The prevalence of developmental defects of enamel, a prospective cohort study of adolescents in Western Sweden: a Barn I TAnadvarden (BITA, children in dental care) study

Potential Association of Molar-Incisor Hypomineralization (MIH) with Dental Agenesis and Infraoccluded Deciduous Molars: Is MIH Related to Dental Anomaly Pattern (DAP)? An Observational Cross-Sectional Study

Background: Dental Anomaly Pattern (DAP) is a collection of morphologic, numeric, and eruptive anomalies of teeth that are often observed together, suggesting a potential genetic relationship. Our objective was to assess the potential associations of Molar-Incisor Hypomineralization (MIH), a common developmental defect of enamel mineralization with a controversial etiology, with two specific components of DAP: (1) agenesis (AG) and (2) infraoccluded deciduous molars (IODM). Establishing such an association between MIH and one or both anomalies would provide evidence supporting a genetic link between MIH and DAP. Methods: We examined pretreatment intraoral standardized photographies and panoramic radiographs from 574 children aged 8-14 years, 287 having MIH and 287 without MIH, comparing the frequencies of AG and IODM in both groups. The subject samples were sourced from the databases of the orthodontic department at a university hospital. Results: The frequencies of AG in the MIH and non-MIH groups were 7% and 8%, respectively (p = 0.751). The corresponding frequencies of IODM were 27% and 19.2%, respectively (p = 0.082). That is, children with MIH did not exhibit an increased frequency of AG or IODM compared to those without MIH. Conclusions: These findings do not support the inclusion of MIH in DAP. Nevertheless, further analysis of possible associations is necessary to definitively validate or invalidate this hypothesis.

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

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

The prevalence of developmental defects of enamel in people with cystic fibrosis: a systematic review

BACKGROUND

Oral health impacts systemic health, individual well-being, and quality of life. It is important to identify conditions that may exacerbate oral disease to aid public health and policy development and promote targeted patient treatment strategies. Developmental defects can increase an individual's risk of dental caries, hypersensitivity, premature tooth wear, erosion, and poor aesthetics. As part of an ongoing study assessing oral health in adults with cystic fibrosis at Cork University Dental School and Hospital, a systematic review of available literature was conducted to assess the prevalence of enamel defects in people with cystic fibrosis.

AIMS

To critically evaluate the literature to determine if the prevalence of developmental defects of enamel is higher in people with cystic fibrosis (PwCF).

METHODS

Data Sources: Three online databases were searched Embase, Scopus, and Web of Science Core Collection. Studies that examined an association between cystic fibrosis and developmental defects of enamel were included in this systematic review.

RESULTS

The initial search identified 116 publications from the following databases Embase, Web of Science Core Collection, and Scopus. Eleven studies were included for qualitative analysis. Nine studies concluded that PwCF had a higher prevalence of enamel defects than control people and one study found no difference in cystic fibrosis (CF) status. All studies had a risk of bias that may influence study results and their interpretation.

CONCLUSIONS

The results of the systematic review show a consistent pattern that PwCF have a higher prevalence of DDE than people without CF. Genetic dysfunction, chronic systemic infections, and long-term antibiotic use are possible aetiological causes. This review highlights the need for future studies to investigate if DDEs are caused by the underlying CFTR mutation or as a consequence of disease manifestations and/or management.

Dental Developmental Defects: A Pilot Study to Examine the Prevalence and Etiology in a Population of Children between 2 and 15 Years of Age

Dental development defects (DDDs) are quantitative and/or qualitative alterations produced during odontogenesis that affect both primary and permanent dentition. The etiology remains unknown, being associated with prenatal, perinatal, and postnatal factors. The aims were to identify the possible etiological factors, as well as the prevalence of DDDs in the primary and permanent dentition in a pediatric population. Two hundred twenty-one children between 2 and 15 years of age, patients of the master's degree in Pediatric Dentistry of the Complutense University of Madrid, were reviewed. DDDs were observed in 60 children. Next, a cross-sectional, case-control study was carried out (60 children in the control group and 60 children in the case group). The parents or guardians completed a questionnaire aimed at identifying associated etiological factors. The prevalence of DDDs in patients attending our master's program in both dentitions was 27.15%. Otitis, tonsillitis, high fevers, and medication intake stood out as the most relevant postnatal factors among cases and controls. The permanent maxillary right permanent central incisor and the primary mandibular right second molar were the most affected; there were no differences in relation to gender. One out of three children who presented DDDs in the primary dentition also presented DDDs in the permanent dentition. Prenatal and postnatal etiological factors showed a significant relationship with DDD alterations, considered risk factors for DDDs in both dentitions.

