Microscopic study of enamel defects in deciduous teeth of infants of diabetic mothers

Full-Mouth Rehabilitation of a 15-Year-Old Girl Affected by a Rare Hypoparathyroidism (Glial Cell Missing Homolog 2 Mutation): A 3-Year Follow-Up

OBJECTIVE

Familial isolated hypoparathyroidism is a rare genetic disorder due to no or low production of the parathyroid hormone, disturbing calcium and phosphate regulation. The resulting hypocalcemia may lead to dental abnormalities, such as enamel hypoplasia. The aim of this paper was to describe the full-mouth rehabilitation of a 15-year-old girl with chronic hypocalcemia due to a rare congenital hypoparathyroidism.

CLINICAL CONSIDERATIONS

In this patient, in the young adult dentition, conservative care was preferred. Onlays or stainless-steel crowns were performed on the posterior teeth, and direct or indirect (overlays and veneerlays) were performed on the maxillary premolars, canines, and incisors, using a digital wax-up. The mandibular incisors were bleached. The treatment clearly improved the patient's oral quality of life, with fewer sensitivities, better chewing, and aesthetic satisfaction. The difficulties were the regular monitoring and the limited compliance of the patient.

CONCLUSION

Despite no clinical feedback in the literature, generalized hypomineralized/hypoplastic teeth due to hypoparathyroidism in a young patient can be treated as amelogenesis imperfecta (generalized enamel defects) with a conservative approach for medium-term satisfactory results.

HIGHLIGHTS

This study provides new insights into the management of enamel hypoplasia caused by familial isolated hypoparathyroidism, helping to improve patient outcomes in similar cases.

Enamel incremental markings in the deciduous teeth of children from the Early Bronze and modern ages

OBJECTIVE

The purpose of this study was to determine whether children from Early Bronze Age and modern populations differ in terms of the width of the neonatal line (NNL) and the occurrence of accentuated lines in enamel.

DESIGN

The sample (N = 59) consisted of two groups: 29 deciduous teeth removed from the jaws of children (dental age range from 1 to 10 years) whose skeletal remains were found in Early Bronze archaeological graves in Mokrin Serbia, and 30 present-day exfoliated deciduous teeth from 6 to 11 year old children. Mothers, whose children participated in this study, provided information regarding their health during pregnancy. The analysis was carried out on ground sections with a scanning electron microscope. Two clinicians measured the width of the NNL and counted the accentuated lines in the enamel.

RESULTS

There was a statistically significant difference between the children from the two groups regarding the width of the NNL. The width of the NNL between children whose mothers were healthy and diagnosed with gestational diabetes was significantly different. Most subjects did not have accentuated lines in the prenatal enamel, regardless of whether they were from the Bronze or Modern age. Accentuated lines were dominantly found in the postnatal enamel of the children from the Early Bronze age.

CONCLUSIONS

This study is the first to investigate the width of the NNL in teeth of Maros children and Serbian children from the modern age. The wider NNL of children from the Early Bronze age indicates the possibility that they have experienced more overall stress in perinatal life.

Structural Changes in Primary Teeth of Diabetic Children: Composition and Ultrastructure Analysis

Diabetes affects the developing enamel by altering the mineralization process, which can have a detrimental effect on oral health. The objectives of this study were to examine the ultrastructure and composition of surface enamel in primary teeth of diabetic children and its clinical implications. Hundred extracted primary teeth from diabetic children (Test group: n = 50) and healthy children (Control group: n = 50), between 6 and 12 years of age, were subjected to scanning electron microscopy to qualitatively examine the enamel surface. Energy dispersive X-ray (EDX) analysis was performed to investigate the mass percentage of calcium (Ca) and phosphorous (P) in the surface enamel. Ultrastructural aberrations of surface enamel were observed in the test group teeth. Additionally, prism perforations were seen at the junction of rod and inter-rod enamel and the prisms were loosely packed. An even aprismatic layer of surface enamel was evident in the control group teeth. There was a statistically significant difference (p < 0.05) of Ca and P mass percentage between the test and control group teeth. The mean mass percentage rates of Ca and P were 33.75% and 16.76%, respectively. A poor surface characteristic and elemental composition of the enamel surface of primary teeth is observed in diabetic children. Therefore, appropriate caries preventive measures are mandatory to maintain the structural integrity of the tooth in these patients.

