Elevated serum 25(OH)-vitamin D levels are negatively correlated with molar-incisor hypomineralization

Vitamin D and vitamin K1 as novel inhibitors of biofilm in Gram-negative bacteria

BACKGROUND

The persistent surge in antimicrobial resistance represents a global disaster. The initial attachment and maturation of microbial biofilms are intimately related to antimicrobial resistance, which in turn exacerbates the challenge of eradicating bacterial infections. Consequently, there is a pressing need for novel therapies to be employed either independently or as adjuvants to diminish bacterial virulence and pathogenicity. In this context, we propose a novel approach focusing on vitamin D and vitamin K1 as potential antibiofilm agents that target Gram-negative bacteria which are hazardous to human health.

RESULTS

Out of 130 Gram-negative bacterial isolates, 117 were confirmed to be A. baumannii (21 isolates, 17.9%), K. pneumoniae (40 isolates, 34.2%) and P. aeruginosa (56 isolates, 47.9%). The majority of the isolates were obtained from blood and wound specimens (27.4% each). Most of the isolates exhibited high resistance rates to β-lactams (60.7-100%), ciprofloxacin (62.5-100%), amikacin (53.6-76.2%) and gentamicin (65-71.4%). Approximately 93.2% of the isolates were biofilm producers, with 6.8% categorized as weak, 42.7% as moderate, and 50.4% as strong biofilm producers. The minimum inhibitory concentrations (MICs) of vitamin D and vitamin K1 were 625-1250 µg mL-1 and 2500-5000 µg mL-1, respectively, against A. baumannii (A5, A20 and A21), K. pneumoniae (K25, K27 and K28), and P. aeruginosa (P8, P16, P24 and P27) clinical isolates and standard strains A. baumannii (ATCC 19606 and ATCC 17978), K. pneumoniae (ATCC 51503) and P. aeruginosa PAO1 and PAO14. Both vitamins significantly decreased bacterial attachment and significantly eradicated mature biofilms developed by the selected standard and clinical Gram-negative isolates. The anti-biofilm effects of both supplements were confirmed by a notable decrease in the relative expression of the biofilm-encoding genes cusD, bssS and pelA in A. baumannii A5, K. pneumoniae K28 and P. aeruginosa P16, respectively.

CONCLUSION

This study highlights the anti-biofilm activity of vitamins D and K1 against the tested Gram-negative strains, which emphasizes the potential of these vitamins for use as adjuvant therapies to increase the efficacy of treatment for infections caused by multidrug-resistant (MDR) strains and biofilm-forming phenotypes. However, further validation through in vivo studies is needed to confirm these promising results.

An Investigation into the Prevalence of Enamel Hypoplasia in an Urban Area Based on the Types and Affected Teeth

Enamel hypoplasia (EH) is a qualitative defect, and it can have a significant impact on oral health. The aim of this study was to evaluate the prevalence of enamel hypoplasia in urban area in Albania.

METHODOLOGY

In total, 234 children of both sexes aged 8-12 years old were randomly selected in five schools in Tirana, Albania. They underwent an intra-oral examination. Diagnostic criteria were in accordance with a European meeting on MIH held in Athens, 2003, and the FDI. Medical history was retrieved using questionnaires, and data obtained from clinical examination were recorded.

RESULTS

The prevalence of enamel hypoplasia was 12.8%. The most commonly occurring enamel hypoplasia was the mild type (58.62%). The mandibular first molar showed the highest prevalence of enamel hypoplasia (19.5%), and the maxillary canines and premolars were the least affected (2.3%). In this study, medical story did not have a significant effect on enamel hypoplasia.

CONCLUSIONS

The prevalence of enamel hypoplasia remains high at 12.8%. Interestingly, the features of enamel hypoplasia were consistent across both sexes, with no correlation found between them. The predominant occurrence of mild enamel hypoplasia underscores the importance of implementing oral hygiene strategies in schools to mitigate its progression.

Is there a rise of prevalence for Molar Incisor Hypomineralization? A meta-analysis of published data

Since Molar Incisor Hypomineralization was first described as a pathologic entity, public perception often suggests a considerable rise in prevalence of the respective disease. Since there are still considerable doubts regarding the etiology and-accordingly-prevention of MIH and respective therapeutic approaches are difficult this question is of considerable clinical and public interest. Accordingly, a systematic literature search in accordance with the PRISMA guidelines for systematic reviews on Medline, Cochrane Database, EMBASE, LILACS, Web of Science, Google scholar, Scopus was performed to retrieve original articles reporting the prevalence of MIH as defined by the European Academy of Pediatric Dentistry (EAPD). From initially 2360 retrieved titles, 344 full texts were assessed for possible inclusion and finally 167 articles of mainly moderate to high quality and based on data of 46'613 individuals were included in the meta-analysis. All studies published before 2001 had to be excluded since it was not possible to align the findings with the EAPD classification. Studies varied considerably regarding cohort size (25 to 23'320, mean 1'235)) and age (5.6-19 y, mean 9.8 y). Over all studies, the weighted mean for the prevalence for MIH was 12.8% (95% CI 11.5%-14.1%) and no significant changes with respect to either publication year or birthyear were found. A sub-analysis of eleven studies reporting on the prevalence in different age groups, however, revealed strong evidence for an increasing prevalence between the years 1992 (3%) and 2013 (13%).Therefore, based on data from cross-sectional studies a possible rise in prevalence of MIH remains unclear. Future prospective large-scale studies under standardized examination conditions with an emphasis on examiner calibration are needed to gain better understanding in the evolution of the prevalence of MIH.

The association between serum vitamin D status and dental caries or molar incisor hypomineralisation in 7-9-year-old Norwegian children: a cross-sectional study

BACKGROUND

Research focusing on the association between serum vitamin D and oral health outcomes in children, such as dental caries and molar incisor hypomineralisation (MIH), shows inconsistent results. Previous studies have predominantly investigated dental caries and MIH as dichotomized outcomes, which limits the information on their distribution. In addition, the methods used for analysing serum vitamin D have varied. The present study aimed to investigate potential associations between serum vitamin D status measured by Liquid Chromatography with Tandem Mass Spectrometry (LC-MS/MS) and the prevalence, as well as the number of teeth, affected by dental caries or MIH among 7-9-year-old Norwegian children.

METHODS

The study had a cross-sectional design and included 101 children aged 7-9 years. Serum 25-hydroxyvitamin D (25(OH)D) was measured and included as continuous (per 25 nmol/l) and categorised (insufficient (< 50 nmol/l) and sufficient (≥50 nmol/l)) exposure variables. Adjusted negative binomial hurdle models were used to investigate the potential associations between serum vitamin D and the oral health outcomes (dental caries and MIH) adjusted for sex, age, body mass index, season of blood draw, and mother's educational level.

