Morphological and immunocytochemical analyses on the effects of diet-induced hypocalcemia on enamel maturation in the rat incisor

Surface and Structural Studies of Age-Related Changes in Dental Enamel: An Animal Model

In the animal kingdom, continuously erupting incisors provided an attractive model for studying the enamel matrix and mineral composition of teeth during development. Enamel, the hardest mineral tissue in the vertebrates, is a tissue sensitive to external conditions, reflecting various disturbances in its structure. The developing dental enamel was monitored in a series of incisor samples extending the first four weeks of postnatal life in the spiny mouse. The age-dependent changes in enamel surface morphology in the micrometre and nanometre-scale and a qualitative assessment of its mechanical features were examined by applying scanning electron microscopy (SEM) and atomic force microscopy (AFM). At the same time, structural studies using XRD and vibrational spectroscopy made it possible to assess crystallinity and carbonate content in enamel mineral composition. Finally, a model for predicting the maturation based on chemical composition and structural factors was constructed using artificial neural networks (ANNs). The research presented here can extend the existing knowledge by proposing a pattern of enamel development that could be used as a comparative material in environmental, nutritional, and pharmaceutical research.

Does age estimated from teeth forming in different early life periods show differential discrepancy with known age?

OBJECTIVES

The aim of this study is to explore growth discrepancies in the dentition of impoverished children and examine how dental development is impacted by environmental influences throughout childhood, thereby identifying which teeth are more sensitive to the effects of biocultural factors and are consequently less useful to predict age.

METHODS

Length measurements of developing teeth (deciduous and permanent) were taken from individuals of known age and sex (n = 61) from the Certosa collection, a 19th century skeletal assemblage representing Italian children of low socioeconomic status. Discrepancies between age estimates based on tooth length and chronological age were calculated, and the accuracy and precision of age prediction between earlier forming teeth and later forming teeth were compared.

RESULTS

Deciduous teeth produced more precise dental age estimates (mean age discrepancy -0.092 years), while discrepancies between chronological age and age based on developing permanent dentition were larger (-0.628 years). The difference between these discrepancies in age estimates for deciduous and permanent teeth was significant (p < 0.001), indicating that age prediction from deciduous tooth length is more accurate than age predicted using permanent tooth length.

CONCLUSION

An increasing variation and delay in tooth length for age reflects increasing susceptibility to biocultural factors, which impacts tooth growth during the course of childhood. Teeth whose development occurs earlier in life are less variable in their growth and provide more accurate estimations of age as a result.

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.

Altered Ca2+ signaling in enamelopathies

Biomineralization requires the controlled movement of ions across cell barriers to reach the sites of crystal growth. Mineral precipitation occurs in aqueous phases as fluids become supersaturated with specific ionic compositions. In the biological world, biomineralization is dominated by the presence of calcium (Ca²⁺) in crystal lattices. Ca²⁺ channels are intrinsic modulators of this process, facilitating the availability of Ca²⁺ within cells in a tightly regulated manner in time and space. Unequivocally, the most mineralized tissue produced by vertebrates, past and present, is dental enamel. With some of the longest carbonated hydroxyapatite (Hap) crystals known, dental enamel formation is fully coordinated by specialized epithelial cells of ectodermal origin known as ameloblasts. These cells form enamel in two main developmental stages: a) secretory; and b) maturation. The secretory stage is marked by volumetric growth of the tissue with limited mineralization, and the opposite is found in the maturation stage, as enamel crystals expand in width concomitant with increased ion transport. Disruptions in the formation and/or mineralization stages result, in most cases, in permanent alterations in the crystal assembly. This introduces weaknesses in the material properties affecting enamel's hardness and durability, thus limiting its efficacy as a biting, chewing tool and increasing the possibility of pathology. Here, we briefly review enamel development and discuss key properties of ameloblasts and their Ca²⁺-handling machinery, and how alterations in this toolkit result in enamelopathies.