Factors and Mechanisms Involved in Acquired Developmental Defects of Enamel: A Scoping Review

BACKGROUND

Developmental Defects of Enamel (DDE) is a pathology of the teeth that can greatly alter the quality of life of patients (hypersensitivity, esthetic issues, loss of function, etc.). The acquired DDE may occur as a result of a wide range of acquired etiological factors and his prevalence of this pathology may reach up to 89.9%. The main objective of this research was to identify and analyze, in current literature, the factors related to acquired DDE, in order to propose a general theory about the mechanisms involved.

METHODS

The search of the primary literature was conducted until [December 31, 2021]. Our search strategy uses the Pubmed/MEDLINE database and was structured around 3 terms ["Development," "Defect," and "Enamel"]. To be included, references had to be primary studies, written in English. Exclusion criteria were reviews, in vitro, animal, genetic or archeology studies, and studies focused on clinical management of DDE. One hundred and twenty three articles were included in this scoping review: 4 Randomized clinical trials, 1 letter, 5 cases reports, 2 fundamentals studies, and 111 observational studies (33 Cross-sectional studies, 68 Cohort study and 10 Case-control study). The quality of evidence was assessed using the PEDro scale for clinical trials, the Newcastle-Ottawa scale for observational studies, and a published tool to assess the quality of case reports and case series.

RESULTS

A scoping review of the literature identified 114 factors potentially involved in acquired DDE. The most frequently encountered pathologies are those causing a disorder of calcium homeostasis or a perturbation of the ARNT pathway in mother or child. The link between the ARNT pathway and metabolism deficiency in uncertain and needs to be defined. Also, the implication of this mechanism in tissue impairment is still unclear and needs to be explored.

CONCLUSIONS

By identifying and grouping the risk factors cited in the literature, this taxonomy and the hypotheses related to the mechanism allow health practitioners to adopt behaviors that limit the risk of developing aDDE and to set up a prevention of dental pathology. In addition, by reviewing the current literature, this work provides guidance for basic research, clinical studies, and literature searches.

Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel

Importance

Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure.

Objective

To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors.

Design, Setting, and Participants

This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021.

Exposures

Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy.

Main Outcomes and Measures

Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines.

Results

A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White) were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks' gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = -2.04; 95% CI, -3.70 to -0.38; P = .02). The magnitude of these associations was large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors.

Conclusions and Relevance

In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.

Dental microstructure records life history events: A histological study of mandrills (Mandrillus sphinx) from Gabon

Accentuated lines in dental microstructure are hypothesized to correlate with potentially stressful life history events, but our understanding of when, how and why such accentuated lines form in relation to stressful events is limited. We examined accentuated line formation and life history events in the teeth of three naturally deceased mandrills (Mandrillus sphinx, Cercopithecidae), for whom we had detailed life history information. We determined the ages at formation of accentuated lines in histological tooth sections and used dates of birth and death to calibrate dental histology to calendar time and individual age. We found accentuated lines that matched their mother's resumption of sexual cycles in two individuals, and possibly in the third individual. The subjects also formed lines when their mothers were mate-guarded by males or wounded. Accentuated lines matched the birth of the next sibling in one of two cases. Both females formed accentuated lines when they experienced their own sexual swelling cycles, but lines did not match all sexual swelling cycles. Mate-guarding matched an accentuated line in one case, but not in another. Lines matched all three parturitions in the two females. Changes in alpha male and captures did not consistently coincide with accentuated line formation, but repeated captures were associated with lines. Using simulated data, we show that the observed number of matches between lines and events would be very unlikely under a null hypothesis of random line formation. Our results support the hypothesis that some life history events are physiologically stressful enough to cause accentuated line formation in teeth. They contribute to our understanding of how primate life histories are recorded during dental development and enhance our ability to use teeth to reconstruct life history in the absence of direct observation.

Assessment of physiological disturbances during pre- and early postnatal development based on microscopic analysis of human deciduous teeth from the Late Epipaleolithic site of Shubayqa 1 (Jordan)

OBJECTIVES

To study pre- and early postnatal tooth formation and to analyze the effects of physiological disturbances on enamel and dentin formation in deciduous teeth of infants from the Late Epipaleolithic (Natufian) site Shubayqa 1.

MATERIALS AND METHODS

Ten deciduous teeth from six infants (ages at death between 21 and 239 days) were analyzed by light and scanning electron microscopy.