RESULTS

Of the 101 children in the total sample, 27% had insufficient vitamin D levels (< 50 nmol/l). The descriptive analysis indicated that the children with insufficient vitamin D levels had a higher prevalence (33.3%) and a higher number of teeth affected by dental caries (mean (SD) = 0.7 (1.4)), compared to children with sufficient levels of vitamin D (21.6% and mean (SD) = 0.4 (0.8), respectively). The same holds for MIH, with a higher prevalence (38.5%) and a higher number of teeth affected (mean (SD) = 1.2 (2.3)), compared to children with sufficient levels of vitamin D (30.1% and mean (SD) = 0.8 (1.6), respectively). However, in the adjusted hurdle model analysis, neither the prevalence or number of teeth affected by caries or MIH showed statistically significant associations with having insufficient or lower vitamin D levels.

CONCLUSIONS

Vitamin D status was not significantly associated with the prevalence and number of teeth affected by caries and MIH among the participating children. Large prospective studies with multiple serum vitamin D measurements and oral examinations throughout childhood are warranted to elucidate the relationship.

Correlation between vitamin D levels in serum and the risk of dental caries in children: a systematic review and meta-analysis

BACKGROUND

Vitamin D plays a crucial role in oral health, and its deficiency is associated to significant changes in oral health diseases. We aimed to explore the relationship between levels of 25-hydroxyvitamin D (25(OH) D) and dental caries in children.

METHODS

Four electronic databases were searched by two investigators including PubMed, Embase, Web of Science, and Cochrane Library. Dental caries results were presented as either prevalence or based on the index of primary and permanent teeth/surfaces with decaying, missing, and filled areas, while vitamin D levels were determined through laboratory testing. Two researchers independently selected studies, collected information, assessed risk of bias, and evaluated the study quality. Any disagreements were resolved through discussion.

RESULTS

A total of 13 studies were included, comprising 5 cross-sectional studies, 5 cohort studies, 3 case-control studies, all of which had high methodological quality. Our meta-analysis showed that children with vitamin D deficiency had a 22% higher risk of dental caries than those with normal vitamin D levels, with a relative risk (RR) of 1.22 and a 95% confidence interval (CI) of 1.18 to 1. 25. Further subgroup analysis according to the three types of studies showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (cohort studies: 62%; cross-sectional studies, 19%; and case-control studies, 5%). Additionally, according to age, subgroup analysis also showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (permanent teeth studies, 28%; deciduous teeth studies, 68%; and mixed dentition studies 8%).

CONCLUSIONS

Levels of 25 (OH) D have been found negatively associated with dental caries in children, indicating that low vitamin D levels may be considered a potential risk factor to this dental disease.

A certain protective effect of vitamin D against dental caries in US children and youth: A cross-sectional study

OBJECTIVES

Recent studies reported that evidence of the association between caries and vitamin D was inconclusive. We investigated the relationship between dental caries and serum vitamin D levels in US children and youth aged 5-19 years through the National Health and Nutrition Examination Survey (NHANES). The purpose of this study was to analyze the relations between serum 25-hydroxyvitamin-D [25(OH)D] level and dental caries in children and youth.

METHODS

Data were collected from the NHANES dataset performed in 2011-2018. A total of 8896 subjects completed the examination was enrolled. Serum 25(OH)D was determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). All teeth examined and caries assessment was conducted by licensed dentists. Statistical analyses included complex samples Chi-square tests, analysis of variance, logistic regression analyses, and restricted cubic splines conducted by R software.

RESULTS

There was a nonlinear relation between dental caries and age in youth. Vitamin D showed a relatively stable protective effect when the concentration exceeded 60 nmol/L. There was a dose-effect relation that a 10 nmol/L increase in serum 25(OH)D concentrations was associated with a decreased caries odd by 10%.

CONCLUSIONS

Our findings suggested that vitamin D sufficiency may be a protective factor for dental caries.

Etiological Factors of Molar Incisor Hypomineralization: A Systematic Review and Meta-Analysis

Molar incisor hypomineralization (MIH) is a defect of the dental enamel that predominantly affects first molars and permanent incisors. Identifying the significant risk factors associated with MIH occurrence is essential for the implementation of prevention strategies. The purpose of this systematic review was to determine the etiological factors associated with MIH. A literature search was carried out from six databases until 2022; it covered pre-, peri-, and postnatal etiological factors. The PECOS strategy, PRISMA criteria, and the Newcastle-Ottawa scale were used, and 40 publications were selected for qualitative analysis as well as 25 for meta-analysis. Our results revealed an association between a history of illness during pregnancy (OR 4.03 (95% CI, 1.33-12.16), p = 0.01) and low weight at birth (OR 1.23 (95% CI, 1.10-1.38), p = 0.0005). Furthermore, general illness in childhood (OR 4.06 (95% CI, 2.03-8.11), p = 0.0001), antibiotic use (OR 1.76 (95% CI, 1.31-2.37), p = 0.0002), and high fever during early childhood (OR 1.48 (95% CI, 1.18-1.84), p = 0.0005) were associated with MIH. In conclusion, the etiology of MIH was found to be multifactorial. Children with health disorders in the first years of life and those whose mothers underwent illnesses during pregnancy might be more susceptible to MIH.

Molar-Incisor Hypomineralization: Prevalence Comparative Study in 6 Years of Interval

The aim of this study was to evaluate the prevalence evolution rate of MIH (molar-incisor hypomineralization) after a 6-year period in Araraquara/SP, Brazil. This population-based study evaluated MIH in 545 schoolchildren (6-12 years of age) and other associated alterations, dental caries and dental fluorosis (DF). A semistructured questionnaire was sent to the schoolchildren's parents/guardians with the purpose of identifying the socioeconomic profile. Associations between MIH and the clinical characteristics were analyzed by the Poisson analysis of regression with robust variance, estimating the RPc (crude prevalence ratio) with CI 95%. The level of significance of 5% was adopted. The MIH prevalence in Araraquara/SP in 2016 was 14.3% (n = 78), and at this time, an increase of 2% was observed, in comparison with the data of the first prevalence study conducted in 2010 (12.3%). The mild degree compromise was the most prevalent diagnosis in the affected teeth (82.0%). Among children with MIH, the mean number of affected teeth was 2.78. Of the total number of children with MIH, 32.0% presented alterations in both first permanent molars and permanent incisors. There is no significant association between MIH and dental caries experience on permanent dentition (PRc = 1.141; CI 95% 0.709-1.835) or on primary dentition (PR c  = 1.132; CI 95% 0.749-1.709). Children with MIH presented significantly less prevalence of dental fluorosis (PR c  = 0.505; CI 95% 0.268-0.950). There is no association between MIH and monthly Brazilian minimal wage income (PR c  = 1.130; CI 95% 0.655-1.949). It was concluded that the number of MIH cases had increased, revealing a greater need for defining the etiological factors and establishing a correct diagnosis to make it possible to institute early intervention.

Effects of a 2-Year Early Childhood Vitamin D3 Intervention on Tooth Enamel and Oral Health at Age 6-7 Years

INTRODUCTION

The aim of the study was to compare the effects of a 30 µg/day versus 10 µg/day vitamin D supplementation, given during the two first years of life, on oral health at the age of six to 7 years.

