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Dontsop M, Nwankwo K, Walker R, Potter C, Chen CK, Bol R, Sherden L, Gangula PR, Farmer-Dixon C. Investigating the relationship between dental cavities and protective factors among children aged 0-5 years. J Clin Pediatr Dent 2024; 48:60-68. [PMID: 38239157 PMCID: PMC10962213 DOI: 10.22514/jocpd.2024.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 01/23/2024] Open
Abstract
The purpose of this study was to determine the protective factors that contribute to the prevention of children aged 0-5 years from developing dental cavities. The oral hygiene practices of 266 children aged 0-5 years were assessed through surveys administered from 2019 to 2022 to identify clinical, dietary, social and parental factors. The Partial Least Squares (PLS) Regression and Artificial Neuron Networks (ANN) Models were used to determine protective factors associated with the prevention of dental cavities in children. The race distribution of the children as identified by caregivers is as follows: (1) Black or African-American (53.4%); (2) Asian (25.9%); (3) White (18.4%); and (4) Native American (2.3%). We found behavioral protective factors to significantly affect the oral health outcome (cavities) among children aged 0-5 years (p < 0.05). We also found that children whose parents/caregivers flossed their teeth were less likely to develop cavities. In addition, children were least likely to have cavities if their parents/caregivers used toothpaste and mouthwash, avoided sharing chewed food, and refrained from drinking 100% juice. In contrast, children were more likely to obtain cavities if their parents/caregivers had a lower education level, rarely cleaned their teeth, and often consumed marijuana, cow or goat milk, juice drinks and sugary beverages. The education level of parents, and on the contrary, oral hygiene practices of the family, play a significant role in influencing the prevalence of cavities in children aged 0-5 years.
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Affiliation(s)
- Marlene Dontsop
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Kyle Nwankwo
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Riva Walker
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Christianna Potter
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Chau-Kuang Chen
- School of Graduate Studies, Meharry Medical College, Nashville, TN 37208, USA
| | - Ruth Bol
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Lisa Sherden
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Pandu R Gangula
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Cherae Farmer-Dixon
- Department of Dental Public Health, School of Dentistry, Meharry Medical College, Nashville, TN 37208, USA
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Samuel SR, Lai CWM, Khan MM, Mathew MG, Kramer MS, Hsu CYS. Gestational Serum Retinol Deficiency Is Associated with Enamel Hypoplasia. J Dent Res 2023; 102:1417-1424. [PMID: 37899507 DOI: 10.1177/00220345231200788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Enamel hypoplasia (EH) is a prevalent developmental defect of teeth that can result from various insults, including prenatal nutrient deficiencies. This study aimed to evaluate the association between prenatal serum retinol deficiency and EH in the deciduous teeth of offspring at 2-y of age. A cohort of 1,450 pregnant women was enrolled, and their prenatal nutritional status was assessed between 12 and 14 wk of gestation. Maternal serum retinol, serum 25-hydroxyvitamin D (25OHD), hemoglobin, body mass index, and birth outcomes, infant feeding practices, family socioeconomic status, and demographic information were recorded. Oral health examinations were conducted for the children semiannually, and EH was diagnosed using the Modified DDE index on all the surfaces of erupted teeth. A modified Poisson regression analysis was used to assess the cumulative risk of EH over a period of 2-y. A total of 920 (63.4%) mother-child pairs completed the study, and the cumulative EH prevalence among offspring after 2-y of follow-up was 16.5% (N = 152; 87/1,114 children in the first year and 132/920 in the second year, with 20/920 having EH only in the first year). After adjusting for potential confounders, maternal serum retinol deficiency significantly increased the risk of deciduous EH (risk ratio [RR], 2.0; 95% confidence interval [CI], 1.1-3.7). In addition, deficient serum 25OHD (RR, 6.5; 95% CI, 4.0-10.7), caesarean delivery (RR, 1.6; 95% CI, 1.0-2.4), Muslim (RR, 2.9; 95% CI, 2.0-4.1) and Christian (RR, 2.4; 95% CI, 1.6-3.5) versus Hindu religions, and very preterm birth (RR, 1.7; 95% CI, 1.1-2.9) increased the risk of EH. Children presenting with EH had 2 or more teeth affected, and the maxillary incisors were the most frequently affected, followed by the first primary molars and canines. In conclusion, maternal serum retinol deficiency during the 12 to 14 wk of gestation may increase the risk of deciduous EH, besides the well-established 25OHD deficiency.