Development of undergraduate students' diagnostic accuracy for the classification of molar incisor hypomineralization

INTRODUCTION

One of the major difficulties with respect to molar incisor hypomineralization (MIH) is its classification and differentiation from other enamel development defects (EDDs). The aim of this study was to evaluate diagnostic accuracy in dental students to classify MIH as well as its differentiation from other EDDs by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

METHODS

In this one-group pre-test and post-test study, 59 second-year students assessed 115 validated photographs using the MIH Index on the Moodle learning platform. This index assesses the clinical features and extent of MIH, differentiating it from other EDDs. Students received automatic feedback after the pre-test. Two weeks later, students re-evaluated the same photographs. Both pairwise accuracy and overall diagnostic accuracy were estimated and compared for pre- and post-testing, with the area under the curve AUC, along with 95% confidence intervals (95% CI).

RESULTS

The lowest diagnostic accuracy was for the ability to discriminate between white or cream-coloured demarcated opacities and hypomineralization-type defect that is not MIH. The overall pre-test accuracy was AUC = 0.83 and increased significantly post-test to AUC = 0.99 (p < .001). The overall accuracy to discriminate the extent of the lesion also increased significantly post-test (p < .001).

CONCLUSION

Diagnostic skills to classify MIH can be developed by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

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

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

Prenatal, neonatal and postnatal factors and the developmental defects of dental enamel

OBJECTIVE

To estimate the prevalence of developmental defects in dental enamel and its possible association with prenatal, neonatal and postnatal conditions in six-year-old schoolchildren in a southern Brazilian municipality.

METHODS

A cross-sectional study was conducted involving 655 six-year-old schoolchildren. Sociodemographic and health data were collected through interviews with mothers and children's oral examinations at schools. Multivariate analyses were performed using Poisson regression with robust estimator.

RESULTS

The prevalence of developmental defects of enamel was 44.0%. Demarcated opacities were the most prevalent, followed by diffuse opacities. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were independently associated with the prevalence of demarcated opacities.

CONCLUSIONS

The prevalence of developmental defects in dental enamel was 44.0%. Late pregnancy, maternal schooling less than eight years, female gender and child's white skin color were associated with the prevalences.

RANTES and developmental defects of enamel in children: A Brazilian prenatal cohort (BRISA)

OBJECTIVE

Little is known about the effect of maternal immunological factors on the etiology of developmental defects of enamel (DDE). RANTES (Regulated on Activation Normal T Cell Expressed and Secreted) is a chemokine produced by fibroblasts, lymphoid and epithelial mucosa cells in response to various external stimuli. Despite its importance for embryogenesis, RANTES expression has been demonstrated in multiple diseases characterized by inflammation, tumor and immune response, and wound healing. We hypothesized that altered levels of RANTES during pregnancy are associated with the immune and inflammatory response in women, which could lead to the occurrence of DDE in utero (DDE-iu), directly or mediated by preterm birth. Therefore, this study aimed to evaluate the direct and indirect effects of serum levels of RANTES in pregnant women in the occurrence of DDE-iu in children.

METHODS

This is a longitudinal case-control study. The mothers and their children (327) were evaluated in three moments: prenatal care, post childbirth, and when the child was between 12.3 and 36 months of age. The analysis was performed with structural equation modeling, estimating the standardized coefficient (SC), adopting α = 5%.

RESULTS

There was a direct and negative effect of RANTES on the outcome (SC = -0.137; p = 0.022). This association was not mediated by preterm birth (SC = 0.007; P = 0.551). When considering the specific types of DDE-iu, RANTES had a direct effect on hypoplasia (SC = -0.190; p = 0.007), but not on opacity (SC = 0.343; p = 0.074).