METHODS

In 2013-2016, we conducted a randomized, double-blinded, clinical trial from age 2 weeks to 2 years of daily vitamin D3 supplementation (10 vs. 30 µg), including 975 healthy infants. For the present follow-up study at age 6-7 years, a sample of 123 children underwent oral examination by investigators blinded to the intervention group. Tooth enamel defect and caries findings, oral rinse active matrix metalloproteinase-8 levels, and tooth eruption were recorded. The intervention groups were compared with χ2 and Mann-Whitney U tests. Associations of the oral health outcomes were evaluated with correlation analysis and logistic regression.

RESULTS

Of the children (median age 7.4 years, 51% boys), 56% belonged to the 30 µg intervention group. Developmental defect of enamel (DDE) was found in 39% of the children in the 10 µg intervention group and in 53% of the 30 µg group (p = 0.104). In total, 94% of children were vitamin D sufficient (25[OH]D ≥50 nmol/L) and 88% had caries-free teeth. No associations were found between vitamin D intervention group in infancy and oral health or the presence of DDE.

CONCLUSION

Daily supplementation with 10 µg vitamin D3 in the Northern Hemisphere seems adequate in healthy children younger than 2 years in ensuring good oral health at early school age.

Identification by whole-exome sequencing of new single-nucleotide polymorphisms associated with molar-incisor hypomineralisation among the Lebanese population

OBJECTIVE

Molar-incisor hypomineralization (MIH) is a developmental qualitative enamel defect, causing a worldwide challenging dental problem. The etiology of this defect remains unclear. Here we identify by whole-exome sequencing (WES) new single-nucleotide polymorphisms (SNPs) in genes expressed during enamel mineralization and in those modulating prenatal, natal and postnatal risk factors among the Lebanese MIH children: immune system and xenobiotic detoxification.

DESIGN

Dental examination for MIH was performed based on the MIH index for diagnostic criteria. Saliva samples were collected from 37 non-related, MIH-diagnosed subjects for DNA extraction. WES was performed on the Illumina HiSeq2000 platform. The χ² test and Fisher's exact test were used to determine relationship between SNPs frequencies and MIH. OR and its 95% CI were used to report the strength of association. The significance threshold was set at 0.05.

RESULTS

Among the Lebanese population, 37 SNPs presented a significant association with MIH in the following genes: AMTN, MMP-20, STIM1, STIM2, ORAI1, SLC34A2, SLC34A3, VDR, PVALB, HSP90B1, TRPM7, SLC24A4, CA6, SLC4A2, TNFRSF11A, IL10RB, ARNT, ESR1 and CYP1B1.

CONCLUSION

This is the first WES study conducted in patients with MIH. Yet, interactions between polymorphisms in different gene categories are to be investigated for a better assessment of MIH susceptibility.

[Molar incisor hypomineralisation (MIH)-discussion of prevalence and etiology with special reference to the results from the Munich birth cohorts GINIplus and LISA]

After caries, molar incisor hypomineralisation (MIH)-also known as chalky teeth-is one the most common dental diseases in children and adolescents. In addition to aesthetic limitations, especially on the anterior teeth, hypersensitivities and enamel breakdowns on permanent molars are of functional importance. While the MIH prevalence rates range from ~ 10% to ~ 30% and is well described, the situation regarding aetiology is unsatisfactory. Although efforts have been made in the past to clarify the aetiology, no plausible reason is available so far. Aetiology research has to be judged as methodologically challenging, since it should ideally be embedded in prospectively planned birth cohort studies. The aim of this article is to summarize typical clinical characteristics of MIH, epidemiological findings and potential causes with special reference to the earlier published results from the two Munich birth cohort studies GINIplus and LISA.

Molar incisor hypomineralization: A review and prevalence in Japan

Molar incisor hypomineralization (MIH) is defined as hypomineralization of systemic origin of one to four first permanent molars, and incisors are also frequently affected. This disorder is a serious concern in pediatric dentistry. Teeth affected by MIH have many dental problems, such as hypersensitivity, poor aesthetics, and rapid progression of dental caries. The prevalence of MIH ranges from 2.8% to 21% among studies with more than 1000 subjects in different countries and age groups. The etiology of MIH is unclear, but genetic and environmental factors have been proposed. This review describes the prevalence, etiology, and clinical management of MIH. A detailed description of MIH prevalence in Japan is also provided.

Molar Incisor Hypomineralization: Clinical Characteristics with Special Emphasis on Etiological Criteria

Molar incisor hypomineralization (MIH) is an entity to describe the enamel defects of the first permanent molars with the involvement of one or more incisors due to an underlying systemic cause. It is a frequently encountered challenge by dentists in a dental clinic and dental complications affecting patient's quality of life. Early diagnosis is the key to protect and prevent the deterioration of the condition. This article aims to highlight different aspects of etiology to treatment options in young patients related to MIH.

Serum Levels of Vitamin D and Dental Caries in 7-Year-Old Children in Porto Metropolitan Area

Vitamin D deficiency has been associated with significant changes in dental structures. In children, it can induce enamel and dentin defects, which have been identified as risk factors for caries. This study aimed to assess the association between low serum 25-hydroxyvitamin D (25(OH) D) levels (<30 ng/mL) and the prevalence of caries in the permanent teeth and mixed dentition of 7-year-old children. A sample of 335 children from the population-based birth cohort Generation XXI (Porto, Portugal) was included. Data on children’s demographic and social conditions, health status, dental health behaviours, dental examination including erupted permanent first molars, and blood samples available for vitamin D analysis were collected. Dental outcomes included the presence of caries, including non-cavitated lesions (d_1–6mft/D_1–6MFT > 0), and advanced caries (d_3–6mft/D_3–6MF > 0). Serum 25(OH) D was measured using a competitive electrochemiluminescence immunoassay protein-binding assay. Bivariate analysis and multivariate logistic regression were used. Advanced caries in permanent teeth was significantly associated with children’s vitamin D levels <30 ng/mL, gastrointestinal disorders, higher daily intake of cariogenic food, and having had a dental appointment at ≤7 years old. Optimal childhood levels of vitamin D may be considered an additional preventive measure for dental caries in the permanent dentition.

Plant-based milks: the dental perspective

Background Consumption of plant-based milk in the UK is increasing at the expense of cow's milk. Cow's milk consumption has traditionally been advocated by the dental profession as 'good for teeth'.Aims To identify the range of plant-based milks available in the UK and compare their nutritional benefits with cow's milk. A secondary aim was to explore reasons behind the increase in popularity of plant-based milks and discuss dental relevance.Methods Branded plant-based milks available in UK supermarkets were identified and nutritional data collected. Data were obtained from product labelling and manufacturer websites. The sample was collected in December 2019.Results Eighty-two products were identified. Differences were observed between plant-based and cow's milk, in particular regarding calcium, iodine, vitamin B12 and sugar content. Sugar content varied from 0-7.6 g/100 ml.Conclusions Dairy is a key source of dietary iodine and many plant-based milks contain much lower levels. Many plant-based milks contain free sugars which are cariogenic. Dentists should be aware of this emerging market and be able to advise patients accordingly.

The association between serum 25-hydroxyvitamin D levels and dental caries in US adults

OBJECTIVES

We investigated whether 25-hydroxyvitamin D concentration is independently associated with dental caries among adults in the United States.