Oral pathology in inflammatory bowel disease

The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Factors associated with molar incisor hypomineralization in Thai children

Molar incisor hypomineralization (MIH) is a qualitative developmental enamel defect that affects one to four permanent first molars, with or without involvement of permanent incisors. Its etiology is of systemic origin, but is not well understood. Therefore, we conducted this cross-sectional study to examine pre-, peri-, and postnatal risk factors for MIH among children, 7-8 yr of age, in urban areas of Khon Kaen, Thailand. Molar incisor hypomineralization defects were diagnosed using the European Academy of Pediatric Dentistry criteria. Mothers or primary caregivers were interviewed on maternal medical history and habits during pregnancy, pregnancy and delivery complications, and the child's medical history. Molar incisor hypomineralization defects were observed in 78 (27.7%) of 282 children. Multiple logistic regression analysis showed a statistically significant association between the development of MIH and Cesarean section (adjusted OR = 2.0, 95% CI = 1.1-3.7), complications during vaginal delivery (adjusted OR = 4.5, 95% CI = 1.9-11.0), and severe/chronic illness when under 3 yr of age (adjusted OR = 2.9, 95% CI = 1.6-5.0). There was no association of preterm birth and low birth weight with MIH. The results suggest that Cesarean section, complications during vaginal delivery, and poor health during the first 3 yr of life are independent risk factors for MIH.

Effect of high phosphorus diet on tooth microstructure of rodent incisors

Enamel hypoplasia and disruption of dentinogenesis are the most common abnormalities of development and mineralization of human teeth. Several reports are available in the literature on the influence of dietary calcium on the formation of human and rodent tooth; however, the information about the influence of dietary phosphorus on the tooth formation is scarce. The aim of the present investigation was to examine the chronic effect of high phosphorus diet and improper dietary calcium to phosphorus ratio on the mandibular incisor microstructure in a hystricomorph rodent--Octodon degu--using macroscopic observation, histopathological examination, transmission and scanning electron microscopy. The present study shows that enamel and dentin development is disturbed under high phosphorus diet and improper calcium to phosphorus ratio. Disturbed mineral metabolism resulted in enamel depigmentation, enamel hypoplasia, enamel pitting and altered dentin morphology. The results suggest that more attention should be focused on dietary phosphorus content when facing altered tooth structure in young patients with deciduous or permanent dentition. Furthermore, we showed that degus can be used as an experimental animal model for the study of the developmental teeth disturbances.

Aetiology of Molar-Incisor Hypomineralisation: A systematic review

AIM

This was to review and assess the studies on aetiology of Molar-Incisor Hypomineralisation (MIH) or, as a proxy, of demarcated opacities in permanent first molars and to consider the potential factors involved with findings obtained in animal experiments.

METHODS

A systematic search by Medline online database was performed. Abstracts behind appropriate titles were studied and finally the full articles were evaluated for their strength of evidence in the aetiology of MIH.

RESULTS

From a total of 1,142 articles 28 were identified and selected for review. The selected papers covered medical problems in prenatal, perinatal and postnatal period, medication of the child during the first years of life, and exposure to fluoride or environmental toxicants (dioxins and PCBs) in the early childhood. Based on the assessment of the articles it was still not possible to specifically name those factors causing MIH although correlations between several potential factors and MIH were presented. Among the factors suggested and found to cause enamel defects in animal experiments were: high fever, hypoxia, hypocalcaemia, exposure to antibiotics (amoxicillin, a macrolide), and dioxins.

CONCLUSION

Despite increased knowledge on the aetiology of MIH insufficient evidence to verify the causative factors exists. Further studies, especially prospective ones, are needed to improve the level and strength of evidence of the role of the present putative factors and to reveal new factors that may be involved. Any combined effect of several factors should be taken into account. Experimental dose/response studies and research on the molecular mechanisms causing the abnormal function of the ameloblasts are also necessary to deepen our knowledge of MIH.