CONCLUSION

Lower serum levels of RANTES may contribute to a higher number of teeth with DDE-iu, specifically hypoplasia. However, more evidence supported by clinical, laboratory and epidemiological studies is still needed.

Developmental enamel defects and their relationship with caries in adolescents aged 18 years

Randomly selected 1,611 individuals aged 18 years formed a nationally representative sample from all provinces of Poland. Developmental defects of the enamel (DDE) and caries were assessed using the modified DDE index, molar incisor hypomineralisation (MIH) Treatment Need Index (MIH-TNI), FDI and WHO criteria by 22 trained and calibrated dentists. T-test was used for comparing group means. A simple and multiple logistic regression tests were used to assess the relationship between DDE and caries severity expressed as DMFT (p < 0.05). The prevalence of DDE was 13.7%. Demarcated opacities (DEO) were the most frequent (9.65%); 4% had diffuse opacities (DIO) and 1.5% had hypoplasia. MIH was diagnosed in 0.6% patients. The prevalence of caries was 93.2%, with mean DMFT of 6.50 ± 4.22. The DMFT value was 7.52 ± 4.77 in the group of patients with demarcated opacities (DEO); 7.85 ± 4.74 with diffuse opacities (DIO) and 7.56 ± 4.57 with enamel hypoplasia, respectively. There was a significant relationship between caries severity and DDE (p < 0.001), DEO (p = 0.001) and DIO (p = 0.038), and between DDE and DMFT index (p < 0.001). The results obtained in the study proved the significant relationship between DDE and DMFT in 18-year-olds, the assessment of which was the aim of the study.

Molar Incisor Hypomineralization in adolescents and adults and its association with facial profile and occlusion

OBJECTIVES

To date, there are no data available in the scientific literature about the diagnosis of Molar Incisor Hypomineralization (MIH) in adults. We aimed to assess the MIH prevalence and clinical characteristics in adolescents and adults and its association with facial profile and occlusion.

MATERIALS AND METHODS

In this cross-sectional study, permanent teeth were evaluated in 275 patients between the ages of 12 and 49 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index. Statistical analyses were performed using chi-square, Fisher's tests, and ordinal logistic regression.

RESULTS

MIH was observed in 12.73% of all patients. The most commonly affected teeth were permanent molars, while incisors, premolars, and canines were less affected. MIH usually appears as demarcated opacities, with less than one-third of the tooth affected. There was no association between severe defects and facial profile and occlusion, but rather with the higher age of the participants.

CONCLUSION

Enamel hypomineralization mainly affects the first and second permanent molars, but it could also be observed in the third molars, although it is not associated with the orthodontic characteristics investigated.

CLINICAL RELEVANCE

This is the first study to highlight the prevalence of MIH in adults. This result showed the importance of other specialists beyond Pediatric Dentistry in the diagnosis of this defect. In addition, hypomineralization of other permanent teeth (canines, premolars, and second molars) has been described previously in other studies, but this is the first to identify MIH in third molars.

Developmental Enamel Defects in Children from the Southern Region of Ecuador

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.

Dental and Dental Hygiene Students' Knowledge and Capacity to Discriminate the Developmental Defects of Enamel: A Self-Submitted Questionnaire Survey