SUBJECTS AND METHODS

This investigation was a cross-sectional study. A total of 4,244 participants (aged 20-80 years) were enrolled through the 2007-2008 National Health and Nutrition Examination Survey (NHANES). Serum 25-hydroxyvitamin D was categorized into four groups based on previous studies: normal (≥75 nmol/ml), insufficient (50-74.9 nmol/ml), deficient (25-49.9 nmol/ml), and severely deficient (<25 nmol/ml). The dependent and independent variables included dental caries and serum 25-hydroxyvitamin D, respectively. The data were analyzed using univariate analyses, multivariable-adjusted analyses, and subgroup analyses.

RESULTS

The fully adjusted model showed that 25-hydroxyvitamin D levels were negatively associated with dental caries after adjusting for the confounders (OR = 0.93, 95% CI 0.89 to 0.98). Compared with the normal group, the likelihood of dental caries was 2.48, 1.29, and 1.43 times higher in the severely deficient, deficient, and insufficient groups, respectively.

CONCLUSIONS

Our findings suggest that serum 25-hydroxyvitamin D levels are significantly associated with the occurrence of dental caries among US adults.

Vitamin D and Immunity in Infants and Children

The last couple of decades have seen an explosion in our interest and understanding of the role of vitamin D in the regulation of immunity. At the molecular level, the hormonal form of vitamin D signals through the nuclear vitamin D receptor (VDR), a ligand-regulated transcription factor. The VDR and vitamin D metabolic enzymes are expressed throughout the innate and adaptive arms of the immune system. The advent of genome-wide approaches to gene expression profiling have led to the identification of numerous VDR-regulated genes implicated in the regulation of innate and adaptive immunity. The molecular data infer that vitamin D signaling should boost innate immunity against pathogens of bacterial or viral origin. Vitamin D signaling also suppresses inflammatory immune responses that underlie autoimmunity and regulate allergic responses. These findings have been bolstered by clinical studies linking vitamin D deficiency to increased rates of infections, autoimmunity, and allergies. Our goals here are to provide an overview of the molecular basis for immune system regulation and to survey the clinical data from pediatric populations, using randomized placebo-controlled trials and meta-analyses where possible, linking vitamin D deficiency to increased rates of infections, autoimmune conditions, and allergies, and addressing the impact of supplementation on these conditions.

The relationship between molar incisor hypomineralization, dental caries, socioeconomic factors, and polymorphisms in the vitamin D receptor gene: a population-based study

OBJECTIVES

The purpose of this cross-sectional study was to investigate whether polymorphisms in vitamin D receptor (VDR) genes increase the prevalence of dental caries, molar incisor hypomineralization (MIH), and hypomineralized primary second molars (HPSM).

MATERIAL AND METHODS

A representative population-based sample of 731 schoolchildren, 8 years of age, was randomly selected in Curitiba, Paraná, Brazil. MIH, HPSM, and dental caries were clinically assessed by four calibrated examiners (kappa > 0.80) using European Academy of Pediatric Dentistry (2003) criteria, the modified Developmental Defects of Enamel (DDE) index, and the Decayed, Missing, or Filled Teeth (DMFT) index by the World Health Organization (2013), respectively. The VDR rs739837 and rs2228570 polymorphisms were genotyped using real-time polymerase chain reaction. Associations were analyzed by Poisson regression with robust variance (α = 0.05).

RESULTS

Schoolchildren with MIH presented a higher prevalence of dental caries (DMFT > 1, PR = 2.52, confidence interval = 1.60-3.97, p ≤ 0.001). No association was observed between MIH, HPSM, and dental caries, with rs739837 and rs2228570 polymorphisms. Individuals with the GT/GG genotype in rs739837 polymorphism presented a higher prevalence of MIH in molars and incisors than individuals TT (PR = 2.34, confidence interval = 1.08-5.07, p = 0.03).

CONCLUSION

Children with MIH presented a significant higher prevalence of dental caries than children without MIH. To carry at least one G allele in rs739837 was associated to higher prevalence of MIH in molars and incisors.

CLINICAL RELEVANCE

Our findings suggested that more severe cases with incisors affected by MIH could be associated with polymorphism in VDR gene.

Relationship between deciduous molar hypomineralisation and parameters of bone metabolism in preschool children

BACKGROUND

The aetiology of deciduous molar hypomineralisation (DMH) is still largely unknown.

AIM

The aim of the study was to elucidate the occurrence of DMH as a function of the parameters of bone metabolism, as it is suspected that abnormalities in these parameters may affect the mineralisation of teeth.

DESIGN

In a prospective cohort study, 958 children aged 1-6 years were examined. The inclusion criteria were: a blood sample to determine the parameters of bone metabolism; and documentation of enamel mineralisation using the European Academy of Paediatric Dentistry (EAPD) criteria. Multivariable methods were applied to analyse the incidence of DMH relative to the concentrations of serum calcium, phosphate, vitamin D, vitamin B12 and alkaline phosphatase, taking into account the effects of age, gender and height.

RESULTS

The proportion of children diagnosed with DMH was 4.0% (38 of 958). A significant difference between DMH-affected and non-DMH-affected children was found only in the serum concentration of calcium (2.47 ± 0.08 mmol/l vs. 2.52 ± 0.10 mmol/l, respectively, P = 0.004). The risk of DMH significantly increased, by 1.63-fold (95% CI: 1.03-2.57), if the calcium level dropped by 0.1 mmol/l, regardless of age, gender or adjusted height. During the follow-up examination of 17 DMH-affected subjects, the calcium level remained consistently low 1 year later (t-test, P > 0.05).

CONCLUSION

Children with DMH showed consistently subclinically lower serum calcium levels. No associations were found for other parameters.

The Role of Vitamins in Oral Health. A Systematic Review and Meta-Analysis

The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.

Association of High-Dose Vitamin D Supplementation During Pregnancy With the Risk of Enamel Defects in Offspring: A 6-Year Follow-up of a Randomized Clinical Trial

IMPORTANCE

Enamel defects of developmental origin affect up to 38% of schoolchildren and is recognized as a global public health challenge. The impaired enamel formation results in pain owing to hypersensitivity, posteruptive breakdowns, rapid caries progression, and extractions in some cases. The etiology is unknown; therefore, prevention is currently not possible.

OBJECTIVE

To assess the association of a high-dose vitamin D supplementation in pregnant women with enamel defects and caries in their offspring.

DESIGN, SETTING, AND PARTICIPANTS

Post hoc analysis of a double-blind, single-center, randomized clinical trial, the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort (COPSAC2010). Enrollment began March 2009 and included 623 women recruited at 24 weeks of pregnancy and 588 of their children. A dental examination was completed at age 6 years in 496 of 588 children (84%). Data were analyzed in 2018.

INTERVENTION

High-dose vitamin D3 (2400 IU/d; N = 315) or matching placebo tablets (N = 308) from pregnancy week 24 to 1 week post partum. In addition, all women received 400 IU/d of vitamin D3 as part of standard care.

