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Elfituri AA, De Nova MJ, Najirad M. The impact of osteogenesis imperfecta severity on oral health-related quality of life in Spain: a cross-sectional study. Orphanet J Rare Dis 2024; 19:108. [PMID: 38459573 PMCID: PMC10921673 DOI: 10.1186/s13023-024-03096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) affects dental and craniofacial development; therefore, it can influence oral health-related quality of life (OHRQoL). The objective of this study was to explore the influence of the severity of OI on OHRQoL in adults older than eighteen years residing in Spain. METHOD Adults with OI were recruited from the Spanish Association of Crystal Bone (AHUCE) foundation. OHRQoL was evaluated using the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14sp), oral hygiene habits, and a dental care survey. Clinical and radiological dental examinations were performed to evaluate the patients' oral conditions. RESULTS A total of 65 adults (n = 46 females) aged between nineteen and sixty-two years who were diagnosed with OI and classified as type I, III, and IV (n = 20, 14, and 31, respectively) participated in this research. The total OHIP-14sp scores were significantly greater (worse) for type III (23 [SD = 10]) and type IV (21.4 [SD = 12]) than for type I (13.8 [SD = 6]) (P < 0.05). The negative impact of OHRQoL was due to the association of type III OI with all domains except for the handicap domain, while type IV OI was associated with the physical disability, social disability, and handicap domains (P < 0.05 for all). CONCLUSION The severity of OI negatively impacted OHRQoL in adults. This association was statistically significant.
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Affiliation(s)
- Amira Ahmed Elfituri
- Faculty of Dentistry, Complutense University, Pza. Ramon y Cajal, Moncloa-Aravaca, Madrid, Spain.
| | - Manuel Joaquín De Nova
- Faculty of Dentistry, Complutense University, Pza. Ramon y Cajal, Moncloa-Aravaca, Madrid, Spain
| | - Mohammadamin Najirad
- Department of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
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Rapoport M, Bober MB, Raggio C, Wekre LL, Rauch F, Westerheim I, Hart T, van Welzenis T, Mistry A, Clancy J, Booth L, Prince S, Semler O. The patient clinical journey and socioeconomic impact of osteogenesis imperfecta: a systematic scoping review. Orphanet J Rare Dis 2023; 18:34. [PMID: 36814274 PMCID: PMC9945474 DOI: 10.1186/s13023-023-02627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare heritable connective tissue disorder primarily characterised by skeletal deformity and fragility, and an array of secondary features. The purpose of this review was to capture and quantify the published evidence relating specifically to the clinical, humanistic, and economic impact of OI on individuals, their families, and wider society. METHODS A systematic scoping review of 11 databases (MEDLINE, MEDLINE in-progress, EMBASE, CENTRAL, PsycINFO, NHS EED, CEA Registry, PEDE, ScHARRHUd, Orphanet and Google Scholar), supplemented by hand searches of grey literature, was conducted to identify OI literature published 1st January 1995-18th December 2021. Searches were restricted to English language but without geographical limitations. The quality of included records was assessed using the AGREE II checklist and an adapted version of the JBI cross-sectional study checklist. RESULTS Of the identified 7,850 records, 271 records of 245 unique studies met the inclusion criteria; overall, 168 included records examined clinical aspects of OI, 67 provided humanistic data, 6 reported on the economic impact of OI, and 30 provided data on mixed outcomes. Bone conditions, anthropometric measurements, oral conditions, diagnostic techniques, use of pharmacotherapy, and physical functioning of adults and children with OI were well described. However, few records included current care practice, diagnosis and monitoring, interactions with the healthcare system, or transition of care across life stages. Limited data on wider health concerns beyond bone health, how these concerns may impact health-related quality of life, in particular that of adult men and other family members, were identified. Few records described fatigue in children or adults. Markedly few records provided data on the socioeconomic impact of OI on patients and their caregivers, and associated costs to healthcare systems, and wider society. Most included records had qualitative limitations. CONCLUSION Despite the rarity of OI, the volume of recently published literature highlights the breadth of interest in the OI field from the research community. However, significant data gaps describing the experience of OI for individuals, their families, and wider society warrant further research to capture and quantify the full impact of OI.