Chemical, mechanical and morphological properties of hypomineralized enamel of permanent first molars

OBJECTIVE

The microstructure of hypomineralized enamel in permanent teeth has been described in several studies as less distinct prism sheaths and disorganized enamel with lack of organization of the enamel crystals. The mechanical properties, hardness and modulus of elasticity of the hypomineralized enamel have lower values compared with normal. The aim of this study was to examine normal and hypomineralized enamel using scanning electron microscopy (SEM), hardness measurements and X-ray microanalysis (XRMA).

MATERIAL AND METHODS

Four extracted hypomineralized permanent first molars, sectioned and cut in half, were analyzed with SEM, XRMA and hardness measurements.

RESULTS

An inverse relation was found between the micro hardness and the Ca:C ratio in hypomineralized and normal enamel. The acid-etched hypomineralized enamel appeared on SEM to be covered with a structureless layer and the prisms appeared disorganized, with thick prism sheaths and loosely packed crystallites. Furthermore, bacteria were found deep in porous hypomineralized enamel close to the enamel-dentin junction.

CONCLUSIONS

Teeth diagnosed with molar incisor hypomineralization have significantly lower hardness values in the hypomineralized enamel compared with normal enamel. The hardness values vary according to the morphological and chemical properties.

Histomorphometric and microchemical characterization of maturing dental enamel in rats fed a boron-deficient diet

Few reports are available in the literature on enamel formation under nutritional deficiencies. Thus, we performed a study to determine the effects of boron (B) deficiency on the maturing dental enamel, employing the rat continuously erupting incisor as the experimental model. Male Wistar rats, 21 days old, were used throughout. They were divided into two groups, each containing ten animals: +B (adequate; 3-mg B/kg diet) and -B (boron deficient; 0.07-mg B/kg diet). The animals were maintained on their respective diets for 14 days and then euthanized. The mandibles were resected, fixed, and processed for embedding in paraffin and/or methyl methacrylate. Oriented histological sections of the continuously erupting incisor were obtained at the level of the mesial root of the first molar, allowing access to the maturation zone of the developing enamel. Dietary treatment did not affect food intake and body weight. Histomorphometric evaluation using undecalcified sections showed a reduction in enamel thickness (hypoplasia), whereas microchemical characterization by energy-dispersive X-ray spectrometry did not reveal alterations in enamel mineralization.

Molar-incisor-hypomineralisation (MIH). A retrospective clinical study in Greek children. II. Possible medical aetiological factors

AIM

This was to examine the potential medical aetiological factors involved in the development of MIH.

METHODS

During the years 2003--2005, all MIH cases diagnosed according to set criteria were selected from the new patients clinic of a Community Dental Centre for Children (Athens). The age, gender and teeth involved were recorded. A control group of socio-demographically matched controls was also identified. The potential aetiological factors were retrieved through personal interview with the parents and from each child and mother's medical book. Only verified aetiological factors were recorded. Evaluation of the correlation of affected teeth and the timing of the insult was performed in a separate group of 225 affected children aged 8-12 with their entire 12 'index' teeth erupted.

RESULTS

From the 3,518, 5.5 to 12 years old children examined, 360 (10.2%) had MIH. Aetiology of MIH: 44 children (12.2%), presented without any relevant medical history, the remaining 316 (87.8%) recorded various medical problems associated with MIH, compared with 18.9% for controls. Perinatal (163, 33.6%) and postnatal (162, 33.9%) problems were the most frequently found and prenatal the least (33, 8.6%). For 42 children (11.7%) problems occurred in more than one chronological period, mainly during both the perinatal and postnatal period (11.1%). The most common prenatal problem was repeated episodes of high fever (12/33), in the perinatal period birth by Caesarean section (92/163) and other birth complications (34/163). Various respiratory conditions (88/162), repeated episodes of high fever (31/162) and neonatal illness (28/162) were the commonly reported problems in the postnatal period. Many MIH cases presented with more than one medical problem during the peri-and postnatal period.

STATISTICAL ANALYSIS

Children with MIH recorded 68.9% more frequent medical problems than controls (p<0.0001). A positive correlation (p<0.001) between the total number and type of affected teeth with the timing of the insult was observed in the 225 MIH children with all their 'index' teeth erupted.