MAIN OUTCOMES AND MEASURES

Enamel defect was defined as having at least 1 molar affected by demarcated opacity, enamel breakdown, and/or atypical restoration. Caries was defined as decayed, missing, or filled surfaces in both the deciduous and permanent dentitions (World Health Organization standard).

RESULTS

The risk of enamel defects in the permanent dentition was lower in the offspring of mothers who received high-dose vitamin D supplementation during pregnancy compared with standard dose (15.1% [n = 26 of 172] vs 27.5% [n = 44 of 160]; odds ratio, 0.47; 95% CI, 0.27-0.81). A similar association was observed for the deciduous dentition (8.6% [n = 21 of 244] vs 15.9% [n = 40 of 252]; odds ratio, 0.50; 95% CI, 0.28-0.87). There was no association between supplementation and caries.

CONCLUSIONS AND RELEVANCE

High-dose vitamin D supplementation during pregnancy was associated with approximately 50% reduced odds of enamel defects in the offspring. This suggests prenatal vitamin D supplementation as a preventive intervention for enamel defects, with a clinically important association with dental health.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00856947.

A systematic review and meta-analysis of systemic exposure associated with molar incisor hypomineralization

OBJECTIVE

To evaluate systemic exposures associated with molar incisor hypomineralization (MIH).

METHODS

This systematic review was performed using published observational studies that evaluated the systemic exposures associated with MIH. The sources of articles searched were PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and Grey literature. The risk of bias was analysed according to the Newcastle-Ottawa Scale for quality assessment. The meta-analysis was performed considering the exposures during the prenatal, perinatal and postnatal periods using the CMA software.

RESULTS

A total of 4207 articles were identified. Twenty-nine studies were eligible for inclusion and 27 were included in the meta-analysis. The studies presented low and moderate risks of bias, except for one that was classified as having a high risk of bias. Maternal illness during pregnancy (OR 1.40; 95% CI 1.18-1.65, P < 0.0001) and psychological stress (OR = 2.65; 95% CI 1.52-4.63; P = 0.001) was observed to be significantly associated with higher odds of MIH. During the perinatal period, caesarean delivery (OR = 1.32, 95% CI 1.11-1.57, P = 0.001) and delivery complications (OR = 2.06; 95% CI 1.47-2.88, P < 0.0001) were also associated with MIH. In the postnatal period, only respiratory diseases (OR = 1.98; 95% CI 1.45-2.70, P < 0.0001) and fever (OR = 1.50; 95% CI 1.22-1.84; P < 0.0001) were associated with higher prevalence of MIH. The evidence was graded as very low quality.

CONCLUSIONS

Maternal illness, psychological stress, caesarean delivery, delivery complications, respiratory diseases and fever during the first years of a child's life were significantly associated with a higher odds of MIH. However, this should be interpreted with caution, once the primary studies were observational, with serious limitations according to the risk of bias, imprecision, and inconsistency. Further, well-designed cohort studies are still required.

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.

The Associations of Maternal and Neonatal Vitamin D with Dental Development in Childhood

BACKGROUND

Vitamin D influences the formation and mineralization of teeth.

OBJECTIVE

To investigate the association of maternal and neonatal vitamin D concentrations with the dental development of 10-y-old children, in a population-based prospective cohort study among 3,770 mothers and children in the Netherlands.

METHODS

Maternal venous blood samples were collected in the second trimester (median 20.4 weeks of gestation; range: 18.5-23.2 wk) whereas umbilical cord blood samples were collected immediately after delivery (median 40.1 weeks of gestation; range 35.9-42.3 wk). Dental development was defined using the Demirjian method. Multivariate regression models were built to analyze the studied associations.

RESULTS

High concentrations of 25-hydroxyvitamin D [25(OH)D] during midpregnancy (β: -0.04; 95% CI: -0.08, -0.01) and at birth (β: -0.06; 95% CI: -0.10, -0.02) were associated with a lower dental age in children. The children of mothers with severe vitamin D deficiency [25(OH)D <25.0 nmol/L] during midpregnancy exhibited a higher dental age (β: 0.14; 95% CI: 0.03, 0.24) and higher developmental stages of the mandibular first premolar (β: 0.32; 95% CI: 0.04, 0.60) compared with the children of mothers with optimal values of 25(OH)D (≥75.0 nmol/L). Children with vitamin D deficiency [25(OH)D 25.0-49.9 nmol/L] at birth exhibited a higher dental age (β: 0.11; 95% CI: 0.01, 0.20), higher developmental stages of the mandibular second premolar (β: 0.27; 95% CI: 0.02, 0.51), and higher developmental stages of the mandibular second molar (β: 0.24; 95% CI: 0.00, 0.48) compared with children with sufficient-to-optimal values of 25(OH)D (≥50.0 nmol/L) at birth.

CONCLUSION

Higher maternal and neonatal 25(OH)D concentrations are associated with decelerated dental development in childhood. The lower the vitamin D level during midpregnancy or at birth, the higher the dental age of children, and the higher the developmental stages of the mandibular teeth.

Factors associated with molar-incisor hypomineralisation in schoolchildren aged 8-10 years: a case-control study

BACKGROUND

The aetiology of molar-incisor hypomineralisation (MIH) is multifactorial and may involve genetic and environmental factors.

AIM

To verify the factors associated with MIH in schoolchildren from 8 to 10 years of age.

DESIGN

This is a case-control study with a sample consisting of children aged 8 to 10 years, paired by gender and school type, in a ratio of 1:3. The case group included 186 children with MIH and the control included 558 children without MIH. Data were collected through a semi-structured questionnaire and clinical examination. Chi-square, linear-by-linear, Mann-Whitney, and logistic regression tests were conducted. A value of P < 0.05 was considered significant.

RESULTS

The prevalence of mild MIH was 19.5%, moderate MIH 2.2% and severe MIH 3.2%. An association was observed between MIH with treatment need and a higher mean DMF-T and decayed and missing teeth (P < 0.05). According to the aetiological factors studied, mothers who presented a fever during pregnancy had a 2.54 times greater chance of having children with severe MIH than mothers who did not present a fever (P = 0.045).

CONCLUSION

The presence of fever during pregnancy and the need for treatment were associated with MIH.

Prevalence of molar incisor hypomineralization and regional differences throughout Japan

Background

Molar incisor hypomineralization (MIH) frequently occurs in children worldwide. However, MIH prevalence throughout Japan has not yet been investigated. The purpose of this study was to clarify MIH prevalence rates and to consider potential regional differences throughout Japan.

Methods

A total of 4496 children aged 7–9 years throughout Japan were evaluated in this study. MIH prevalence rates among children were evaluated in eight regions throughout Japan. A child’s residence was defined as the mother’s residence during pregnancy. The localization of demarcated opacities and enamel breakdown was recorded on a standard code form using a guided record chart. Logistic regression analysis was used to evaluate whether MIH prevalence rates differed among age groups, sex, and regions.

