Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: A randomized controlled clinical trial

OBJECTIVES

The aim of this study was to evaluate the impact of treating demarcated opacities in anterior teeth on the esthetic perception of children and their parents. Additionally, the masking effect was evaluated quantitively and qualitatively.

METHODS

Thirty-nine patients, 8-18 years-old, presenting white-creamy opacity in permanent incisors were randomly allocated to test or control group. Test received resin infiltration and control received a placebo. The questionnaire Child's and Parent's Questionnaire about Teeth Appearance was used. The masking effect was quantitatively analyzed using the Lab System to calculate the color difference (ΔE) between the opacity and the surrounding enamel in Photoshop. Fisher's, Chi-square, Wilcoxon, Mann-Whitney tests and Spearman's correlation were applied to data analysis.

RESULTS

In the test group, a significant impact on physical and psychological domains in parents' and in social domain in parents' and children's perception was observed (p<0.05). Significant difference in ΔE between test and control groups was seen from 15 min of application onwards (p<0.05). After treatment, the mean ΔE was 4.07 (SD=3.07) in the test and 7.35 (SD=3.54) in the control group (p<0.01). One month later, the mean ΔE was 4.22 (SD=2.96) in the test and 6.06 (SD=2.52) in the control group (p<0.01). Total masking was seen only in the test group (p<0.01).

CONCLUSION

Aesthetic treatment of hypomineralization opacities in anterior teeth with resin infiltration impacted positively on parents and children. Resin infiltration reduced the color difference between opacities and sound enamel significantly after an application time of at least fifteen minutes.

CLINICAL SIGNIFICANCE

Opacities in anterior teeth impact the self-image of children and parents negatively. This study demonstrated that 15 min resin infiltration can mask opacities in permanent incisors and recover social wellbeing. This minimally invasive approach can be offered to MIH children who report dissatisfaction with their incisors.

Traumatic injuries in primary dentition and their immediate and long-term consequences: a 10-year retrospective study from the State University of Rio de Janeiro, Brazil

BACKGROUND/AIM

Dental trauma is a highly prevalent problem worldwide. The aim of this study was to describe characteristics of trauma to anterior primary teeth and its sequelae for primary and successor teeth over a 10-year period of assistance at the paediatric dental traumatology clinic in the State University of Rio de Janeiro, Brazil.

MATERIALS AND METHODS

The data were obtained from the dental records of children assisted from 2006 to 2016. Inclusion criteria were trauma to anterior primary teeth; aged <1 to 9 years at the time of trauma; and at least one follow-up appointment. The data concerning traumatized teeth, child's age, soft tissue injuries, types of traumatic dental injuries and sequelae in both dentitions were collected.

RESULTS

Of the 1230 dental records, 483 (39.3%) were eligible, consisting of 815 teeth. The mean age at the time of trauma was 37.4 months (239 males and 244 females). The most important characteristics were: tooth 51 was most affected; falls, at home, on a ceramic floor, were the main cause; gingival laceration, enamel fracture and intrusive luxation were the most frequent types of trauma; premature tooth loss of primary teeth and enamel discoloration in their successor were the most frequent sequelae; and injuries in the periodontal tissue were demonstrated as the highest risk for sequelae in successors (OR, 3.798; p< 0.001).

CONCLUSIONS

Most traumatic injuries occur in young children, in their home environment. Consequences for the primary teeth were more frequent compared to the permanent successor tooth. Traumatized primary teeth involving periodontal tissue have more chances to result in sequelae to their successor teeth.

Prevalence and Severity of Molar Incisor Hypomineralization in Brazilian Children

Purpose: The purpose of this study was to evaluate the prevalence, severity, and distribution of molar incisor hypomineralization (MIH) and its association with socioeconomic characteristics among eight-year-old students from public schools in Petrópolis, Rio de Janeiro, Brazil. Methods: This cross-sectional study evaluated 450 eight-year-old Brazilian children. A questionnaire was used to assess socioeconomic factors (family income, maternal education, and person per household). MIH was diagnosed based on European Academy of Paediatric Dentistry criteria. The severity of MIH was evaluated at patient and tooth levels. The examinations were conducted in school environments. Descriptive analysis, chi-square, Fisher's exact, and Kruskal-Wallis tests were performed. Results: The prevalence of MIH was 28.7 percent. The average of affected molars and incisors was 2.25 (standard deviation [SD] equals 1.03) and 0.84 (1.22 SD). The maxillary molars were the most affected, but mandibular molars showed greater severity. The majority of MIH-children had white-creamy opacities (51.9 percent). There was no association between MIH and socioeconomic factors. MIH was more prevalent in boys (P=0.025). The number of incisors with MIH rose with the increasing number of affected molars (P=0.02). A significant association between severity and the mean number of affected molars was observed (P=0.004). Conclusions: The prevalence of molar incisor hypomineralization was 28.7 percent. MIH severity at the individual level was significantly associated with the number of affected teeth and the occurrence of affected incisors.

The effect of pulp inflammation and premature extraction of primary molars on the successor permanent teeth. A retrospective study

BACKGROUND

Untreated caries on primary molars often leads to pulp inflammation and extraction.