RESULTS

Marked prism cross-striations and an abnormal wavy course of the prisms were recorded in pre- and postnatal enamel of all analyzed teeth. Single or multiple accentuated incremental lines were observed in prenatal enamel of nine teeth and in postnatal enamel of eight teeth. Accentuated Andresen lines and broader zones exhibiting an enhanced calcospheritic pattern were recorded in the pre- and postnatally formed dentin of nine teeth.

DISCUSSION

The structural abnormalities in the pre- and postnatally formed enamel of the infants are considered indicative of chronic stress that negatively affected the activity of secretory ameloblasts. The structural aberrations in pre- and postnatal dentin denote that odontoblasts were also affected by this stress. The presence of single or multiple accentuated incremental lines in pre- and postnatal enamel is interpreted as reflecting (short-term) impacts of higher intensity superimposed on the chronic stress. Our findings suggest compromised maternal health affecting the late fetus and compromised health in newborns. Although limited by the small number of analyzed individuals, the present study contributes to the knowledge of maternal and early infant health conditions in Late Epipaleolithic populations.

Childhood health as reflected in adult urban and rural samples from medieval Denmark

This study examines the evidence of three skeletal markers relating to childhood health that leave permanent observable changes in the adult skeleton. Two are well known to paleopathology, namely Harris lines (HL) and linear enamel hypoplasia (LEH). The third skeletal marker is less commonly used; the permanent changes in the temporal bones, induced by chronic or recurrent infectious middle ear disease (IMED) in childhood. A total of 291 adult skeletons from an urban (n = 109) and a rural (n = 182) cemetery, from the Danish medieval period (1050-1536 CE) were included. The markers were examined for their co-occurrence, and differences between the two samples. No statistically significant difference for the three skeletal markers between the two samples was found. A trend was nevertheless apparent, with greater frequencies for all three skeletal markers for the urban population. A statistically significant relationship was found only between IMED and HL. This positive relation was very low (r_ɸ = 0.307, 0.275) and may be considered non-existent. The lack of co-occurrence is interpreted as if an individual was exposed to conditions that could cause the osteological expression of all three markers this could be a life-threatening health condition, during developing years.

Type 1 diabetes mellitus effects on dental enamel formation revealed by microscopy and microanalysis

BACKGROUND

Type 1 diabetes mellitus (T1DM) largely affects children, occurring therefore at the same period of deciduous and permanent teeth development. The aim of this work was to investigate birefringence and morphology of the secretory stage enamel organic extracellular matrix (EOECM), and structural and mechanical features of mature enamel from T1DM rats.

METHODS

Adult Wistar rats were maintained alive for a period of 56 days after the induction of experimental T1DM with a single dose of streptozotocin (60 mg/kg). After proper euthanasia of the animals, fixed upper incisors were accurately processed, and secretory stage EOECM and mature enamel were analyzed by transmitted polarizing and bright field light microscopies (TPLM and BFLM), energy-dispersive x-ray (EDX) analysis, scanning electron microscopy (SEM), and microhardness testing.

RESULTS

Bright field light microscopies and transmitted polarizing light microscopies showed slight morphological changes in the secretory stage EOECM from diabetic rats, which also did not exhibit statistically significant alterations in birefringence brightness when compared to control animals (P > .05). EDX analysis showed that T1DM induced statistically significant little increases in the amount of calcium and phosphorus in outer mature enamel (P < .01) with preservation of calcium/phosphorus ratio in that structure (P > .05). T1DM also caused important ultrastructural alterations in mature enamel as revealed by SEM and induced a statistically significant reduction of about 13.67% in its microhardness at 80 μm from dentin-enamel junction (P < .01).

CONCLUSIONS

This study shows that T1DM may disturb enamel development, leading to alterations in mature enamel ultrastructure and in its mechanical features.

[Effect of maternal health and prenatal environmental exposure factors on tooth development]

Odontogenesis is a consequence of a complex series of reciprocal signal interactions between odontogenic epithelium and neural crest-derived odontotgenic mesenchyme. These interactions result from a complex interplay of genetic and environmental factors. Given that a fetus develops in the mother, maternal health and environmental exposures have a great influence on tooth development. In this review, we focused on the key issues in the developmental defects of teeth induced by various types of maternal environmental factors, including environmental endocrine disruptors, joint action of two or more chemical exposures, and maternal health status. This review also discussed the adverse effects of maternal environmental factors on tooth development. These effects include enamel developmental defects, molar incisor hypomineralization, dental fluorosis, hyperdontia and hypodontia. Overall, this review provides a theoretical basis for the prevention of tooth defects in early life, assessment of risks from developmental tooth defects, and advancement of pediatric oral health management.