Results

The overall prevalence of MIH in Japan was 19.8%. The prevalence of MIH was 14.0% in the Hokkaido region, 11.7% in the Tohoku region, 18.5% in the Kanto Shin-Etsu region, 19.3% in the Tokai Hokuriku region, 22.3% in the Kinki region, 19.8% in the Chugoku region, 28.1% in the Shikoku region, and 25.3% in the Kyushu region. These regional differences were statistically significant. Moreover, MIH prevalence rates decreased with age. No significant sex differences in MIH prevalence rates were demonstrated.

Conclusions

To our knowledge, this is the first MIH study carried out in several regions throughout Japan. Regional differences existed in MIH prevalence rates; particularly, MIH occurred more frequently in children residing in southwestern areas than those in northeastern areas of Japan.

Prevalence of Deleterious Oral Habits among 3- to 5-year-old Preschool Children in Bhubaneswar, Odisha, India

Aim

Oral habits during and beyond preschool age are one of the important etiological factors in developing malocclusion and other ill effects on orofacial structures. The objective of the present study was to know the prevalence of deleterious oral habits among 3- to 5-year-old preschool children in Bhubaneswar, Odisha, India.

Materials and methods

This cross-sectional study was conducted among preschool children, in the age group of 3 to 5 years in the city of Bhubaneswar, Odisha, India. To carry out this study, six private schools, two from each of the three electoral constituency, were selected using cluster sampling technique. A total of 500 students, studying in LKG and UKG and their respective mothers/caregivers were selected for the study as per the inclusion/exclusion criteria. Prevalence of different oral habits in children was calculated from the data obtained. Using Statistical Package for the Social Sciences (SPSS), version 17.0 software, Chi-square test was applied to compare the differences present between boys and girls and their significant values (p < 0.05).

Results

The result of this study showed a high prevalence of oral habits (36%) among preschool children in Bhubaneswar, Odisha, India. Lip biting was found to be the most prevalent habit (13.4%), followed closely by thumb sucking (12.8%), bruxism (12.8%), and mouth breathing (11%).

Conclusion

The study revealed a great dearth of a well-established dental education program for preschool children as well as their parents, caretakers, teachers, and pediatricians in order to provide an effective and timely care to the children.

How to cite this article: Dhull KS, Verma T, Dutta B. Prevalence of Deleterious Oral Habits among 3- to 5-year-old Preschool Children in Bhubaneswar, Odisha, India. Int J Clin Pediatr Dent 2018;11(3):210-213.

A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale

Aim

Parental presence often provides unique challenge in dental operatory and is directly related to the quality dental treatment. The present study was done to investigate parent's ability to assess dental anxiety of their 6- to 10-year-old child and to determine how parent's and children's fear assessments correlate with each other.

Materials and methods

Prior to dental treatment, 94 child-parent combinations were included to complete Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire, and Frankl score was assigned to children during treatment by operator.

Results

Mean dental anxiety score reported by the children was 27.74, whereas by their parents was 39.64. There was a poor consistency of parents to predict their child dental fear (p < 0.05). Parents reported higher dental fear for their children.

Conclusion

Parents assessment of their child's fear may vary in accordance to factors, including their own dental fear. Such input may prevent dentists from establishing an accurate association with the child's patient.How to cite this article: Malhotra R, Gandhi K, Kumar D, Ahuja S, Kapoor R, Sahni A. A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2018;11(3):205-209.

Salivary Cortisol and Alpha-amylase-Biomarkers of Stress in Children undergoing Extraction: An in vivo Study

Aim

The anxiety of dental procedure evokes physiological response in the human body similar to fear. The level of cortisol and alpha-amylase in saliva can be considered as one of the major biomarkers of stress and anxiety. Our study was aimed to correlate the stress and anxiety with the levels of salivary cortisol (SC) and salivary alpha-amylase (SAA) in patients undergoing routine dental extraction.

Materials and methods

The levels of SC and SAA were assessed pre- and postextraction in the salivary samples of 20 children.

Results

The values of cortisol and alpha-amylase showed a significant increase postextraction.

Conclusion

Salivary cortisol and SAA can be considered an important and noninvasive tool for assessment of anxiety, such as dental extraction, in children.

Clinical significance

Increase in the stress levels of a child in the dental operatory procedures like tooth extraction suggests the use of some behavior modification and shaping techniques by dentists to overcome the anxiety of the child before commencement of the procedure. This can aid in better cooperation of the child during treatment as well as helps in internal motivation toward future dental treatment.

How to cite this article: Chaturvedi Y, Chaturvedy S, Marwah N, Chaturvedi S, Agarwal S, Agarwal N. Salivary Cortisol and Alpha-amylase—Biomarkers of Stress in Children undergoing Extraction: An in vivo Study. Int J Clin Pediatr Dent 2018; 11(3):214-218.

Comparison of Vitamin D Level of Children with Severe Early Childhood Caries and Children with No Caries

AIM

To compare the levels of vitamin D in children with severe early childhood caries (SECC) and children without caries and to determine the association of vitamin D deficiency and SECC.

MATERIALS AND METHODS

A total of 30 children each from case (with caries) and control group (without caries) of age between 3 and 6 years were selected from the Department of Pedo-dontics and Preventive Dentistry, Faculty of Dental Sciences, SGT University, Gurugram. Caries status of the children was recorded using decayed, extracted, and filled teeth (deft) index. Blood samples for serum 25(OH) vitamin D were taken from each child. All the data collected were compiled and subjected to appropriate statistical analysis.

RESULTS

Case group has mean serum 25(OH) vitamin D level of 12.19 ng/mL [4.37 standard deviation (SD), 95% confidence interval of 10.5-13.8] and control group has mean serum 25(OH) vitamin D level of 20.11 ng/mL (4.12 SD, 95% confidence interval of 18.56-21.65). When the mean levels of serum 25(OH) vitamin D were compared between case and control groups, there was a statistically significant difference (p-value <0.0001). Simple linear regression in case group shows statistically significant inverse correlation between vitamin D levels and SECC (p-value<0.0001).

CONCLUSION

Our results showed that vitamin D deficiency is risk factor both for incidence of dental caries and for its severity in children.

CLINICAL SIGNIFICANCE

Vitamin D deficiency is an important modifiable risk factor for dental caries in children. Hence, by supplementing vitamin D in children and preventing the deficiency of vitamin D, dental caries can be prevented.How to cite this article: Chhonkar A, Gupta A, Arya V. Comparison of Vitamin D Level of Children with Severe Early Childhood Caries and Children with No Caries. Int J Clin Pediatr Dent 2018;11(3):199-204.

A cross-sectional study on the association between vitamin D levels and caries in the permanent dentition of Korean children

Background

A recent study in Canada reported that vitamin D deficiency is associated with dental caries. Because Koreans have been reported to be deficient in vitamin D, we investigated the relationship between dental caries and reduced serum vitamin D levels in Korean children. The purpose of this study was to analyze the relationships between blood vitamin D [25(OH)D] concentrations and dental caries in the permanent dentition of Korean children.