CONCLUSION

Children with MIH present with more medical problems than controls during their prenatal, perinatal and postnatal period. The majority of these illnesses may produce hypocalcaemia, hypoxia and pyrexia to the child or the mother. The number of affected teeth was associated with the timing of the possible insult; children with prenatal, perinatal and postnatal problems present more affected teeth in increasing order.

Ultrastructure and composition of basement membrane separating mature ameloblasts from enamel

At a late stage of amelogenesis, a basement-membrane-like (BML) structure appears between mature ameloblasts and the enamel surface. Although this BML structure is known to contain certain basement membrane components, its detailed nature and role were not well defined. As such, this study examined the BML structure using high-resolution electron microscopy combined with immunohistochemical staining. Mandibular rat incisors were processed for the preparation of Epon sections for ultrastructural observations, and frozen sections were used for immunostaining laminin, heparan sulphate proteoglycan (HSPG) and type IV collagen. The BML structure was characterized by the presence of abundant ribbon-like 'double tracks', 4.5-5.0 nm wide; the form known to be taken by HSPG in basal laminae. The main ultrastructural component of basal laminae, known as 'cords', was replaced by fine filaments of type IV collagen. Immunohistochemical staining of the BML structure showed an intense reaction for HSPG, moderate staining for type IV collagen and negligible staining for laminin. These observations indicate that this structure is an atypical basement membrane in which the cord network is replaced by type IV collagen filaments. However, the BML structure was found to be unusually rich in HSPG, similar to kidney glomerular basement membrane. It is likely that this specialized basement membrane mediates firm attachment of mature ameloblasts to the enamel surface, and filters the influx and efflux of materials to and from enamel during maturation.

Changes in amelogenesis in the rat incisor following short-term hypocalcaemia

There is a relationship between hypocalcaemia and the enamel hypoplasia. Earlier studies in rats have reported a severe hypocalcaemia and enamel hypoplasia a month after thyro-parathyroidectomy (TPTX). The aims of this study were to look at earlier stages and to attempt to correlate morphological changes with alterations in the distribution of amelogenin. Twenty-five Wistar rats were, under anaesthesia, thyro-parathyroidectomized. Sham operated rats were included as controls. After 14, 30 or 57 days, the animals were reanesthatized and the tissues fixed by intracardiac perfusion of fixative. The lower incisors were processed for light microscopy and immunogold electron microscopy. After 14 days the thyro-parathyroidectomised rats were severely hypocalcaemic but amelogenesis was morphologically similar to controls. After 30 and 57 days, enamel defects were observed in the late secretory and early maturation stages in the thyro-parathyroidectomised rats. The immunocytochemical study revealed a concentration of stippled material immunolabelled for amelogenin at the secretory pole of the ameloblasts in the hypocalcaemic rats. The absence of enamel defects after 14 days suggests that this was an insufficient hypocalcaemic period to induce morphological alterations. The concentration of stippled material containing amelogenin suggests that alterations in matrix formation may be the basis of the morphological changes.

Identification of the calcium-sensing receptor in the developing tooth organ

Calcium (Ca2+) is a critical component of tooth enamel, dentin, and the surrounding extracellular matrix. Ca2+ also may regulate tooth formation, although the mechanisms for such action are poorly understood. The Ca2+-sensing receptor (CaR) that is expressed in the parathyroid gland, kidney, bone, and cartilage has provided a mechanism by which extracellular Ca2+ can regulate cell function. Because these tissues play an important role in maintaining mineral homeostasis and because Ca2+ is hypothesized to play a crucial role in tooth formation, we determined whether the CaR was present in teeth. In this study, using immunohistochemistry, CaR protein was detected in developing porcine molars localized in the predentin (pD), early secretory-stage ameloblasts, maturation-stage smooth-ended ameloblasts (SA), and certain cells in the stratum intermedium. CaR protein and messenger RNA (mRNA) were detected also in an immortalized ameloblast-like cell line (PABSo-E) using immunofluorescence, reverse-transcription polymerase chain reaction (RT-PCR), and Northern analysis. Based on the observation that the CaR is expressed in cultured ameloblasts, we determined whether increments in medium Ca2+ concentration could activate the intracellular Ca2+ signal transduction pathway. In PABSo-E cells, increasing extracellular Ca2+ in the medium from 0 (baseline) to 2.5mM or 5.0 mM resulted in an increase in intracellular Ca2+ above baseline to 534 +/- 69 nM and 838 +/- 86 nM, respectively. Taken together, these results suggest that the CaR is expressed in developing teeth and may provide a mechanism by which these cells can respond to alterations in extracellular Ca2+ to regulate cell function and, ultimately, tooth formation.

