Developmental defects of enamel in primary teeth: highly prevalent, unevenly distributed in the oral cavity and not associated with birth weight

Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders

AIMS

Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period.

METHODS AND RESULTS

In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD = 2.7) to 2.04 (SD = 3.6), while GVPI was reduced significantly from 1.8 (SD = 0.9) to 1.4 (SD = 0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p < .001) while older maternal age (OR = 1.38, 95%CI = 1.057-1.808) and consumption of more than three sugary snacks/day (OR = 0.005, 95%CI = 0-0.0794) were significantly correlated with dental caries.

CONCLUSION

The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.

Gestational Serum Retinol Deficiency Is Associated with Enamel Hypoplasia

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.

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.

Enamel Phenotypes: Genetic and Environmental Determinants

Dental enamel is a specialized tissue that has adapted over millions of years of evolution to enhance the survival of a variety of species. In humans, enamel evolved to form the exterior protective layer for the crown of the exposed tooth crown. Its unique composition, structure, physical properties and attachment to the underlying dentin tissue allow it to be a resilient, although not self-repairing, tissue. The process of enamel formation, known as amelogenesis, involves epithelial-derived cells called ameloblasts that secrete a unique extracellular matrix that influences the structure of the mineralizing enamel crystallites. There are over 115 known genetic conditions affecting amelogenesis that are associated with enamel phenotypes characterized by either a reduction of enamel amount and or mineralization. Amelogenesis involves many processes that are sensitive to perturbation and can be altered by numerous environmental stressors. Genetics, epigenetics, and environment factors can influence enamel formation and play a role in resistance/risk for developmental defects and the complex disease, dental caries. Understanding why and how enamel is affected and the enamel phenotypes seen clinically support diagnostics, prognosis prediction, and the selection of treatment approaches that are appropriate for the specific tissue defects (e.g., deficient amount, decreased mineral, reduced insulation and hypersensitivity). The current level of knowledge regarding the heritable enamel defects is sufficient to develop a new classification system and consensus nosology that effectively communicate the mode of inheritance, molecular defect/pathway, and the functional aberration and resulting enamel phenotype.

The Relationship between Eating Behavior and Early Childhood Caries in Children

BACKGROUND: Eating process in children is not only to fulfill hunger but also to fulfill the nutritional needs of children’s growth and development. Eating disorders can cause health problems for children, including dental and oral health. Poor oral and dental health in children can affect self-confidence, chewing ability, and nutritional fulfillment. Nowadays, Early Childhood Caries (ECC) is the most common hard tissue disease in primary teeth that affects children. AIM: This study aims to determine the relationship between eating behavior and ECC in children. METHODS: This research is an observational study with a cross-sectional design. Sampling was done by purposive sampling with a total sample of 165 children aged 3–5 years old and their mothers. The Children Eating Behavior Questionnaire (CEBQ) was used to measure the eight eating types of children. ECC is measured by def-t index. Data analysis was done using Chi-square test. RESULTS: The prevalence of ECC was 47.9%. There was a significant relationship between food responsiveness (p = 0.001; OR = 3.235; 95% CI 1.648–6.341), food fussiness (p = 0.010; OR = 2.380; 95% CI 1.273–4.450), and enjoyment of food (p = 0.005; OR = 0.377; 95% CI 0.198–0.72) with the incidence of ECC. However, Emotional over Eating, Desire to Drink, Satiety Responsiveness, Emotional under Eating, and Slowness in Eating were not associated with the incidence of ECC. CONCLUSION: Children’s eating behavior contributes to the incidence of ECC.

Relationship between preterm, low birth weight, and development defects of enamel in the primary dentition: A meta-analysis

BACKGROUND

This study aimed to systematically analyze the relationship between preterm (PT), low birth weight (LBW), and developmental defects of enamel (DDE) in the primary dentition.

METHODS

Following the retrieval of the databases, case-control studies, cross-sectional studies, and cohort studies on the relationship between PT, LBW and DDE, which had been published in English or Chinese up to January 2022 were included. The data about odds ratio (OR) and 95% confidence interval (95% CI) were extracted and calculated using STATA 12.0 Software. Case-control studies were evaluated using the Newcastle-Ottawa Scale (NOS), while cross-sectional studies and cohort studies were evaluated using the JBI scale. The heterogeneity of each study was evaluated using the Q test.

