the World Health Organization, and defects were classified using the modified DDE index. Six models were considered: presence of DDE (Model 1) or opacities (Model 4), number of teeth with DDE (Model 2) or opacities (Model 5), and incidence rate of DDE (Model 3) or opacities (Model 6). Associations were estimated by relative risk (RR) in Poisson regression models. In the adjusted analysis, the mother's lowest education level was associated with the highest occurrence of DDE in Models 1 (RR = 26.43; p = 0.002), 2 (RR = 9.70; p = 0.009), and 3 (RR = 5.63; p = 0.047). Breastfeeding for over 12 months (RR = 0.45; p = 0.030) and recent use of anti-infection drugs (RR = 0.20; p = 0.039) had a protective effect on DDE (Model 1). The factors associated with the highest incidence of opacities were not having health insurance (RR = 2.00; p = 0.043) (Model 5), and belonging to a family of poor social class (RR = 4.67; p = 0.007) (Model 6). Children in a situation of socioeconomic vulnerability have a higher risk of presenting extrauterine DDE. Breastfeeding was a protection factor for DDE development.

Impact of Developmental enamel defects on quality of life in 5-year-old children

BACKGROUND

Developmental enamel defects (DDE) represent one of the prevalent oral problems in childhood; however, few studies have evaluated its impact on quality of life in the children's own perception.

AIM

To evaluate the DDE impact on quality of life of 5-year-old children.

METHODS

This cross-sectional observational study assessed 566 children aged 5 years old, in Teresina, Piauí, Brazil, according to their self-perceptions. Children answered the Pediatric Quality of Life Inventory^™ Version 4.0 and Oral Health Scale. The dmft index, modified DDE index and Foster and Hamilton criteria were used to diagnose dental caries, DDE and malocclusion, respectively. A single examiner performed the clinical examination. Descriptive analyses and Poisson regression with robust variance were performed.

RESULTS

The prevalence of DDE was 33.7%. For children's self-reports, the presence of DDE had a negative association with oral health-related quality of life (OHRQoL; PR 1.09, 95% CI 1.02-1.15). Enamel hypoplasia had a negative impact on the physical function (PR 1.05; 95% CI 1.01-1.10) and oral health (PR 1.06, 95% CI 1.01-1.11) domains. Diffuse opacity had a negative impact on the social aspect (PR 1.09, 95% CI 1.02-1.18).

CONCLUSIONS

Enamel defects had a negative impact on OHRQoL according to the self-reports of the children.

Dental caries and vitamin D status in children in Asia

Dental caries and vitamin D inadequacy are known to affect children worldwide. Vitamin D has a vital role in tooth formation. There is growing evidence linking suboptimal serum vitamin D level with dental caries in children. This paper reviews the literature on both the prevalence of dental caries and of vitamin D deficiency in children in four Asian regions, discusses their associated risk factors, and reviews the global evidence on the association between dental caries and vitamin D in children. Caries prevalence in children ranged from 40% to 97% in Eastern Asia, 38-73.7% in Southern Asia, and 26.5-74.7% in Western Asian countries. Moreover, a higher prevalence of vitamin D deficiency in Asian children was identified, even in countries in equatorial regions, ranging from 2.8% to 65.3% in Eastern Asia, 5-66.7% in Southern Asia, 4-45.5% in Western Asia and 38.1-78.7% in Central Asian countries. Obesity, age, female gender, higher latitude, season, darker skin pigmentation, sunlight protection behaviors, less sunlight exposure and low intake of food containing vitamin D were important factors associated with lower serum vitamin D in Asia. Suboptimal vitamin D level in children may be a significant risk factor for dental caries, and requires further research to ascertain such an association in children in Asia, as well as to understand its exact influence on caries risk and development.

Developmental defects of enamel in primary teeth: highly prevalent, unevenly distributed in the oral cavity and not associated with birth weight

AIM

Estimate the prevalence of developmental defects of enamel (DDE) in the primary dentition, describe the distribution among tooth groups and investigate the association with birth weight.

