Dental enamel defects, caries experience and oral health-related quality of life: a cohort study

Evaluation of Pediatric Oral Health-Related Quality of Life score in children with traumatic dental avulsion injury: A Questionnaire-Based Cross-Sectional survey

BACKGROUND/AIM

Dental avulsion injury, being one of the traumatic dental injuries, has negative impacts on children's life quality. This study aims to evaluate the Pediatric Oral Health-Related Quality of Life (POQL) scores of children with dental avulsion history from their perspective.

MATERIALS AND METHODS

The population of this cross-sectional study comprises 40 patients, aged between 8 and 14, who have a history of dental avulsion, in comparison to 40 other healthy peers. A questionnaire including general questions (such as age, gender, loss of tooth due to dental avulsion, malocclusion) and POQL instrument, with subscales including physical function, social function, emotional function, and role function, were completed by these children. Mann-Whitney U-test is used when comparing the POQL scores.

RESULTS

The social scores (median: 47, interquartile range [IQR]: 17-95) and total score percentages (median: 30, IQR: 14-40) of children with a history of avulsion were higher than those of their healthy peers (p < 0.05). The higher total POQL scores among girls (median: 37, IQR: 31-47) with a history of dental avulsion compared to boys (median: 19, IQR: 8-34) (p = .002) can be attributed to girls achieving higher scores in both social (median: 81, IQR: 39-100) and emotional (median: 35, IQR: 17-47) scores following dental avulsion (psocial = .02, pemotional = .006). Whether the avulsed tooth is replanted or not, it has not made any visible impact on the POQL scores. However, the loss of replanted teeth over time has created a borderline significant difference in emotional scores (median: 21, IQR: 11-35, p = .055).

CONCLUSION

Within the limits of our study, avulsion injuries have negative effects on children's emotional, social, and total quality of life. Even though avulsion injuries may be inevitable, to prevent these negative effects, it is vital to provide appropriate psychological support in the treatment of these children.

Assessing oral health and the minimally important differences in oral health-related quality of life of non-diabetic and diabetic patients: a cross-sectional study

BACKGROUND

Non-diabetics and diabetics might have different oral health problems and impacts on their oral health-related quality of life (OHRQoL). Comparison of oral health status and coping strategies between these patients, and evaluation of factors associated with OHRQoL might facilitate better treatment planning for improved patient-centred outcome.

METHODS

One hundred and eleven non-diabetics and 107 diabetics attending a public hospital were clinically examined and evaluated for coping strategies (abbreviated coping orientation to problems experienced) and OHRQoL [short-form oral health impact profile (OHIP-14S)]. Factors associated with OHRQoL were analysed through correlation/partial correlation. Minimally important differences (MID) of OHIP-14S were calculated to confirm associations between attachment loss, caries, and tooth loss with OHRQoL.

RESULTS

Non-diabetics had worse periodontal status. Diabetics had more missing teeth. Non-diabetics and diabetics employed maladaptive coping to manage oral health problems. Overall, non-diabetics reported worse OHRQoL. Determination of MID showed that non-diabetics with high-severe attachment loss and <20 teeth experienced poorer OHRQoL. Diabetics with caries, high-severe attachment loss, and <25 teeth experienced poorer OHRQoL.

CONCLUSION

Different factors were associated with OHRQoL of non-diabetics and diabetics. Delivery of treatment aimed at maintaining teeth in a periodontally healthy and caries free state, and provision of more chewing units might help improve OHRQoL of diabetics. © 2024 Australian Dental Association.

The Impact of Molar Incisor Hypomineralisation on Children and Adolescents: A Narrative Review

Molar incisor hypomineralisation (MIH) is a qualitative developmental enamel defect with a prevalence of 13% worldwide. This review aims to outline the current evidence regarding the impact of MIH on children's oral health and, more broadly, their day-to-day activities. MIH is associated with negative sequelae, including hypersensitivity, post-eruptive breakdown, the rapid development of carious lesions and poor aesthetics. Other concerns pertain to the clinical management of MIH and include difficulty in achieving local anaesthesia, increased dental fear and anxiety (DFA) and increased behaviour management problems. Oral health-related quality of life (OHRQoL) is the most standardised measure of patient impact; however, no instruments have been validated for use in MIH populations. The few existing observational studies investigating the impact of MIH on OHRQoL in children have produced conflicting results. Interventions to alleviate hypersensitivity and improve aesthetics had a positive impact on the OHRQoL of MIH-affected children. Multiple methodological issues make it difficult to measure the impact of MIH, including heterogeneity in the MIH severity classification, an overlap in the indices used to diagnose dental caries and MIH as well as the subjectivity of outcome measures for hypersensitivity and DFA.