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Affiliation(s)
| | | | | | - Lena Lande Wekre
- TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Bjørnemyr, Nesodden, Norway
| | | | | | - Tracy Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, MD, USA
| | | | | | | | - Lucy Booth
- Wickenstones Ltd, Abingdon, Oxfordshire, UK
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Arantes C, Sica I, Bezerra M, Amaral C, Bellato C, Logar G. Osteogenesis imperfecta type III: Oral, craniofacial characteristics and atypical radiographic findings oral. J Clin Exp Dent 2021; 13:e1053-e1056. [PMID: 34667502 PMCID: PMC8501861 DOI: 10.4317/jced.58263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a disease characterized by decreased bone mineral density, causing susceptibility to bone fractures by mild trauma and bone deformities. The aim of this study was to describe an osteogenesis imperfecta type III clinical case, its craniofacial and oral changes as well as its atypical radiographic findings. An eighteen-year-old, male patient diagnosed with osteogenesis imperfecta type III was referred for dental evaluation; the clinical examination showed the craniofacial and oral changes of the disease such as triangular face, class III malocclusion, anterior open bite and posterior crossbite, dentinogenesis imperfecta presenting amber discoloration. The radiographic examination revealed teeth with pulp chamber obliteration and root canals, however unusual findings were also observed such as: bilateral increase of the mandibular canals and preservation of the pulp chamber and third molar root canals. Our findings show that is essential an adequate knowledge of anatomy, a careful anamnestic evaluation and a complete radiological evaluation of the patient with OI. Key words:Dental anomalies, developmental disability, rare disorders.
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Affiliation(s)
- Camila Arantes
- Graduate Program in Dentistry, University of Western São Paulo, Presidente Prudente, Brazil
| | - Isabela Sica
- Graduate Program in Dentistry, University of Western São Paulo, Presidente Prudente, Brazil
| | - Milena Bezerra
- Graduate Program in Dentistry, University of Western São Paulo, Presidente Prudente, Brazil
| | - Cristhiane Amaral
- DDS, Ms, Department of Special Care Dentistry, Dental School, University of Western Sao Paulo, Presidente Prudente, Sao Paulo, Brazil
| | - Caio Bellato
- DDS, MS, Department of Surgery, University of Western Sao Paulo, Presidente Prudente, Sao Paulo, Brazil
| | - Gustavo Logar
- DDS, Ms, Department of Special Care Dentistry, Dental School, University of Western Sao Paulo, Presidente Prudente, Sao Paulo, Brazil
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Taqi D, Moussa H, Schwinghamer T, Vieira AR, Dagdeviren D, Retrouvey JM, Rauch F, Tamimi F. Missing and unerupted teeth in osteogenesis imperfecta. Bone 2021; 150:116011. [PMID: 34020077 DOI: 10.1016/j.bone.2021.116011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/02/2021] [Accepted: 05/14/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and craniofacial and dental abnormalities such as congenitally missing teeth and teeth that failed to erupt which are believed to be doubled in OI patients than normal populations and were associated with low oral health quality of life. However, the etiology of these abnormalities remains unclear. To understand the factors influencing missing and unerupted teeth, we investigated their prevalence in a cohort of OI patients as a function of the clinical phenotype (OI type), the genetic variant type, the tooth type and the onset of bisphosphonate treatment. METHOD A total of 144 OI patients were recruited from The Shriners Hospital, Montreal, Canada, between 2016 and 2017. Patients were evaluated using intraoral photographs and panoramic radiographs. Missing teeth were evaluated in all patients, and unerupted teeth were assessed only in patients ≥15 years old (n = 82). RESULTS On average, each OI patient had 2.4 missing teeth and 0.8 unerupted teeth, and the most common missing and unerupted teeth were the premolars and the upper second molars, respectively. These phenomena were more prominent in OI type III and IV than in OI type I, and were not sex or age-related. Missing teeth were significantly more common in patients with C-propeptide variants than all other variants (p-value <0.05). Unerupted teeth were significantly more common in patients with α1 and α2 glycine variants or substitutions than in those with haploinsufficiency variants. Early-onset of bisphosphonate treatment would significantly increase the risk of unerupted teeth in patients with OI types III and IV (OR = 1.68, 95% CI (1.15-1.53)). CONCLUSION The prevalence of missing and unerupted teeth at the tooth type level in OI patients varies according to the nature of the collagen variants and the OI type. These findings highlight the role of collagen in tooth development and eruption.