Prenatal factors associated with the neonatal line thickness in human deciduous incisors

The neonatal line (NNL) is used to distinguish developmental events observed in enamel which occurred before and after birth. However, there are few studies reporting relationship between the characteristics of the NNL and factors affecting prenatal conditions. The aim of the study was to determine prenatal factors that may influence the NNL thickness in human deciduous teeth. The material consisted of longitudinal ground sections of 60 modern human deciduous incisors obtained from full-term healthy children with reported birth histories and prenatal factors. All teeth were sectioned in the labio-lingual plane using diamond blade (Buechler IsoMet 1000). Final specimens were observed using scanning electron microscopy at magnifications 320×. For each tooth, linear measurements of the NNL thickness were taken on its labial surface at the three levels from the cemento-enamel junction. The difference in the neonatal line thickness between tooth types and between males and females was statistically significant. A multiple regression analyses confirmed influence of two variables on the NNL thickness standardised on tooth type and the children's sex (z-score values). These variables are the taking of an antispasmodic medicine by the mother during pregnancy and the season of the child's birth. These two variables together explain nearly 17% of the variability of the NNL. Children of mothers taking a spasmolytic medicine during pregnancy were characterised by a thinner NNL compared with children whose mothers did not take such medication. Children born in summer and spring had a thinner NNL than children born in winter. These results indicate that the prenatal environment significantly contributes to the thickness of the NNL influencing the pace of reaching the post-delivery homeostasis by the newborn's organism.

The long-term effects of birth by caesarean section: the case for a randomised controlled trial

Birth by caesarean section is rising rapidly around the world and is associated with a range of adverse short and long-term outcomes in offspring. The latter include features of the metabolic syndrome, type-1 diabetes, and asthma. Though there are several plausible candidate biological mechanisms, evidence of a causal relationship between mode of delivery and long-term outcomes remains lacking. Here we review the evidence to date, and examine ways in which future studies might advance understanding. We conclude that a randomised controlled trial of mode of delivery for the healthy term, cephalic pregnancy, is neither unethical nor unfeasible and should be seriously considered as the optimum means of addressing a question of great relevance to public health.

Systemic disorders and their influence on the development of dental hard tissues: a literature review

OBJECTIVES

This report highlights the influence of a number of disorders with systemic physiological effects that impact on the development of dental hard tissues. It focuses in particular, on the pathological effects of systemic conditions with less well recognised, but no less important, impacts on dental development. Such conditions, include cystic fibrosis, HIV/AIDS, leukaemia, Alstrom syndrome, hypophosphatasia, Prader-Willi syndrome, Tricho-dento-osseous syndrome, tuberous sclerosis, familial steroid dehydrogenase deficiency and epidermolysis bullosa. These, along with developmental and environmental causes of enamel and dentine defects, are discussed and the possible aetiology of such effects are proposed. Furthermore, the dental management and long-term dental care of these patients is outlined.

SOURCES

MEDLINE/PubMed.

CONCLUSIONS

Enamel and dentine defects can present with a wide spectrum of clinical features and may be caused by a variety of factors occurring throughout tooth development from before birth to adulthood. These may include host traits, genetic factors, immunological responses to cariogenic bacteria, saliva composition, environmental and behavioural factors and systemic diseases. These diseases and their spectrum of clinical manifestations on the organs affected (including the dentition) require an increased knowledge by dental practitioners of the disease processes, aetiology, relevant treatment strategies and prognosis, and must encompass more than simply the management of the dental requirements of the patient. It is important that the impact of the disease and its treatment, particularly in respect of immunosuppression where dental interventions may become life-threatening, is also taken into consideration.