RESULTS

A total of 15 studies were included, of which 8 studied the relationship between PT and DDE, and 13 explored the relationship between LBW and DDE including three about the relationship between very low birth weight (VLBW) and DDE. Seven studies explored the relationship between PT, LBW, and DDE. The results of this meta-analysis showed that both PT and LBW especially VLBW (OR= 7.19, 95% CI: 4.98-10.38) were risk factors for DDE in the primary dentition (OR= 2.33, 95% CI: 1.55-3.51) (OR= 1.67, 95% CI: 1.08-2.59). The subgroup results showed that PT and LBW were both associated with the occurrence of enamel hypoplasia (EHP) (OR= 6.89, 95% CI: 3.33-14.34; OR= 2.78, 95% CI: 2.10-3.68) rather than enamel opacity (OR= 0.94, 95% CI: 0.55-1.61; OR= 1.03, 95% CI: 0.66-1.61). There was no publication bias about the included studies (P = 0.75 > 0.05; P = 0.47 > 0.05).

CONCLUSION

This meta-analysis demonstrated that both PT and LBW especially VLBW are associated with a higher risk of DDE in the primary dentition. PT and LBW are both related to the occurrence of EHP. However, the relationship between PT, LBW, and enamel opacity has not been verified.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier: CRD42021262761.

Developmental enamel defects are associated with early childhood caries: Case-control study

BACKGROUND

Knowledge on the association between developmental enamel defects (DED) and early childhood caries (ECC) has importance for the drafting of prevention measures and oral healthcare planning.

AIM

To compare the frequency of ECC in children with and without DED and verify their association with sociodemographic factors.

DESIGN

This case-control study was carried out with Brazilian children aged one to five years. The case group made up of 98 children with ECC and the control group was made up of 98 children without ECC. DED were classified in diffuse opacity, demarcated opacity and enamel hypoplasia (Developmental Defects of Enamel Index). Sociodemographic data were collected by a questionnaire answered by parents. Statistical analysis used McNemar's test and logistic regression analyses.

RESULTS

In the bivariate analysis, ECC was more frequent among children from families with poorer socioeconomic conditions (lower monthly household income [P ≤ .001] and lower maternal schooling [P = .001]) and among those with DED (P ≤ .001). The final logistical model showed that children with DED (OR: 1.94) and a monthly household income less than two Brazilian minimum salaries (OR: 2.24) were more likely to have ECC.

CONCLUSIONS

The occurrence of DED and lower household income were pre-disposing factors for the occurrence of ECC.

Association between developmental dental anomalies, early childhood caries and oral hygiene status of 3-5-year-old children in Ile-Ife, Nigeria

BACKGROUND

To determine the association between developmental dental anomalies (DDA), early childhood caries (ECC) and oral hygiene status of 3-5-year-old children resident in Ile-Ife, Nigeria.

METHODS

This was a cross-sectional study. We analyzed data for 3-5-year-olds extracted from the dataset of a household survey collected to determine the association between ECC and maternal psychosocial wellbeing in children 0-5-year-old. The outcome variables for the study were ECC and poor oral hygiene. The explanatory variable was the presence of developmental dental anomalies (supernumerary, supplemental, mesiodens, hypodontia, macrodontia, microdontia, peg-shaped lateral, dens evaginatus, dens invaginatus, talons cusp, fusion/germination, hypoplasia, hypomineralized second molar, fluorosis, amelogenesis imperfecta). The prevalence of each anomaly was determined. Poisson regression analysis was conducted to determine the association between presence of developmental dental anomalies, ECC and oral hygiene status. The model was adjusted for sex, age and socioeconomic status.

RESULTS

Of the 918 children examined, 75 (8.2%) had developmental dental anomalies, 43 (4.7%) had ECC, and 38 (4.1%) had poor oral hygiene. The most prevalent developmental dental anomalies was enamel hypoplasia (3.9%). Of the 43 children with ECC, 6 (14.0%) had enamel hypoplasia and 3 (7.6%) had hypomineralized second primary molar. There was a significant association between ECC and enamel hypoplasia (p < 0.001) and a borderline association between ECC and hypomineralized second primary molars (p = 0.05). The proportion of children with poor oral hygiene (PR: 2.03; 95% CI: 0.91-4.56; p = 0.09) and ECC (PR: 2.02; 95% CI: 0.92-4.46; p = 0.08) who had developmental dental anomalies was twice that of children with good oral hygiene and without ECC respectively, although the differences did not reach statistical significance.

CONCLUSIONS

Enamel hypoplasia and hypomineralized second primary molars are developmental dental anomalies associated with ECC. developmental dental anomalies also increases the probability of having poor oral hygiene in the population studied.