Background: A prompt and accurate diagnosis of developmental defects of enamel (DDE) is mandatory for proper treatment management. This cross-sectional survey, designed and carried out using anonymous self-administered questionnaires, aimed to assess dental and dental hygiene students’ knowledge and their capability to identify different enamel development defects. Methods: The questionnaire consisted of twenty-eight closed-ended questions. Two different samples of undergraduate students were selected and enrolled: a group of dental hygiene (GDH) students and a group of dental (GD) students. A multivariate logistic regression was performed by adopting the correct answers as explanatory variables to assess the difference between the two groups. Results: Overall, 301 completed questionnaires were analyzed: 157 from the GDH and 144 from the GD. The dental student group showed better knowledge than the GDH of enamel hypomineralization and hypoplasia (p = 0.03 for both). A quarter (25.25%) of the total sample correctly identified the period of development of dental fluorosis with a statistically significant difference between the groups (p < 0.01). Amelogenesis imperfecta (AI) was identified as a genetic disease by 64.45% of the sample, with a better performance from the GD (p = 0.01), while no statistical differences were found between the groups regarding molar incisor hypomineralization. Multivariate analysis showed that AI (OR = 0.40, [0.23;0.69], p < 0.01) and caries lesion (OR = 0.58, [0.34;0.94], p = 0.03) were better recognized by the GD. Conclusions: Disparities exist in the knowledge and management of DDE among dental and dental hygiene students in Italy; however, significant knowledge gaps were found in both groups. Education on the diagnosis and treatment of DDE during the training for dental and dental hygiene students needs to be strongly implemented.

Is it time to reconsider the use of vital teeth bleaching in children and adolescents in Europe?

PURPOSE

The aim of this study was to determine whether carbamide peroxide is effective in bleaching vital permanent teeth in children.

METHODS

A literature search was conducted using all keywords relevant to the research subject. The outcome measures were identified as colour change, tooth sensitivity, oral irritation and patient satisfaction. The certainty of evidence for each outcome was assessed using the current GRADE guidelines.

RESULTS

Of 115 potentially relevant articles, 112 were excluded, as they did not exclusively involve children, intervention involved additional treatment such as microabrasion or restorative work, or case studies. Patient satisfaction was not assessed in the three articles so no analysis could be made with regards to this outcome. The GRADE assessment showed that all of the three articles demonstrated very low certainty of evidence for the other assessed outcomes. The overall findings from the studies suggest that a 10% carbamide peroxide overnight tray system is effective at bleaching vital permanent teeth in children and associated tooth sensitivity and oral irritation are found to be in a similar range compared to those reported in adult studies. However, due to the very low certainty of the evidence, it is not possible to draw these conclusions.

CONCLUSION

Better quality randomised controlled trials are needed to investigate the indication, short and long term effectiveness and side effects of carbamide teeth in vital permanent teeth in children.

Exploring the use of mouth guards in Muay Thai: a questionnaire survey

Objective

To identify Muay Thai participants' attitudes towards use of mouth guards and their experiences of dental trauma.

Materials and methods

An online cross-sectional survey was used to record Muay Thai participants' experiences and opinions regarding use of mouth guards. Participants were recruited from a Muay Thai gym in the north east of England.

Results

92 respondents took part in the survey. 3% reported having never worn a mouth guard, whereas 61% reported routinely wearing mouth guards during a fight. Significantly more (73%) younger participants (18-29 years) reported wearing mouth guards during fights compared to those aged 30 years and older (50%) (p < 0.05). Mouth-formed ('boil and bite') were the most frequently used type of mouth guard (60% of users), followed by custom-made mouth guards provided by a dentist (32%). Factors such as protection, breathing, good fit and comfort were all considered important in the choice of mouth guard. 14% of respondents had experienced dental injuries, with chipped/broken teeth being the most common.

Conclusion

Given the risk for dental trauma in Muay Thai, it is important that participants are advised regarding mouth guard use, particularly those that do not routinely wear them.

Estimating molar-incisor-hypomineralization among 8-year-olds based on 15-year public oral health practice-based data

Background: A wide range in the prevalence of molar-incisor-hypomineralization (MIH) has been reported. Population-based studies are recommended. However, such studies are expensive and time-consuming.Objectives: To estimate the magnitude of MIH condition among 8-year-olds based on routine oral health examinations and to associate first permanent molar (FPM) affection with that of other permanent teeth over time.Materials and methods: This retrospective study, with cross-sectional and longitudinal components, was based on electronic oral health records; all 8-year-olds examined between 2002 and 2016 were included.Results: The average estimated prevalence of MIH was 8.3%; yearly range was 4.8-15.9%. The mean number of affected teeth was 1.4; 62% had one affected tooth. One-surface defects were the most frequent (66%). Asymmetric distribution of affected teeth was observed. In follow-up, 10.7%, 8.4%, and 11.2% had at least one affected permanent canine, premolar, or second permanent molar, respectively. The proportion of children with other MIH-affected permanent teeth was higher in the group with ≥2 MIH-affected teeth than in group with one affected FPM at the age of 8.Conclusions: The average prevalence of MIH was comparable to that reported elsewhere. The number of MIH-affected teeth at early mixed dentition predicts the affection of other permanent teeth over time, mainly that of permanent canines. Further screening of children with MIH is recommended to improve individually tailored early preventive and restorative dental care.