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Affiliation(s)
- S R Samuel
- The Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - C W M Lai
- Faculty of Dentistry, National University of Singapore, Singapore
| | - M M Khan
- Department of Pediatric Dentistry, Taif University, Taif, Saudi Arabia
| | - M G Mathew
- Pediatric and Preventive Dentistry, Christian Dental College, Ludhiana, Punjab, India
| | - M S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University Faculty of Medicine, Montreal, Canada
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C-Y S Hsu
- Faculty of Dentistry, National University of Singapore, Singapore
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Salami A, El Karim I, Lundy F, Loney T, Donaldson M, O'Neill C. An exploratory study of maternal diabetes and offspring use of dental services-Northern Ireland national cohort study. BDJ Open 2023; 9:14. [PMID: 37037830 PMCID: PMC10085974 DOI: 10.1038/s41405-023-00140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 04/12/2023] Open
Abstract
INTRODUCTION A small number of literature has posited a link between prenatal exposure to gestational diabetes mellitus and an increased risk of developmental defects in the enamel of offspring. However, the evidence remains inconclusive. AIMS This study examined the relationship between the diabetes status of mothers and the use of dental services by offspring to that pregnancy. MATERIAL AND METHODS Anonymised data from a cohort of mothers who carried a child to term in Northern Ireland between 2012 and 2017 and service use by the child were taken from administrative databases from March 2015 to September 2021. Descriptive statistics, differences in means and regression analyses were used to examine the relationship between service use and maternal diabetes status, controlling for covariates. RESULTS In multivariate analyses that controlled inter alia for age and deprivation, diabetes status was negatively related to restoration, extraction, prevention, and total service use. In the analysis of the COVID period, pre-COVID prevention was negatively related to extractions, restorations, prevention and services in general. CONCLUSION The relationship between maternal diabetic status and aspects of offspring use of dental services was contrary to that suggested in previous studies and warrants more detailed investigation using this valuable data resource.
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Affiliation(s)
- Anas Salami
- School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK.
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Ikhlas El Karim
- School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Fionnuala Lundy
- School of Medicine Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Michael Donaldson
- Department of Health, Strategic Planning and Performance Group, London, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Vélez-León E, Albaladejo-Martínez A, Pacheco-Quito EM, Armas-Vega A, Delgado-Gaete A, Pesántez-Ochoa D, Melo M. Developmental Enamel Defects in Children from the Southern Region of Ecuador. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111755. [PMID: 36421204 PMCID: PMC9688757 DOI: 10.3390/children9111755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Developmental defects of enamel (DDEs) are widely observed in children and are related to the appearance of dental caries, malocclusion, tooth sensitivity, and unfavorable esthetic conditions. The objective of this cross-sectional study was to determine the prevalence and distribution of enamel defects present in children aged 6 to 12 years in the provinces located in southern Ecuador. A total of 1606 schoolchildren were examined under the World Health Organization criteria for diagnosis of DDEs. The results are presented using percentage frequency measures and chi-square associations. Some types of DDEs were presented by 50% of the schoolchildren, mainly diffuse opacity, with no statistical differences according to place of residence and/or environment, sex, and age (p > 0.05). In Ecuador, it is necessary to carry out studies on the factors that trigger enamel defects, since they may be associated with the high prevalence of caries already reported in other studies in the country.
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Affiliation(s)
- Eleonor Vélez-León
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Correspondence: ; Tel.: +593-95-898-8373
| | | | - Edisson-Mauricio Pacheco-Quito
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
| | - Ana Armas-Vega
- School of Dentistry, Hemisferios University, Quito 170527, Ecuador
| | - Andrés Delgado-Gaete
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
| | | | - María Melo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
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Tolomeu JSO, Soares MEC, Mourão PS, Ramos-Jorge ML. Is gestational diabetes mellitus associated with developmental defects of enamel in children? A systematic review with meta-analysis. Arch Oral Biol 2022; 141:105488. [PMID: 35802995 DOI: 10.1016/j.archoralbio.2022.105488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The present systematic review aimed to verify the association between Gestational Diabetes Mellitus (GDM) and Developmental Defects of Enamel (DDE) in children. Design A systematic search was conducted in four databases and the grey literature. The risk of bias of the studies was analyzed with the aid of the Newcastle-Ottawa scale. A quantitative synthesis was performed through meta-analysis. The quality of the evidence was assessed for each result using the Grading of Recommendations: Assessment, Development and Evaluation approach. RESULTS Thirteen studies (seven cross-sectional, two cohort and four case-control studies) were included in the qualitative analysis and eleven were included in the meta-analyses. Meta-analyses were conducted considering general DDE (regardless of the type of defect), hypoplasia, molar incisor hypomineralization (MIH) and hypomineralized primary second molars (HPSM). Subgroups based on the type of dentition were also analyzed. Children of mothers who had GDM presented a greater likelihood of general DDE (OR = 2.72; 95% CI: 1.66-4.44), MIH (OR = 3.14; 95% CI: 1.20-8.25) and hypoplasia (OR = 2.17; 95% CI: 1.36-3.46). No association was found between HPSM and GDM (OR = 0.60; 95% CI: 0.17-2.20). An association was found between GDM and DDE in the permanent dentition. Therefore, children whose mothers had GDM were more likely to present DDE compared to those whose mothers did not have this metabolic disorder. CONCLUSIONS The results should be interpreted with caution due to the low evidence of the primary studies.