The developmental clock of dental enamel: a test for the periodicity of prism cross-striations in modern humans and an evaluation of the most likely sources of error in histological studies of this kind

Dental tissues contain regular microscopic structures believed to result from periodic variations in the secretion of matrix by enamel- and dentine-forming cells. Counts of these structures are an important tool for reconstructing the chronology of dental development in both modern and fossil hominids. Most studies rely on the periodicity of the regular cross-banding that occurs along the long axis of enamel prisms. These prism cross-striations are widely thought to reflect a circadian rhythm of enamel matrix secretion and are generally regarded as representing daily increments of tissue. Previously, some researchers have argued against the circadian periodicity of these structures and questioned their use in reconstructing dental development. Here we tested the periodicity of enamel cross-striations--and the accuracy to which they can be used--in the developing permanent dentition of five children, excavated from a 19th century crypt in London, whose age-at-death was independently known. The interruption of crown formation by death was used to calibrate cross-striation counts. All five individuals produced counts that were strongly consistent with those expected from the independently known ages, taking into account the position of the neonatal line and factors of preservation. These results confirm that cross-striations do indeed reflect a circadian rhythm in enamel matrix secretion. They further validate their use in reconstructing dental development and in determining the age-at-death of the remains of children whose dentitions are still forming at the time of death. Significantly they identify the most likely source of error and the common difficulties encountered in histological studies of this kind.

Of mice and mutations: phenotypic effects of the diabetic db/db and ob/ob mutations on the skull and teeth of mice

AIM

To compare the phenotypic appearance of the skull bones and teeth of wild type C57BL/6J mice with that of diabetic leptin-deficient (ob/ob) and diabetic leptin receptordeficient (db/db) mice used as models for diabetes.

STUDY DESIGN AND METHODS

Skulls were extracted from the carcasses of mice belonging to wild-type C57B/6J mice, db/db mice on a C57BLKS/J background, and ob/ob mice on a C57B/6J background. After removal of overlying tissue, the skulls and mandibles were then left to dehydrate and examined for phenotypic variations in structure and wear.

RESULTS

Bone surfaces of the skulls of wild type mice had a whiter and smoother surface compared with a yellowish colour with a grainy texture in the two mutant strains. The frontal, parietal and occipital bones were translucent in the two mutant strains. Breakages of the zygomatic arches and mandibles were more common in the ob/ob and db/db mice than in the wild type mice. Half of the teeth of the db/db mice and 90% teeth of the ob/ob mice showed considerable wear compared with marginal wear in the wild type mice.

CONCLUSIONS

These observations suggested that the teeth of the two diabetic mutant strains are exhibiting considerable signs of hypomineralization with increased fragility and decreased bone thickness.

Neonatal lines in the enamel of primary teeth--a morphological and scanning electron microscopic investigation

OBJECTIVE

The neonatal line (NNL) is in principle found in all primary teeth and the line represents the time of birth. Earlier findings of the appearance of the NNL in light microscope and in microradiographs have shown not only changes in the prism direction of the enamel, but that the NNL has a hypomineralized character.

METHODS

The neonatal line was analyzed in un-decalcified sections of primary lower and central incisors, collected from individuals of different ages utilizing polarized light microscopy, microradiography, scanning electron microscopy (SEM) and X-ray analysis (XRMA).

RESULTS

In polarized light the NNL appeared to have a more porous structure than the enamel in general. The appearance of the NNL as a dark line in microradiographs is interpreted as the NNL being less mineralized than neighbouring enamel. Analysis with ImageJ visualized the reduction of the amount of grey value, indicating that the NNL is less mineralized. Analysis of the NNL in SEM showed a reduction of the diameter of enamel prisms, the more narrow diameters continued through the postnatal enamel. A change of the growth direction of the prisms was also observed at the NNL. In a three-dimensional image the NNL appeared as a grove, however, in non-etched enamel no grove was seen. The elemental analyses with XRMA showed no marked changes in the content of C, Ca, P, N, O or S in the area around the NNL.

CONCLUSIONS

The NNL is an optical phenomenon due to alterations in height, and degree of mineralization of the enamel prisms.

Enamel mineral concentration in diabetic rodents

AIM

This was to use x-ray microtomography (XMT), to assess the mineral composition and 3-D structure of enamel and bone in the teeth and skulls of diabetic rodents.

METHODS

Three-dimensional images of the skull were reconstructed using computer generated false colour to highlight different levels of mineralization in bone and enamel.

RESULTS

These showed that diabetic rodents exhibited more wear in their teeth. Deformities were observed in the alveolar process of the mandible and maxilla. Regions of extensive hypomineralization were found in the calvarial bone of skulls. The maximum mineral concentrations and the time constants for diabetic rodents were similar to the controls. The diabetic mice appeared to have random regions of hypomineralization and one diabetic rat had areas of hypoplasia in the mandibular incisors.