METHODS

A cross-sectional study was conducted with a sample of 827 children aged 2-5 years representative of the city of Canela in southern Brazil. Demographic characteristics (gender and age) and birth weight were collected from vaccination cards. The diagnosis of DDE was performed by six trained examiners following the criteria of the Federation Dentaire International. DDE were described both jointly and separately as opacity and hypoplasia. Statistical analysis involved the Chi square test, Mann-Whitney test and Poisson regression with robust variance.

RESULTS

The prevalence of DDE was 55.1% (95% CI 51.6-58.5%), with a mean of 3.0 ± 2.2 teeth affected. Opacity was the more frequent defect (50.4%), followed by hypoplasia (15.5%). Distribution of the defects was uneven, with opacity predominant on second molars and hypoplasia predominant on canines and second molars. Children with a low birth weight did not have a greater probability of opacity (PR: 1.13; 95% CI 0.91-1.41), hypoplasia (PR: 1.33; 95% CI 0.80-2.22) or DDE (PR: 1.11; 95% CI 0.91-1.37).

CONCLUSION

The prevalence of DDE was high, predominant on second molars and not associated with birth weight. These findings indicate directions for future examination/diagnosis protocols and specific orientations.

Canine models of human amelogenesis imperfecta: identification of novel recessive ENAM and ACP4 variants

Amelogenesis imperfecta (AI) refers to a genetically and clinically heterogeneous group of inherited disorders affecting the structure, composition, and quantity of tooth enamel. Both non-syndromic and syndromic forms of AI have been described and several genes affecting various aspects of the enamel physiology have been reported. Genetically modified murine models of various genes have provided insights into the complex regulation of proper amelogenesis. Non-syndromic AI occurs spontaneously also in dogs with known recessive variants in ENAM and SLC24A4 genes. Unlike rodents with a reduced dentition and continuously erupting incisors, canine models are valuable for human AI due to similarity in the dental anatomy including deciduous and permanent teeth. We have performed a series of clinical and genetic analyses to investigate AI in several breeds of dogs and describe here two novel recessive variants in the ENAM and ACP4 genes. A fully segregating missense variant (c.716C>T) in exon 8 of ENAM substitutes a well-conserved proline to leucine, p.(Pro239Leu), resulting in a clinical hypomineralization of teeth. A 1-bp insertion in ACP4 (c.1189dupG) is predicted to lead to a frameshift, p.(Ala397Glyfs), resulting in an abnormal C-terminal part of the protein, and hypoplastic AI. The ENAM variant was specific for Parson Russell Terriers with a carrier frequency of 9%. The ACP4 variant was found in two breeds, Akita and American Akita with a carrier frequency of 22%. These genetic findings establish novel canine models of human AI with a particular interest in the case of the ACP4-deficient model, since ACP4 physiology is poorly characterized in human AI. The affected dogs could also serve as preclinical models for novel treatments while the breeds would benefit from genetic tests devised here for veterinary diagnostics and breeding programs.

Oral Health Status of Kuwaiti Children with a History of Chronic Liver Disease

OBJECTIVE

To investigate the oral health status and dental manifestations of children with a history of chronic liver disease (CLD) compared to healthy children.

SUBJECTS AND METHODS

Twenty children (15 boys and 5 girls) with a history of CLD were compared to 20 healthy controls matched for age and gender. The clinical examination was carried out by the same dentist. Caries prevalence, using the decayed, missing, and filled primary and permanent teeth indices (dmft/DMFT), was recorded. Developmental enamel defects, plaque scores, and gingival overgrowth were also investigated.