Er:YAG laser for the aesthetic treatment of developmental enamel defects in frontal teeth: a case report

Background and aims

Several studies highlighted how the ameloblasts, secretory cells responsible of the tooth enamel formation, are highly sensitive to changes in their environment. Due to enamel maturation, their dysfunctions during a limited period of tooth development may lead to permanent morphological consequences, namely Developmental Enamel Defects (DED). The aim of this study was to show the advantages of Er:YAG laser for DED treatment.

Subjects and methods

The case report presented describes the treatment, by Er:YAG laser, of some DED lesions present in the upper incisors of a young patient. The settings used were: 1W power, 100mJ energy, 10 Hz frequency corresponding to a Fluence of 0.318 J/cm² per pulse or 3, 18 J/cm².

Results

The patient, even in absence of local anesthesia, did not feel any pain or discomfort during and after intervention. Follow-up at 2, 6 and 12 months did not show any problems in an aesthetic point of view as well as regarding hypersensitivity.

Conclusions

The use of Er:YAG laser for the treatment of developmental enamel defects in frontal teeth is a safe, painless and minimally invasive; moreover, it is able to assure a good aesthetic result.

Treatment decisions regarding caries and dental developmental defects in children - a questionnaire-based study among Norwegian dentists

BACKGROUND

Current knowledge on treatment strategies and choice of restorative materials when treating deep caries or severe dental developmental defects (DDDs) in young individuals is scarce. Therefore, the aim was to investigate Norwegian dentists´ treatment decisions and reasons for treatment choice when treating deep caries in primary teeth and severe DDDs in permanent teeth in children.

METHODS

A pre-coded questionnaire was sent electronically to all dentists employed in the Public Dental Service (PDS) in Norway (n = 1294). The clinicians were asked about their background characteristics and how often they registered DDDs. Three clinical cases were presented to the dentists and asked to prioritize treatment options and reasons for their choice.

RESULTS

After three reminders, 45.8% of the dentists answered. Most clinicians were general practitioners (96.3%), females (77.9%), under 41 year-olds (59.4%), graduated in 2001 or later (61.1%), and representing all regions of Norway. The respondents registered molar incisor hypomineralisation (MIH), other DDDs and dental fluorosis (DF) frequently, 523 (91.1%), 257 (44.8%) and 158 (27.5%), respectively. In case 1a with severe dental caries in a primary molar, the preferred treatment was resin-modified glass ionomer cement (RMGIC) (58.3%), followed by glass ionomer cement (GIC) (17.9%) and zinc oxide-eugenol (ZOE) (13.2%). Extraction, compomer or stainless steel crowns (SSC) were preferred by 0.9, 0.7 and 0.4%, respectively. In case 1b, which was identical to case 1a, but treated under general anaesthesia, the preferred treatment alternatives were RMGIC (37.1%), resin composite (RC) (17.6%) and GIC (17.2%). Extraction and SSC were chosen by 15.1 and 7.2%, respectively. In case 2, showing a severely hypomineralised and symptomatic first permanent molar, the dentists preferred RC (38.4%), followed by RMGIC (26.6%) and GIC (19.0%). Extraction and SSC were chosen by 8.7 and 5.4%, respectively. The treatment choices were not significantly affected by the dentists' background characteristics. The reasons for dentists' treatment decisions varied for each patient case; patient cooperation, prognosis of the tooth and own experience were the dominant reasons.

CONCLUSIONS

A notable disparity in treatment choices was shown indicating that Norwegian dentists evaluate each case individually and base their decisions on what they consider best for the individual patient.