CONCLUSIONS

Diabetes may have a detrimental influence on the function of ameloblasts in laying down enamel.

Test of histological methods of determining chronology of accentuated striae in deciduous teeth

One of the difficulties that has prevented Wilson bands, internal defects of enamel growth, from achieving maximum usefulness as indicators of stress in bioarchaeological studies is the inaccuracy of the methods for determining ages of defect occurrence. This study tests a technique that uses microstructural growth markers of enamel to establish the chronology of Wilson bands in deciduous teeth. A sample of 274 teeth from 127 subadults from an Imperial Roman necropolis was sectioned and examined under a microscope. The sample ranged in age at death from birth to 13 years. Sixty-four teeth from 50 individuals were found to have 447 Wilson bands in total. Of those contributing multiple teeth to the sample, 13 individuals had at least one Wilson band in each of two teeth that could be identified as having been formed coevally. These provided the basis for testing the methodology. Paired t-tests found no significant differences between the chronologies of matched pairs in the two teeth, with mean ages from each differing by less than 1 day. The authors propose a hypothesis that explains the development of Wilson bands, and classifies them within the context of other features of enamel. The most important implications arising from this paper are: 1) aging methods using microstructural growth markers can be applied to deciduous teeth; 2) physiological stressors leave different traces in enamel, depending on severity and time of occurrence relative to total crown development; 3) no threshold level exists; all physiological stress will leave a record; 4) therefore, no minimal definition of a Wilson band can be delineated that recognizes all such events; 5) implying that studies using them will only identify minimum rates of occurrence.

Defective enamel ultrastructure in diabetic rodents

We investigated six different types of diabetic rodents. Four expressed a genetic obesity resulting in diabetes. One developed diabetes induced by a diet-dependent obesity, and one with genetic diabetes received anti-diabetic medication. The tooth samples were examined under a scanning electron microscope and with an energy dispersive microanalysis (EDX). The electron micrographs showed severe, varying degrees of damage within the six different diabetic animal types, such as irregular crystallite deposition and prism perforations in genetically obese animals compared to less-disordered prism structures in diet-dependent obesity. Anti-diabetic medication resulted in normal enamel ultrastructure. The EDX analysis revealed a reduction in the amount of calcium and phosphorus in all regions affected by diabetes. Based on these animal studies, we suggest that both juvenile diabetes type I (in infants) and adult diabetes type II (in pregnant mothers, affecting the developing foetus) may affect the normal development of teeth in humans.

Are there structural alterations in the enamel organ of offspring of rats with alloxan-induced diabetes mellitus?

Enamel hypoplasia is the most common developmental defect of human teeth that may be seen in deciduous teeth of babies born to diabetic women. In the present experimental study, we analyzed the enamel organ of the mandibular incisors of the offspring of rats with alloxan-induced diabetes. By light microscopy, no alterations could be found in the enamel organ of rats born to diabetic mothers compared to normal ones, except in one case. In contrast, significant differences were detected with computer-aided morphometry. In the rats born to treated and untreated diabetic mothers, there was thinning of the enamel matrix and of the ameloblasts and the nuclear area of the latter was smaller. In the rats born to treated diabetic mothers, the nuclei of the ameloblasts were more elliptical and there was enlargement of the interstitial area of the stellate reticulum. These results indicate that there are structural defects in the enamel organ of rats born to mothers with alloxan-induced diabetes which could induce the enamel hypoplasia observed by scanning electron microscopy and which may reflect the metabolic alterations seen in this condition. Future studies are needed to determine whether these effects are transitory or permanent.

A detailed study of enamel hypoplasia in a post-medieval adolescent of known age and sex

Developmental disturbances that affect the secretion of enamel matrix can cause defective enamel structure. Linear hypoplasia is one type of enamel defect and manifests itself as a furrow that runs around the circumference of the tooth. Such defects range in size from the microscopic to those that are several millimetres wide. Enamel defects have been widely used by anthropologists for the investigation of growth disruptions in past populations, as they provide a permanent record of disturbances during much of a child's developmental period. This is a detailed case study of enamel growth disruptions in a 15-year-old female from the 18th and 19th century crypt of Christ Church, Spitalfields. The method used relates linear enamel hypoplasia to the incremental structures in the enamel surface, the perikymata, in order to investigate the timing of growth disturbances. Linear enamel hypoplasia was defined here as a greater than expected spacing between neighbouring pairs of perikymata. In addition, this study used recently published histological data on the precise timing of tooth development to establish chronologies for growth disruptions. Defects were matched in at least two teeth with overlapping developmental schedules to ensure that systemic disturbances, as opposed to localised traumas, were identified. Thirteen enamel defects were matched between five different teeth from the same individual from Spitalfields. Most linear enamel hypoplasias were evident on the anterior dentition. Using an 8-day average perikymata periodicity, the age at first defect in this individual was calculated as 1.5 years and the last growth disruption occurred when she was 4.6 years of age. The distribution of the defects was examined to identify any seasonal pattern in the occurrence of the growth disturbances.