RESULTS

No statistically significant differences were found in mean dmft scores for children with a history of CLD (4.9 ± 5.4) and for healthy individuals (3.9 ± 4.5). However, the mean DMFT score was significantly higher (p =0.025) in children with CLD (4.2 ± 4.6) compared to controls (1.7 ± 1.6). The mean decayed teeth parameter (DT) was also significantly higher in children with CLD (p =0.004). All patients with CLD exhibited enamel defects compared to only 33% in the control group (p< 0.05). A higher mean plaque index was observed in children with a history of CLD (p< 0.001). Also, a positive correlation for gingival overgrowth was noted in patients with a history of CLD (p< 0.05). Green staining was evident only in the permanent dentition of 1 child with CLD.

CONCLUSION

Children with a history of CLD exhibited a high caries prevalence, high plaque scores, and more enamel defects compared to healthy subjects. Gingival overgrowth is less prevalent among pediatric liver transplant patients on tacrolimus therapy.

Testing the Clinical Applicability of Resin Infiltration of Developmental Enamel Hypomineralization Lesions Using an In Vitro Model

Aim

The aim of this study is to investigate the penetration abilities of a commercially available low-viscosity resin infiltrant into developmentally hypomineralized teeth in vitro.

Materials and methods

Four extracted third molars of a 17-year-old patient with signs of developmental enamel hypomineralization (discoloration, increased opacity, and surface roughness) were infiltrated with a low-viscosity resin mixed with a fluorescent dye, according to the manufacturer's standard protocol. Four extracted molars with sound enamel or showing only initial fissure caries were used as a control group. Specimens were embedded in polymethylmethacrylate, and grindings were prepared. High-resolution projectional radiography of the grindings was performed, and, for one specimen, quantitative micro-computed tomography was used to measure hydroxyapatite density in enamel and dentin lesions. After decalcification, the grindings were examined by reflected bright-field microscopy, wide-field fluorescence microscopy, and confocal laser scanning microscopy. Fluorescence micrographs were superimposed on the radiographs and analyzed correlatively.

Results

The pattern of hypo-/demineralization in enamel and dentin in developmentally hypomineralized teeth showed a good congruence with the pattern of resin infiltration. Cavitations and dentin tubules up to a depth of 2 mm beyond cavitations were filled by the infiltrant. In control teeth, the penetration of the infiltrant was limited to decalcified enamel areas (initial fissure caries).

Conclusions

In vitro infiltration of developmentally hypomineralized enamel was successful.

Clinical significance

Resin infiltration might be considered as a routine procedure in the treatment of developmentally hypomineralized teeth. Further investigations with higher sample sizes, different degrees of severity, different stages of lesion extension, and modified treatment protocols are necessary.

How to cite this article

Schnabl D, Dudasne-Orosz V, et al. Testing the Clinical Applicability of Resin Infiltration of Developmental Enamel Hypomineralization Lesions Using an In Vitro Model. Int J Clin Pediatr Dent 2019;12(2):126-132.

Dental caries and developmental defects of enamel in individuals with chronic kidney disease: Systematic review and meta-analysis

OBJECTIVE

To evaluate studies assessing the prevalence of dental caries and developmental defects of enamel (DDE) in individuals with chronic kidney disease (CKD) in comparison with individuals without CKD.

MATERIALS AND METHODS

Electronic searches were performed in PubMed, Web of Science, Scopus, Medline via Ovid, and ProQuest databases from their inception date until February 2018. Two review authors independently selected the studies, extracted data, and assessed the methodological quality. Meta-analysis was performed.

RESULTS

Twenty-seven studies were included in this study. For permanent teeth, 14 studies found that individuals without CKD had higher dental caries scores than those with CKD. However, only five studies presented results with a statistically significant difference between groups. Among the studies evaluating primary teeth, five showed that individuals without CKD had higher dental caries scores than those with CKD. Five studies showed that individuals with CKD had a significantly higher prevalence of DDE than individuals without CKD. The meta-analyses showed that individuals without CKD had significantly higher scores of dental caries teeth and surfaces than individuals with CKD. For DDE, no statistical difference between groups was observed.