Localized infusion of tunicamycin in rat hemimandibles: alteration of the basal lamina associated with maturation stage ameloblasts

At the beginning of the maturation stage of amelogenesis, ameloblasts deposit a basal lamina (BL) at the interface between their apical surface and maturing enamel. This structure is rich in glycoconjugates and is proposed to exhibit adhesive and/or filtering functions. To clarify its role, we have applied a recently developed surgical window model to locally administer tunicamycin (TM), an antibiotic that interferes with N-glycosylation, in the rat hemimandible using an osmotic minipump. Male Wistar rats were infused with either TM or saline as a control. Lectin-gold cytochemistry was performed to reveal glycoconjugates in the BL. Immunogold labeling of enamel proteins and albumin was carried out to verify whether depletion of N-linked sugars in the BL affects the content and distribution of endogenous and exogenous proteins in the enamel layer. Under the influence of the drug, the BL became irregular and exhibited alterations in structural organization and composition. The number of Helix pomatia agglutinin binding sites was not significantly affected but their distribution was altered. The labeling density of wheat germ agglutinin over the BL was slightly reduced. Immunoreactivity for enamel proteins showed only a small decrease, but that of albumin, both between ameloblasts and within the enamel layer, increased significantly. No structural alterations were observed in the contralateral incisor and in other sampled tissues and organs. These results demonstrate that it is possible to achieve a localized administration of TM without systemic side effects and lend support to the proposal that the BL represents a specialized structure with filtering functions.(J Histochem Cytochem 49:165-176, 2001)

A histomorphometric, structural, and immunocytochemical study of the effects of diet-induced hypocalcemia on bone in growing rats

Despite several studies on the effect of calcium deficiency on bone status, there is relatively little information on the ensuing histological alterations. To investigate bone changes during chronic hypocalcemia, weanling rats were kept on a calcium-free diet and deionized water for 28 days while control animals were fed normal chow. The epiphyseal-metaphyseal region of the tibiae were processed for histomorphometric, histochemical, and structural analyses. The distribution of bone sialoprotein (BSP), osteocalcin (OC), and osteopontin (OPN), three noncollagenous bone matrix proteins implicated in cell-matrix interactions and regulation of mineral deposition, was examined using postembedding colloidal gold immunocytochemistry. The experimental regimen resulted in serum calcium levels almost half those of control rats. Trabecular bone volume showed no change but osteoid exhibited a significant increase in all its variables. There were a multitude of mineralization foci in the widened osteoid seam, and intact matrix vesicles were observed in the forming bone. Many of the osteoblasts apposed to osteoid were tartrate-resistant acid phosphatase (TRAP)- and alkaline phosphatase-positive, whereas controls showed few such TRAP-reactive cells. Osteoclasts in hypocalcemic rats generally exhibited poorly developed ruffled borders and were inconsistently apposed to bony surfaces showing a lamina limitans. Sometimes osteoclasts were in contact with osteoid, suggesting that they may resorb uncalcified matrix. Cement lines at the bone-calcified cartilage interface in some cases were thickened but generally did not appear affected at bone-bone interfaces. As in controls, electron-dense portions of the mineralized matrix showed labeling for BSP, OC, and OPN but, in contrast, there was an abundance of immunoreactive mineralization foci in osteoid of hypocalcemic rats. These data suggest that chronic hypocalcemia affects both bone formation and resorption.