Dental indicators of stress and reduced age at death in prehistoric Native Americans

Considerable evidence supports the hypothesis that developmental enamel defects represent stress-induced growth disruptions. In this investigation, the relationship between different kinds of enamel defects and age at death is examined in the prehistoric Libben population from Ottawa County, Ohio. The sample consisted of the permanent dentitions of 143 individuals. Defects were classified based on the criteria of the Developmental Defects of Enamel (DDE) Index. The multifactorial age at death determinations of Lovejoy and coworkers (1977) were used in this analysis. Results reveal a significantly lower mean age at death for individuals with enamel defects vs. individuals with normal teeth. This pattern was clearly present for all defect types examined. No significant differences by sex were detected. The age-at-death distribution for individuals with normal teeth approximated the normal curve. The modal value was reached in the 35-40 year age class. The age-at-death distribution for individuals with enamel defects showed two peaks. The mode occurred in the 15-20 year age class, and the second, lower peak occurred in the 30-35 year age class. The early mortality of individuals with enamel defects may be related to biological damage to the immune system during prenatal or postnatal development.

Macroscopic and scanning electron microscopic appearance and hardness values of developmental defects in human permanent tooth enamel

Defects present in 12 human permanent teeth were classified on the basis of their macroscopic appearance as hypoplasia (three teeth), diffuse opacities (three teeth), white demarcated opacities (one tooth but two defects), or yellow demarcated opacities (five teeth but six defects). The hardness values and SEM appearance of the defective enamel were determined after the teeth were sectioned through the lesion(s) and were distinctive for each type of defect. The thin enamel of the hypoplastic lesions was either opaque (with reduced hardness values) or translucent (with near-normal hardness values and sometimes a change in prism orientation external to an incremental line). The enamel of the diffuse and demarcated opacities was of normal thickness. The changes in the macroscopic and SEM appearance, and the reduced hardness values of the diffuse patchy opacities, were restricted to the outer 150 microns of the enamel. The demarcated opacities varied in position and depth, and in places had a clearly marked boundary with the adjacent normal enamel. Hardness values were related to color change, with yellow lesions being softer than white. Although prism direction was normal within demarcated opacities, prism outlines were less distinct. The findings suggest that temporary and permanent dysfunction of ameloblasts can occur in both secretory and maturation phases, influencing the final appearance of the lesion.

The macroscopic appearance and associated histological changes in the enamel organ of hypoplastic lesions of sheep incisor teeth resulting from induced parasitism

Twenty-one penned female sheep were infected with a high dose of nematodes (200,000 Trichostrongylus vitrinus and 25,000 Ostertagia circumcincta) during first incisor development when aged 7-8 months. Three sheep were infected with 200,000 T. vitrinus only; 10 sheep were untreated. Anorexia, lassitude and severe diarrhoea were seen in 14 of the infected sheep after 21-26 days. Anthelmintic was given to sheep showing undue distress to end the infection and to all remaining sheep on day 33. Animals were killed at 3 stages: during the infection, at intervals during later tooth development, and at the time of eruption of the incisor teeth, 7-8 months after the parasites were given. Hypoplasia of the labial enamel of 15 out of 19 teeth from sheep killed after recovery from the infection was classified according to the extent and depth as pits, grooves or larger areas of missing enamel with ledge-formation cervically. The amount of missing enamel related to the severity of the systemic disturbance which affected the secretory ameloblasts. During the period of active infection, some secretory ameloblasts showed vacuolization or were shorter than in controls; some cells were no longer adjacent to the organic matrix; some continued to function but abnormally and later became separated from the retained organic matrix by connective tissue. Cervically-placed ledges resulted either from the recovery and resumption of activity of some ameloblasts or from differentiation of new secretory cells after the infection ended.