Methods

Data were collected from the Korea National Health and Nutrition Examination Survey performed in 2008–2013. A total of 1688 children (10–12 years of age) were enrolled. Vitamin D intake was measured through analysis of 25-hydroxy vitamin D [25(OH)D] levels. Caries experience in permanent dentition was assessed using the decay-missing-filled teeth (DMFT) index and decayed-missing-filled (DMF) rate. Statistical analyses included complex samples Chi-square tests, complex samples logistic regression analyses, and Pearson’s correlations.

Results

The group with 25(OH) D levels lower than 50 nmol/L had a higher proportion of children with caries in the permanent dentition and permanent first molar than the group with 25(OH)D levels of 50 nmol/L or more. When external factors, such as sex, were controlled, 25(OH)D levels were not significantly correlated with caries, but were significantly correlated with first molar caries. Children with 25(OH)D levels lower than 50 nmol/L were 1.295 times more likely to have first molar caries than those with 25(OH)D levels of 50 nmol/L or more. Additionally, 25(OH)D levels and DMFT were negatively correlated; however, the degree of correlation was not strong.

Conclusions

The association between 25(OH)D and dental caries is still not clear. However, our findings suggested that vitamin D insufficiency may be a risk factor for dental caries.

Foetal, neonatal and child vitamin D status and enamel hypomineralization

Objectives

Recent literature suggested that higher vitamin D concentrations in childhood are associated with a lower prevalence of molar incisor hypomineralization (MIH). As tooth development already starts in utero, we aimed to study whether vitamin D status during foetal, postnatal and childhood periods is associated with the presence of hypomineralized second primary molars (HSPMs) and/or MIH at the age of six.

Methods

Our study was embedded in the Generation R Study, a population‐based, prospective cohort from foetal life onwards in Rotterdam, the Netherlands. HSPMs and MIH were scored from intraoral photographs of the children at their age of six. Serum 25(OH)D concentrations were measured at three points in time, which resulted in three different samples; mid‐gestational in mothers’ blood (n = 4750), in umbilical cord blood (n = 3406) and in children's blood at the age of 6 years (n = 3983).

Results

The children had a mean (±SD) age of 6.2 (±0.5) years at the moment of taking the intraoral photographs. After adjustment for confounders, no association was found between foetal 25(OH)D concentrations and the presence of HSPMs (OR 1.02 per 10 nmol/L higher 25(OH)D, 95% CI: 0.98‐1.07) or MIH (OR 1.05 per 10 nmol/L increase, 95% CI: 0.98‐1.12) in 6‐year‐olds. A higher 25(OH)D concentration in umbilical cord blood resulted in neither lower odds of having HSPM (OR 1.05, 95% CI: 0.98‐1.13) nor lower odds of having MIH (OR 0.95, 95% CI: 0.84‐1.07) by the age of six. Finally, we did not find higher 25(OH)D concentrations at the age of six to be associated with a significant change in the odds of having HSPM (OR 0.97, 95% CI: 0.92‐1.02) or MIH (OR 1.07, 95% CI: 0.98‐1.16).

Conclusions

25(OH)D concentrations in prenatal, early postnatal and later postnatal life are not associated with the presence of HPSMs or with MIH at the age of six. Future observational research is required to replicate our findings. Furthermore, it is encouraged to focus on identifying other modifiable risk factors, because prevention of hypomineralization is possible only if the causes are known.

Vitamin D Compounds Are Bactericidal against Streptococcus mutans and Target the Bacitracin-Associated Efflux System

Vitamin D analogs were identified as compounds that induced lysis of planktonic cultures of Streptococcus mutans in a high-throughput screen of FDA-approved drugs. Previous studies have demonstrated that certain derivatives of vitamin D possess lytic activity against other bacteria, though the mechanism has not yet been established. Through the use of a combinatorial approach, the vitamin D derivative doxercalciferol was shown to act synergistically with bacitracin, a polypeptide-type drug that is known to interfere with cell wall synthesis, suggesting that doxercalciferol may act in a bacitracin-related pathway. Innate resistance to bacitracin is attributed to efflux by a conserved ABC-type transporter, which in S. mutans is encoded by the mbrABCD operon. S. mutans possesses two characterized mechanisms of resistance to bacitracin, the ABC transporter, S. mutans bacitracin resistance (Mbr) cassette, consisting of MbrABCD, and the rhamnose-glucose polysaccharide (Rgp) system, RgpABCDEFGHI. Loss of function of the transporter in ΔmbrA and ΔmbrD mutants exacerbated the effect of the combination of doxercalciferol and bacitracin. Despite conservation of a transporter homologous to mbrABCD, the combination of doxercalciferol and bacitracin appeared to be synergistic only in streptococcal species. We conclude that vitamin D derivatives possess lytic activity against S. mutans and act through a mechanism dependent on the bacitracin resistance mechanism of MbrABCD.

Higher serum 25(OH)D concentrations are associated with improved FEV1 and FVC in adolescence

Vitamin D plays a role in the development of the immune system and the lung, as well as in airway remodelling. Therefore, this study investigated the association between serum 25-hydroxyvitamin D (25(OH)D) concentrations and spirometric lung function parameters at age 15 years.

In the German birth cohorts GINIplus and LISAplus, lung function testing by spirometry and 25(OH)D measurements were performed during the 15-year follow-up examinations. Valid lung function measurements pre- and/or post-bronchodilation and serum 25(OH)D concentrations, which were adjusted for the date of blood sampling to account for seasonal variability, were available for 2607 adolescents. Associations between 25(OH)D concentrations and spirometric parameters were analysed using generalised additive models adjusted for confounding factors.

Serum 25(OH)D concentrations were significantly associated with forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FEV1/FVC measured before bronchodilation after adjustment for potential confounders: FEV1 increased by 10 mL (95% CI 2–17), FVC by 20 mL (95% CI 12–28) and FEV1/FVC decreased by 0.177% (95% CI −0.286 to −0.067) per 10 nmol·L−1 increase in 25(OH)D concentrations. Flow rates (forced expiratory flow rates at 25, 50 and 75% of exhaled FVC (FEF25, FEF50, FEF75) and mean flow rate between 25 and 75% of FVC (FEF25–75)) were not associated with vitamin D. Similar associations were observed for lung function parameters measured after bronchodilation.

Vitamin D concentrations are positively associated with volume-related lung function parameters pre- and post-bronchodilation, suggesting structural changes in peripheral airways.

Expression of Steroid Receptors in Ameloblasts during Amelogenesis in Rat Incisors

Endocrine disrupting chemicals (EDCs) play a part in the modern burst of diseases and interfere with the steroid hormone axis. Bisphenol A (BPA), one of the most active and widely used EDCs, affects ameloblast functions, leading to an enamel hypomineralization pattern similar to that of Molar Incisor Hypomineralization (MIH). In order to explore the molecular pathways stimulated by BPA during amelogenesis, we thoroughly investigated the receptors known to directly or indirectly mediate the effects of BPA. The expression patterns of high affinity BPA receptors (ERRγ, GPR30), of ketosteroid receptors (ERs, AR, PGR, GR, MR), of the retinoid receptor RXRα, and PPARγ were established using RT-qPCR analysis of RNAs extracted from microdissected enamel organ of adult rats. Their expression was dependent on the stage of ameloblast differentiation, except that of ERβ and PPARγ which remained undetectable. An additional large scale microarray analysis revealed three main groups of receptors according to their level of expression in maturation-stage ameloblasts. The expression level of RXRα was the highest, similar to the vitamin D receptor (VDR), whereas the others were 13 to 612-fold lower, with AR and GR being intermediate. Immunofluorescent analysis of VDR, ERα and AR confirmed their presence mainly in maturation- stage ameloblasts. These data provide further evidence that ameloblasts express a specific combination of hormonal receptors depending on their developmental stage. This study represents the first step toward understanding dental endocrinology as well as some of the effects of EDCs on the pathophysiology of amelogenesis.