AIM

To retrospectively investigate the effect of pulp inflammation and extraction of primary molars on their successors regarding alignment in the dental arch and developmental enamel defects (DED).

DESIGN

The participants in this study were children at public schools in Petropolis (Brazil), who participated in a 3-year longitudinal clinical trial. Children (N = 44) were selected for the present study if they had at least one erupted premolar of which the predecessor primary molar presented pulp inflammation at baseline or during any of the 6-month follow-up assessments. All premolars were examined for DED and misalignment. Distinction was made between extraction performed before (E <8) or after the age of 8 years (E ≥8). Distinction was also made between pulp inflammation occurred before (P < 7) or after the age of 7 years (P ≥ 7). A logistic regression analysis was performed, and the odds ratio was calculated.

RESULTS AND CONCLUSIONS

Misalignment occurred more frequently in E <8 as compared to E ≥8 (OR = 2.85; P = .03). There was no significant difference in DED between P < 7 and P ≥ 7.

CONCLUSION

Misalignment of premolars occurs more frequently when the predecessor primary molars are extracted before the age of 8 years.

Frequency of crown and root dilaceration of permanent incisors after dental trauma to their predecessor teeth

BACKGROUND/AIMS

Dental trauma to the predecessor teeth can cause crown and root dilacerations to the successor teeth, which can interfere with the normal development of permanent teeth. The aims of this study were to verify the types of trauma more frequent to the predecessor teeth that cause dilaceration to their successor teeth, to determine the frequency of crown and root dilacerations in permanent incisors, taking into account the child's age at the time of trauma, and to describe the types of treatment performed.

MATERIALS AND METHODS

Details of 815 anterior primary teeth with dental injury were obtained from 483 dental records of children aged 0-9 years at the time of trauma.

RESULTS

Of 815 traumatized primary teeth, 161 successor teeth were clinically and radiographically reviewed until complete eruption and had some type of sequel. Avulsion and intrusive luxation were the most frequent types of trauma to the predecessor teeth that caused dilaceration to their successor teeth. Enamel discoloration (30.4%), hypoplasia (23.6%), root (14.3%) and crown (9.9%) dilacerations were the most common sequelae observed in the successor teeth. Root and crown dilacerations were more frequent in children aged more than and up to 3 years, respectively. Tooth extraction and orthodontic treatment were the most common treatments.

CONCLUSIONS

Dentists must be aware of the relationship between the child's age at the time of trauma to the predecessor tooth and the type of sequel to the successor tooth in order to diagnose, monitor, and treat the sequel properly.

Breakdown of demarcated opacities related to molar-incisor hypomineralization: a longitudinal study

OBJECTIVES

This prospective longitudinal study aimed to evaluate if the occurrence of post-eruptive breakdown of demarcated opacities in hypomineralized teeth is influenced by the color or location of the opacity.

MATERIALS AND METHODS

Patients diagnosed with molar-incisor hypomineralization (MIH) between 2012 and 2014 were eligible. Two calibrated examiners performed the initial and follow-up evaluations according to European Academy of Paediatric Dentistry (EAPD) criteria. Sixty-five patients were included. Fifty-eight (89.2%), with a mean age of 8.8 years (SD: 1.4), were reassessed after 1 year. Two hundred and nine of 1155 tooth surfaces were considered for the study: 86 with white opacity (OP-W), 91 with yellow opacity (OP-Y), and 32 with enamel breakdown (EB).

RESULTS

From the OP-W, OP-Y, and EB, 14, 27.5, and 46.9% worsened to breakdown exposing dentin, atypical restoration, or extraction (DB + RA or EXT), respectively. Yellow opacities tended to be more prone to breakdown than white opacities. The occurrence of EB, DB + AR, or EXT was not influenced by the location (p = 0.25).

CONCLUSIONS

The color of the opacity seems to play an important role on the occurrence of fracture and should be considered as a potential predictor.

CLINICAL RELEVANCE

Dentists should be aware that demarcated opacities related to MIH tend to fracture over time. Moreover, children with MIH should be seen at shorter intervals.

A systematic review on the association between molar incisor hypomineralization and dental caries

BACKGROUND

Molar incisor hypomineralization (MIH) is a defect of enamel. The lower strength of the enamel can lead to fractures that predispose for plaque accumulation and caries.

AIM

This systematic review aimed to assess the association between MIH and caries.

DESIGN

Studies involving children of all ages, which reported results on MIH and caries in the permanent dentition, were considered eligible. A search was performed in PubMed and was limited to the period from January 2003 to November 2015, and to studies written in English. Reviews, meta-analyses, and case reports were excluded. The studies were evaluated by use of the Newcastle-Ottawa Quality Assessment Scale (NOS).

RESULTS

Seventeen publications were compiled in the review. Most publications reported that children with MIH have higher caries experience. One study did not observe a difference in DMF values among children affected or not by MIH. Three studies reported that children with MIH were 2.1 to 4.6 times more likely to have caries in the permanent dentition than children without MIH.

CONCLUSIONS

A significant association between MIH and caries was found. The results should, however, be interpreted cautiously due to the lack of high-quality studies. The present systematic review confirms the need for further well-designed studies.