Do patients with molar incisor hypomineralization have more dental anxiety and behavior management problems? A systematic review with meta-analysis

This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Oral health-related quality of life in children with celiac disease

PURPOSE

There is limited knowledge about oral health-related quality of life (OHRQoL) in children with celiac disease (CD). This study aimed to assess OHRQoL in children with CD compared to healthy controls.

METHODS

This case-control study included children with CD and healthy controls. Three scales were used to assess OHRQoL in different age groups: 6-7 years, 8-10 years, and 11-14 years. The OHRQoL scores were compared between cases and controls to examine the possible associations between OHRQoL and demographics, socioeconomic status, and oral health.

RESULTS

Overall, 104 children with CD and 104 healthy children (controls) were included. The mean age was 10.67 ± 2.39 years in CD patients and 10.69 ± 2.36 in controls (P = 0.971). Male and female children constituted 50% of each group. Children with CD had significantly higher OHRQoL scores than controls (P = 0.003). Low education levels of parents of children with CD and a higher number of siblings in controls were associated with high OHRQoL scores (P = 0.002, P < 0.020, and P = 0.010, respectively). Recurrent aphthous stomatitis (RAS) increased the OHRQoL scores by 7.5 on average (P = 0.016).

CONCLUSION

Children with CD had poor OHRQoL compared with healthy controls. Poor OHRQoL in children with CD was associated with RAS and with lower parental income and education. RAS was an independent predictor of poor OHRQoL in children with CD.

Silver diamine fluoride, atraumatic restorations, and oral health-related quality of life in children aged 5-13 years: results from the CariedAway school-based cluster randomized trial

Objective

Silver diamine fluoride (SDF) is a non-surgical treatment for the arrest and prevention of dental caries that results in irreversible black staining of dental decay. The objective of this study was to evaluate the short-term impact of SDF treatment on oral health-related quality of life (OHRQoL) relative to a standard package of glass ionomer sealants and atraumatic restorative treatment (ART) in children aged 5–13 years.

Methods

CariedAway is a pragmatic, longitudinal, cluster-randomized non-inferiority trial of non-surgical interventions for caries. Secondary study outcomes included OHRQoL and academic performance. Oral health-related quality of life was measured at each study visit using the Child Oral Health Impact Profile. Change in OHRQoL was assessed using linear regression and non-inferiority was determined using t tests.

Results

160 children with an average age of 8.7 years completed quality of life assessments. Untreated decay at baseline (approximately 25%) was associated with significantly worse OHRQoL and treatment in both groups resulted in incremental improvement: children receiving SDF improved their OHRQoL scores from 16.44 (SD = 11.12) to 14.62 (SD = 11.90), and those receiving traditional sealants and atraumatic restorations slightly improved from 16.65 (SD = 10.56) to 16.47 (SD = 11.09). Quality of life in children receiving silver diamine fluoride was non-inferior to those receiving sealants and ART at least 6 months post-treatment (mean difference = 1.85, 95% CI = − 2.10, 5.80), and change in OHRQoL did not depend on the severity of baseline decay.

Conclusions

OHRQoL is related to untreated dental caries, and observed changes following SDF treatment were non-inferior relative to standard preventive therapies.

Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review

PURPOSE

Molar Incisor Hypomineralization (MIH) are first molars with developmental enamel defects and are common findings in many child populations. The porous nature of MIH enamel and the presence of post-eruptive enamel breakdown leads to the presence of hypersensitivity and pain, which is often the patient's main complaint and can result in dental fear and affect the quality of life. The present review aims to summarise the evidence for the ability of MIH to cause problems, such as dental fear and anxiety (DFA) and to summarise the evidence for a possibly negative impact on the oral health-related quality of life (OHRQoL) of MIH affected children and adolescents, in a systematic review.

METHOD

Two searches, (1) MIH AND dental anxiety and (2) MIH AND Quality of life, were performed in MEDLINE/PubMed and Scopus. Selection demands were fulfilling the MIH diagnosis criteria using validated instruments and questionnaires for assessing DFA and OHRQoL, respectively.