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Affiliation(s)
- Doaa Taqi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
| | - Hanan Moussa
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; Faculty of Dentistry, Benghazi university, Libya.
| | | | | | - Didem Dagdeviren
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
| | - Jean-Marc Retrouvey
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; School of Dentistry, University of Missouri, Kansas City, USA.
| | - Frank Rauch
- Shriners Hospital for Children, Montreal, Quebec, Canada.
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
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Taqi D, Moussa H, Schwinghamer T, Ducret M, Dagdeviren D, Retrouvey JM, Rauch F, Tamimi F. Osteogenesis imperfecta tooth level phenotype analysis: Cross-sectional study. Bone 2021; 147:115917. [PMID: 33741542 PMCID: PMC8278321 DOI: 10.1016/j.bone.2021.115917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dental anomalies in Osteogenesis imperfecta (OI), such as tooth discoloration, pulp obliteration (calcified dental pulp space), and taurodontism (enlarged dental pulp space) vary between and within patients. To better understand the associations and variations in these anomalies, a cross-sectional study was designed to analyze the dental phenotype in OI patients at the individual tooth type. METHOD A cohort of 171 individuals with OI type I, III and IV, aged 3-55 years, were recruited and evaluated for tooth discoloration, pulp obliteration, and taurodontism at the individual tooth level, using intraoral photographs and panoramic radiographs. RESULTS Genetic variants were identified in 154 of the participants. Patients with Helical α1 and α2 glycine substitutions presented the highest prevalence of tooth discoloration, while those with α1 Haploinsufficiency had the lowest (<10%). C-propeptide variants did not cause discoloration but resulted in the highest pulp obliteration prevalence (~%20). The prevalence of tooth discoloration and pulp obliteration was higher in OI types III and IV and increased with age. Tooth discoloration was mainly observed in teeth known to have thinner enamel (i.e. lower anterior), while pulp obliteration was most prevalent in the first molars. A significant association was observed between pulp obliteration and tooth discoloration, and both were associated with a lack of occlusal contact. Taurodontism was only found in permanent teeth and affected mostly first molars, and its prevalence decreased with age. CONCLUSION The dental phenotype evaluation at the tooth level revealed that different genetic variants and associated clinical phenotypes affect each tooth type differently, and genetic variants are better predictors of the dental phenotype than the type of OI. Our results also suggest that tooth discoloration is most likely an optical phenomenon inversely proportional to enamel thickness, and highly associated with pulp obliteration. In turn, pulp obliteration is proportional to patient age, it is associated with malocclusion and likely related to immature progressive dentin deposition. Taurodontism is an isolated phenomenon that is probably associated with delayed pulpal maturation.
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Affiliation(s)
- Doaa Taqi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
| | - Hanan Moussa
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; Faculty of Dentistry, Benghazi University, Libya.
| | | | - Maxime Ducret
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; Faculty of Dentistry, Lyon University, Lyon, France.
| | - Didem Dagdeviren
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
| | - Jean-Marc Retrouvey
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; School of Dentistry, University of Missouri, Kansas City, USA.
| | - Frank Rauch
- Shriners Hospital for Children, Montreal, Quebec, Canada.