CONCLUSIONS

Individuals with CKD present lower dental caries scores and a higher prevalence of DDE in comparison with individuals without CKD.

Prevalence and etiology of molar-incisor hypomineralization (MIH) in the city of Istanbul

Background/purpose

Molar-Incisor-Hypomineralisation (MIH) is the term used to depict a condition in which one or more of the permanent molar teeth and usually no less than one incisor tooth is hypomineralised and the prevalence rates vary from 2.4 to 40.2%. The aim of this study was to assess the prevalence and the risk factors of MIH in children in Istanbul, Turkey.

Materials and methods

A total of 1511 (760 M, 751 F), 8- to 11-year-old children were examined who had their first permanent molar and incisors evaluated using the EAPD criteria for MIH. Hypomineralized molars and incisors were recorded based on developmental defects of enamel index. The potential aetiological factors were retrieved through personal interview and etiological questions were asked to the parents. Statistical analysis was performed with a chi-Square test.

Results

MIH was observed in 215 (14.2%; 102 male, 113 female) children. The sample (1511 children) comprised 71 (9.9%) 8 year-olds with MIH and 144 (18.2%) 11 year-olds with MIH. A significant difference was found between 8 (9.9%) and 11-year-old (18.2%) children with MIH (p ≤ 0.001). Complications during the mother's pregnancy, birth prematurity, average breast feeding period, diarrhea frequency, digestive system diseases, asthma, frequent high fever, ear infection, renal failure, rubeola, chickenpox and parotitis were found to be significantly associated with MIH (p < 0.001).

Conclusion

There are many events that can cause MIH which we cannot control or predict. Therefore, longitudinal studies with large sample size are needed so as to determine how various likely etiological factors described affect the etiological role.

Dental Caries and Developmental Defects of Enamel in the Primary Dentition of Preterm Infants: Case-Control Observational Study

AIM

Assessment of dental health in the primary dentition of preterm infants (PTI) including investigation of mother- and infant-related risk factors in a case-control study design.

MATERIAL AND METHODS

One hundred twenty-eight infants aged 3-4 years were included. Sixty-four PTI (27 males) were randomly selected from the preterm registry of the Jena University Hospital. As a control group served 64 full-term infants (FTI) recruited from the Department of Paediatric Dentistry, matched for age and sex. Dental examinations were provided by one dentist under standard clinical conditions. Caries was scored using the International Caries Detection and Assessment System (ICDAS II) and the DMFT, gingival health using the Periodontal Screening Index, and developmental defects of enamel using the DDE index. Mother- and infant-related factors were collected via a questionnaire and from medical records.

RESULTS

The caries prevalence was 50.0% (ICDAS II >0) in PTI and 12.5% (ICDAS II >0) in FTI. The caries experience was higher in PTI (DMFT 1.0 ± 3.1) than in FTI (DMFT 0.3 ± 1.0). PTI had a higher risk of caries (OR 7.0), initial lesions (OR 6.2), DDE (OR 7.5), and gingivitis (OR 6.5) than FTI. The highest risk occurred in PTI with an extremely low birth weight (<1,000 g). A higher risk of DDE was present when mothers suffered from illness during pregnancy (OR 3.9). A higher risk of caries was revealed in infants with respiratory syndrome (OR 6.2) or when their mothers had a lower socioeconomic status (OR 6.3).

CONCLUSIONS

PTI had less healthy teeth than FTI and are at a higher risk for DDE, caries, and gingivitis. The poorer dental health in PTI is associated with a low birth weight, a low socioeconomic status, and mothers' illness during pregnancy.

Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia

Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5–10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child’s age (Adjusted Odd’s Ratio (AOR) = 1.30, 95% CI: 1.14–1.49) and mother’s extraction history (AOR = 2.05, 95% CI: 1.40–3.00) were significantly associated with caries experience in the child’s primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19–1.93) of primary dentition caries.