RESULTS

After removing duplicates and articles not fulfilling the selection demands, 6 studies concerning MIH and DFA and 8 studies concerning MIH and OHRQoL remained.

CONCLUSION

Children and adolescents with diagnosed MIH did not seem to suffer from increased dental fear and anxiety, but indicated an impaired oral health-related quality of life.

Prevalence of Missing First Permanent Molars in a Selected Population in a University Dental Clinic Setting: A Retrospective Radiographic Study

Aim and objective

This study aimed to determine the prevalence of missing first permanent molars (FPMs) in the 7–29-year-old selected population of Al Ahsa, Saudi Arabia.

Materials and methods

This study retrospectively analyzed 398 panoramic radiographs of patients aged from 7 to 29 years old for missing FPM. Patients were divided into two age-groups: 7–15 and 16–29 years old. Study variables including gender, age, missing FPM, dental arch, and right or left sides of the arch were recorded. The data were statistically analyzed using Chi-square tests.

Results

Of the total study sample, 23.1% of patients had only one missing FPM, 13.3% of patients had two, and 2.8% of them had three missing FPM teeth. No patient had four missing FPM teeth. A total of 60.8% (242) radiographs in the overall sample did not show any missing teeth. The mandibular FPMs (35.2%) were found missing more frequently than their maxillary counterparts (17.4%) and the left mandibular quadrant showed a higher rate of missing FPM (21.9%). No statistically significant association was seen between the missing FPM and the gender or age-group (p > 0.05).

Conclusion

The high prevalence rates of missing FPM in the study population warrants attention. Further prospective studies are needed to comprehensively evaluate the effect of early loss of the FPM on space changes in the arch and subsequent reduction in complex orthodontic treatment needs.

How to cite this article

Almugla YM. Prevalence of Missing First Permanent Molars in a Selected Population in a University Dental Clinic Setting: A Retrospective Radiographic Study. Int J Clin Pediatr Dent 2021;14(2):269–272.

New insight into dental epithelial stem cells: Identification, regulation, and function in tooth homeostasis and repair

Tooth enamel, a highly mineralized tissue covering the outermost area of teeth, is always damaged by dental caries or trauma. Tooth enamel rarely repairs or renews itself, due to the loss of ameloblasts and dental epithelial stem cells (DESCs) once the tooth erupts. Unlike human teeth, mouse incisors grow continuously due to the presence of DESCs that generate enamel-producing ameloblasts and other supporting dental epithelial lineages. The ready accessibility of mouse DESCs and wide availability of related transgenic mouse lines make mouse incisors an excellent model to examine the identity and heterogeneity of dental epithelial stem/progenitor cells; explore the regulatory mechanisms underlying enamel formation; and help answer the open question regarding the therapeutic development of enamel engineering. In the present review, we update the current understanding about the identification of DESCs in mouse incisors and summarize the regulatory mechanisms of enamel formation driven by DESCs. The roles of DESCs during homeostasis and repair are also discussed, which should improve our knowledge regarding enamel tissue engineering.

Oral alterations in patients with cystinosis

Cystinosis is a rare autosomal recessive lysosomal storage disorder, which leads to abnormal accumulation of cysteine in various organs, including progressive dysfunction of kidneys. The most severe and frequent form, affecting ∼95% of patients, is termed infantile nephropathic cystinosis (NC) (OMIM 219800). We have reported oral findings in two patients with NC and described esthetic and functional rehabilitation in one of them. The first case describes a 16-year-old male patient, who was diagnosed with NC when he was 1-year-old. The patient exhibited generalized enamel hypoplasia, grade 1 drug-induced gingival overgrowth, caries lesion in molar tooth and supernumerary tooth (ie, distomolar). The second case describes a 14-year-old male patient diagnosed with NC at 3 years old. Clinical examination revealed generalized enamel hypoplasia and grade 1 drug-induced gingival overgrowth. Radiographic examination showed supernumerary tooth (mesiodens). The treatment included gingivoplasty and restoration with direct composite resin. The severity of hypoplasia highlights the importance of a dental rehabilitation treatment, as proposed here. Direct restoration with composite resin allowed harmony, function, and esthetics to be restored, in addition to being a rapid and low-cost technique.