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Affiliation(s)
- Jéssica Samara Oliveira Tolomeu
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
| | - Maria Eliza Consolação Soares
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil.
| | - Priscila Seixas Mourão
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
| | - Maria Letícia Ramos-Jorge
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória, 187, Centro, Diamantina, Minas Gerais, Brazil
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Collignon AM, Vergnes JN, Germa A, Azogui S, Breinig S, Hollande C, Bonnet AL, Nabet C. Factors and Mechanisms Involved in Acquired Developmental Defects of Enamel: A Scoping Review. Front Pediatr 2022; 10:836708. [PMID: 35281236 PMCID: PMC8907975 DOI: 10.3389/fped.2022.836708] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Developmental Defects of Enamel (DDE) is a pathology of the teeth that can greatly alter the quality of life of patients (hypersensitivity, esthetic issues, loss of function, etc.). The acquired DDE may occur as a result of a wide range of acquired etiological factors and his prevalence of this pathology may reach up to 89.9%. The main objective of this research was to identify and analyze, in current literature, the factors related to acquired DDE, in order to propose a general theory about the mechanisms involved. METHODS The search of the primary literature was conducted until [December 31, 2021]. Our search strategy uses the Pubmed/MEDLINE database and was structured around 3 terms ["Development," "Defect," and "Enamel"]. To be included, references had to be primary studies, written in English. Exclusion criteria were reviews, in vitro, animal, genetic or archeology studies, and studies focused on clinical management of DDE. One hundred and twenty three articles were included in this scoping review: 4 Randomized clinical trials, 1 letter, 5 cases reports, 2 fundamentals studies, and 111 observational studies (33 Cross-sectional studies, 68 Cohort study and 10 Case-control study). The quality of evidence was assessed using the PEDro scale for clinical trials, the Newcastle-Ottawa scale for observational studies, and a published tool to assess the quality of case reports and case series. RESULTS A scoping review of the literature identified 114 factors potentially involved in acquired DDE. The most frequently encountered pathologies are those causing a disorder of calcium homeostasis or a perturbation of the ARNT pathway in mother or child. The link between the ARNT pathway and metabolism deficiency in uncertain and needs to be defined. Also, the implication of this mechanism in tissue impairment is still unclear and needs to be explored. CONCLUSIONS By identifying and grouping the risk factors cited in the literature, this taxonomy and the hypotheses related to the mechanism allow health practitioners to adopt behaviors that limit the risk of developing aDDE and to set up a prevention of dental pathology. In addition, by reviewing the current literature, this work provides guidance for basic research, clinical studies, and literature searches.
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Affiliation(s)
- Anne-Margaux Collignon
- URP 2496 Laboratory Orofacial Pathologies, Imaging, and Biotherapies and Life Imaging Platform (PIV), Montrouge, France.,Department of Odontology, AP-HP, Paris, France.,Dental School Faculty, Paris University, Paris, France.,Department of Epidemiology, Public Health, Prevention and Legislation, Dental Faculty, Toulouse University Hospital, Paul Sabatier University, Toulouse, France
| | - Jean-Noël Vergnes
- Department of Epidemiology, Public Health, Prevention and Legislation, Dental Faculty, Toulouse University Hospital, Paul Sabatier University, Toulouse, France.,Inserm UMR 1295 CERPOP, Toulouse University, Toulouse, France
| | - Alice Germa
- Department of Odontology, AP-HP, Paris, France.,Dental School Faculty, Paris University, Paris, France.,CRESS, EPOPE Team, INSERM, INRA, Paris, France
| | - Sylvie Azogui
- Department of Odontology, AP-HP, Paris, France.,Dental School Faculty, Paris University, Paris, France.,Education and Health Practices Laboratory (LEPS) (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Sophie Breinig
- Inserm UMR 1295 CERPOP, Toulouse University, Toulouse, France.,Pediatric and Neonatal Intensive Care Unit, CHU Toulouse, Toulouse, France
| | - Clémence Hollande
- Department of Hepatology, Université de Paris Centre, Hôpital Beaujon, AP-HP, Paris, France
| | - Anne-Laure Bonnet
- URP 2496 Laboratory Orofacial Pathologies, Imaging, and Biotherapies and Life Imaging Platform (PIV), Montrouge, France.,Department of Odontology, AP-HP, Paris, France.,Dental School Faculty, Paris University, Paris, France
| | - Cathy Nabet
- Department of Epidemiology, Public Health, Prevention and Legislation, Dental Faculty, Toulouse University Hospital, Paul Sabatier University, Toulouse, France.,Inserm UMR 1295 CERPOP, Toulouse University, Toulouse, France