Association of vitamin D and dental caries in children: Findings from the National Health and Nutrition Examination Survey, 2005-2006

BACKGROUND

The authors sought to determine associations between serum vitamin D levels and dental caries in noninstitutionalized children aged 5 to 12 years in the United States.

METHODS

The authors used National Health and Nutrition Examination Survey, 2005-2006, data to study childhood caries and vitamin D. Vitamin D deficiency and inadequacy were defined as serum 25-hydroxyvitamin D (25[OH]D) less than 30 nanomoles per liter and between 30 and 49 nmol/L, respectively. Associations between vitamin D and caries experience (a combined measure of untreated caries or restorations) were examined after adjustment for confounders using multivariate logistic regression at a critical value of 5%. Sample weights were used to generate nationally representative estimates.

RESULTS

The overall prevalence of serum 25(OH)D less than 30 nmol/L and 25(OH)D between 30 and 49 nmol/L among 5- to 12-year-olds was 3% and 16%, respectively. Prevalence of 25(OH)D less than 30 nmol/L and 25(OH)D between 30 and 49 nmol/L among children with caries experience was 2% and 16%, respectively. Multivariate logistic regression analysis found no significant association between vitamin D and caries experience (P = .78). Furthermore, this association was not significant after adjusting for age, sex, race and ethnicity, ratio of family income to poverty threshold, and sugar consumption (P = .46).

CONCLUSIONS

The authors did not find a significant association between 25(OH)D status and caries experience in US children who participated in NHANES, 2005-2006.

PRACTICAL IMPLICATIONS

The authors' findings do not support existing evidence of an association between caries and vitamin D.

Association between Bone Mass and Dental Hypomineralization

The aim of this study was to examine the association between the bone mass (bone mineral content [BMC]) and hypomineralized second primary molars (HSPMs)/molar incisor hypomineralization (MIH) in 6-y-old children. This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study, starting from fetal life until adulthood in Rotterdam, Netherlands. The European Academy of Pediatric Dentistry criteria were used to score the intraoral photographs on the presence or absence of HSPMs and MIH. Bone mass was measured with a dual-energy x-ray absorptiometry (DXA) scan. Intraoral photographs and DXA scans were available in 6,510 6-y-old children. Binary logistic regression models were used to study the association between the bone mass and HSPMs/MIH. In total, 5,586 children had their second primary molars assessed and a DXA scan made; 507 children were diagnosed with HSPM. Of 2,370 children with data on their permanent first molars, 203 were diagnosed with MIH. In the fully adjusted model, children with lower BMC (corrected for bone area) were more likely to have HSPMs (odds ratio, 1.13; 95% confidence interval, 1.02 to 1.26 per 1-standard deviation decrease). A lower BMC (corrected for bone area) was not associated with MIH (odds ratio, 1.02; 95% confidence interval, 0.87 to 1.20 per 1-standard deviation decrease). We observed a negative association between BMC (corrected for bone area) and HSPMs. No association was found between BMC (corrected for bone area) and MIH. Future research should focus on investigating the mechanism underlying the negative association between the bone mass and HSPMs. Our study, in a large population of 6-y-old children, adds the finding that BMC (corrected for bone size) is associated with HSPMs but not with MIH in childhood.

Evaluation of an interdisciplinary preventive programme for early childhood caries: findings of a regional German birth cohort study

OBJECTIVES

The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary preventive programme (PP) for early childhood caries in 3-year-old children in Germany.

MATERIAL AND METHODS

From July 2009 to October 2010, all parents of newborns (n = 1162) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to a dental examination in Jena University Hospital. Participating children were included in a risk-related recall system with continuous oral care over 3 years. Caries-risk assessment tool of the AAPD was used for risk categorizing. High-risk children received fluoride varnish biannual. In 2013, the total birth cohort (participants and non-participants) was invited to evaluate the PP. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Data were analysed statistically (multivariate logistic regression).

RESULTS

Seven hundred fifty-five children (mean age 3.26 ± 0.51 years) were examined. Children in the PP (n = 377) showed significantly lower caries prevalence and experience than non-participants (15.6 vs. 37.8 %, 0.9 ± 3.3 d_1-4mfs vs. 2.6 ± 5.2 d_1-4mfs). Lack of vitamin D supplements (OR = 1.9, CI 0.99-3.51), familial caries experience (OR = 2.2, CI 1.27-3.73) and visible plaque on teeth (OR = 6.5, CI 4.41-9.43) were significant risk factors for caries development, whereas regular dental care (OR = 0.5, CI 0.38-0.79) had a protective effect.

CONCLUSIONS

The PP was an effective interdisciplinary approach for preventing early childhood caries in small children.

CLINICAL RELEVANCE

Early dental visits with caries-risk-related preventive dental care are necessary to prevent early childhood caries (ECC).

TRIAL REGISTRATION

German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Vitamin D and Dental Caries in Children

The purpose of this study was to assess the relationship between vitamin D status and dental caries in Canadian school-aged children participating in the Canadian Health Measures Survey (CHMS). The CHMS was a national cross-sectional study involving physical assessments, laboratory analysis, and interviews. Analysis was restricted to data for 1,017 children 6 to 11 y of age. Outcome variables included the presence of caries and overall total caries score (dmft/DMFT index). Levels of 25-hydroxyvitamin D (25(OH)D) were measured from serum samples obtained from participants. Bivariate analysis, logistic regression for the presence of caries, and multiple linear regression for total caries scores were used. Significance was set at P ≤ 0.05. Overall, 56.4% of children experienced caries, and the mean dmft/DMFT score was 2.47 (95% CI 2.09 to 2.84). The unadjusted odds of children with 25(OH)D levels ≥75 nmol/L having experienced caries was 0.57 (95% CI 0.39 to 0.82), while the odds for caries at the ≥50 nmol/L level was 0.56 (95% CI 0.39 to 0.89). After controlling for other covariates, backward logistic regression revealed that the presence of caries was significantly associated with 25(OH) levels <75 nmol/L and <50 nmol/L, lower household education, not brushing twice daily, and yearly visits to the dentist. Similarly, multiple linear regression revealed that total dmft/DMFT caries scores were also associated with 25(OH)D concentrations <75 nmol/L, not brushing twice daily, lower household education, and yearly visits to the dentist. Data from a cross-sectional, nationally representative sample of Canadian children suggest that there is an association between caries and lower serum vitamin D. Improving children’s vitamin D status may be an additional preventive consideration to lower the risk for caries.