Impact of Molar Incisor Hypomineralization on Oral Health-Related Quality of Life in Mexican Schoolchildren

Objective: To evaluate the impact of Molar Incisor Hypomineralization (MIH) in the OHRQoL in a group of 8 to 10 year-old Mexican schoolchildren. Study design: A cross-sectional study of 411 8 to 10 year-old schoolchildren selected from public schools in Naucalpan, in the State of Mexico. The presence and severity of MIH was evaluated using the European Academy of Pediatric Dentistry (EAPD) criteria. The OHRQoL was evaluated using the Child Perceptions Questionnaire (CPQ). Poisson regression models were performed for the analysis. Results: The prevalence of MIH in the permanent dentition was 40.4%. High scores were found in the four domains of the CPQ for children with MIH compared to children without MIH (p<0.001). In the Poisson model, a greater negative impact in the four CPQ domains was found for schoolchildren with MIH: oral symptoms [RR=1.75 (CI95% 1.63-1.78)]; functional limitations [RR=2.17 (CI95% 2.01-2.35)]; emotional wellbeing [RR=1.94 (CI95% 1.80-2.08)]; and, social well-being [RR=2.62 (CI95% 2.49-2.77)]. A greater impact on the four CPQ domains were found for children with moderate/severe MIH compared to children without MIH (p<0.001). Conclusion: Children with moderate/severe MIH experienced a greater negative impact on their OHRQoL compared to children without MIH.

Indicators of Risk for Dental Caries in Children: A Holistic Approach

BACKGROUND

Dental caries in children is a major public health problem worldwide, with a multitude of determinants acting upon children to different degrees in different communities. The objective of this study was to determine maternal, environmental, and intraoral indicators of dental caries experience in a sample of 6- to 7-y-old children in South East Queensland, Australia.

METHODS

A total of 174 mother-child dyads were recruited for this cross-sectional study from the Griffith University Environments for Healthy Living birth cohort study. Maternal education, employment status, and prepregnancy body mass index were maternal indicators, and annual household income was taken as a proxy for environmental indicators. These were collected as baseline data of the study. Clinical data on children's dental caries experience, saliva characteristics of buffering capacity, stimulated flow rate, and colony-forming units per milliliter of salivary mutans streptococci were collected for the oral health substudy. Univariate analysis was performed with 1-way analysis of variance and chi-square tests. Caries experience was the outcome, which was classified into 4 categories based on the number of carious tooth surfaces. Ordinal logistic regression was used to explore the association of risk indicators with caries experience.

RESULTS

Age (P = 0.021), low salivary buffering capacity (P = 0.001), reduced levels of salivary flow rate (P = 0.011), past caries experience (P = 0.001), low annual household income; <$30,000 (P = 0.050) and <$60,000 (P = 0.033) and maternal employment status (P = 0.043) were associated with high levels of dental caries.

CONCLUSION

These data support the evidence of associations between maternal, environmental, and children's intraoral characteristics and caries experience among children in a typical Western industrialized country. All of these need to be considered in preventative strategies within families and communities.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians, epidemiologists, and policy makers to identify children who are at risk of developing dental caries. With consideration of costs for treatment for the disease, this information could be used to plan cost-effective and patient-centered preventive care.

A Radiographic Evaluation of Missing of Permanent First Molars in a Group of Iranian Children and Adults: A Retrospective Study

The missing of permanent first molars influences the occlusal status and dental health. The purpose of this study was to determine the prevalence of missing first molar teeth in a selected population of Shiraz, Iran. Methods. A total of 2206 panoramic views of patients aged from 7 to 75 years old were inspected for missing of permanent first molars. Patients were categorized into five age groups: from 7 to 15, 16 to 30, 31 to 45, 46 to 60, and more than 60 years old. Data were categorized according to sex, age, and number of lost teeth using SPSS software. Results. No first molar was missing in 59.9% of the cases, 17.05% had lost one, 10.4% had lost two, 7.2% had lost three, and 5% were missing all four of their permanent first molars. The mandibular first molar was the most commonly lost tooth, and the left side in both jaws was more affected than the right side. There was a positive relation between age and missing first molar. Conclusions. A missing first molar is a common finding in southern Iran population. Due to the important role of permanent first molars in occlusion, more education and dental care is recommended to preserve these teeth.