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Lima LJS, Ramos-Jorge ML, Soares MEC. Prenatal, perinatal and postnatal events associated with hypomineralized second primary molar: a systematic review with meta-analysis. Clin Oral Investig 2021; 25:6501-6516. [PMID: 34414520 DOI: 10.1007/s00784-021-04146-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The etiology of hypomineralized second primary molar (HSPM) appears to be multifactorial but remains uncertain. Thus, the objective was to systematically review studies that investigated adverse health conditions in the prenatal, perinatal and postnatal periods associated with HSPM. MATERIAL AND METHODS The search was carried out in five databases and in gray literature. The risk of bias of observational studies was analyzed according to the Newcastle-Ottawa scale. RESULTS A total of 1878 studies were identified. Fourteen were eligible, and seven were included in the meta-analysis. Maternal smoking (OR = 2.88; 95%CI: 1.62-5.15) and presence of maternal hypertension (OR = 2.91; 95%CI: 1.35-6.28) were significantly associated with higher odds of HSPM. In the perinatal period, factors associated with HSPM were low birth weight (OR = 1.50; 95%CI: 1.15-1.96), prematurity (OR = 1.93; 95%CI: 1.37-2.71), delivery complications (OR = 2.42; 95%CI: 1.52-3.83) and need for an incubator (OR = 1.65; 95%CI: 1.01-2.70). Not breastfeeding (OR = 1.26; 95%CI: 1.01-1.58), use of antibiotics by the child (OR = 1.24; 95%CI: 1.04-1.48), fever (OR = 1.37; 95%CI: 1.10-1.72) and asthma (OR = 1.91; 95%CI: 1.16-3.13) were the postnatal factors associated with HSPM. CONCLUSION Maternal smoking, maternal hypertension, low birth weight, prematurity, delivery complications, need for incubation, not breastfeeding, antibiotic use, fever and childhood asthma were associated with HSPM. Well-designed prospective cohort studies are needed. Clinical relevance Understanding the etiological factors can be guiding aspects for individual clinical approaches, as well as guiding the design of preventive interventions for HSPM.
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Affiliation(s)
- Laura Jordana Santos Lima
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, n. 187, Centro, Diamantina, Minas Gerais, Brazil.
| | - Maria Letícia Ramos-Jorge
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, n. 187, Centro, Diamantina, Minas Gerais, Brazil
| | - Maria Eliza Consolação Soares
- Department of Dentistry, School of Biological and Health Sciences, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Rua da Glória, n. 187, Centro, Diamantina, Minas Gerais, Brazil
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Dourado DG, Lima CCB, Silva RNC, Tajra FS, Moura MS, Lopes TSP, De Deus Moura LDFA, de Lima MDDM. Molar-incisor hypomineralization in quilombola children and adolescents: A study of prevalence and associated factors. J Public Health Dent 2020; 81:178-187. [PMID: 33215714 DOI: 10.1111/jphd.12429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This cross-sectional observational study determined the prevalence and factors associated with molar-incisive hypomineralization (MIH) in quilombola children and adolescents in north-eastern Brazil. METHODS The sample consisted of 251 children and adolescents (8 to 14 years old) living in the rural quilombola community Lagoas in São Raimundo Nonato, Piauí (census population). Sociodemographic and health-related data were collected from pre-, peri- and post-natal health records and a clinical examination for MIH diagnosis was performed by four previously trained and calibrated examiners. Descriptive data analysis and Poisson regression were performed. The magnitude of the association was determined by adjusted prevalence ratio (PR) and confidence intervals (95% CI). RESULTS The prevalence of MIH was 46.6%. The presence of MIH was associated with gestational diabetes (PR = 2.49, 95% CI 2.08-2.99; p <0.001) and acute foetal distress (PR = 1.39; 95% CI 1.04-1.86; p = 0.025). CONCLUSION It was concluded that the prevalence of MIH in the quilombola community was high and associated with gestational diabetes and acute foetal distress.
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Affiliation(s)
- Daniele Gomes Dourado
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Cacilda Castelo Branco Lima
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Renara Natália Cerqueira Silva
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Fábio Solon Tajra
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Marcoeli Silva Moura
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Teresinha Soares Pereira Lopes
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
| | | | - Marina de Deus Moura de Lima
- Department of Pathology and Dental Clinic, Campus Universitário Ministro Petrônio Portella, Universidade Federal do Piauí, Teresina, Brazil
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