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada; College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
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Nguyen HTT, Vu DC, Nguyen DM, Dang QD, Tran VK, Le H, Tong SM. Dentinogenesis Imperfecta and Caries in Osteogenesis Imperfecta among Vietnamese Children. Dent J (Basel) 2021; 9:dj9050049. [PMID: 33925433 PMCID: PMC8144955 DOI: 10.3390/dj9050049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 02/05/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder characterized by increased bone fragility and low bone mass, caused mainly by mutations in collagen type I encoding genes. The current study aimed to evaluate dentinogenesis imperfecta (DI), oral manifestations and caries status of OI children. Sixty-eight children (41 males, 27 females) aged from 3 to 17 years old (mean 9 ± 4.13) participated in the study. Participants were classified into three OI type groups (I—2 cases, III—31 cases and IV—35 cases). Clinical examination and an orthopantomogram were used to obtain prevalences and associations of DI, caries status, malocclusion, crossbite, open bite, eruption, impaction and missing teeth with OI. The prevalence of DI among OI patients was 47.1%, more common in OI type III than type IV. The yellow-brown discoloration type was more vulnerable to attrition than the opalescent-grey one in the primary dentition. OI seemed not to have a high risk of caries; the prevalence of caries was 69.1%. A high incidence of malocclusion, crossbite and open bite was observed. In-depth oral information would provide valuable data for better dental management in OI patients. Parents and general doctors should pay more attention to dental care to prevent caries and premature tooth loss.
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Affiliation(s)
| | - Dung Chi Vu
- Department of Endocrinology, Metabolism and Genetics, Vietnam National Children’s Hospital, Hanoi 100000, Vietnam;
| | - Duc Minh Nguyen
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam;
- Division of Research and Treatment for Oral Maxillofacial Congenital Anomalies, Aichi Gakuin University, Aichi 464-8651, Japan
- Correspondence: (D.M.N.); (S.M.T.); Tel.: +81-80-7893-2739 (D.M.N.); +84-91-267-0670 (S.M.T.)
| | - Quang Dinh Dang
- Faculty of Dentistry, Hanoi University of Business and Technology, Hanoi 100000, Vietnam;
| | - Van Khanh Tran
- Center for Gene and Protein Research, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Hung Le
- Dong Da General Hospital, Hanoi 100000, Vietnam;
| | - Son Minh Tong
- School of Odonto-Stomatology, Hanoi Medical University, Hanoi 100000, Vietnam;
- Correspondence: (D.M.N.); (S.M.T.); Tel.: +81-80-7893-2739 (D.M.N.); +84-91-267-0670 (S.M.T.)
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Sarapultseva M, Leleko A, Sarapultsev A. Case report: Rehabilitation of a child with dentinogenesis imperfecta with CAD/CAM approach: Three‐year follow‐up. SPECIAL CARE IN DENTISTRY 2020; 40:511-518. [DOI: 10.1111/scd.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Sarapultseva
- Department of Pediatric Dentistry Medical Firm Vital EVV Ekaterinburg Russia
- Institute of Immunology and Physiology (IIP) Ural Division of Russian Academy of Sciences Ekaterinburg Russia
| | - Alina Leleko
- Department of Pediatric Dentistry Medical Firm Vital EVV Ekaterinburg Russia
- Institute of Immunology and Physiology (IIP) Ural Division of Russian Academy of Sciences Ekaterinburg Russia
| | - Alexey Sarapultsev
- Institute of Immunology and Physiology (IIP) Ural Division of Russian Academy of Sciences Ekaterinburg Russia
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Vettore MV, Borges-Oliveira AC, Prado HV, Lamarca GDA, Owens J. Rare genetic diseases affecting skeletal development and oral health disparities among children and adolescents: a pathway analysis. Int Dent J 2020; 70:469-476. [PMID: 32681533 DOI: 10.1111/idj.12583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To examine the relationships of rare genetic diseases affecting skeletal development, socio-demographic characteristics, and oral health-related behaviours with dental clinical measures in children and adolescents. METHODS A cross-sectional study paired by age, gender and social class included 61 children and adolescents with osteogenesis imperfecta (n = 40) or mucopolysaccharidoses (n = 21) and those without genetic rare diseases (n = 60). Participants were selected at two referral hospitals for rare genetic diseases in the city of Belo Horizonte, Brazil. Caregivers completed a questionnaire to obtain age, gender, caregiver's schooling, social class, patterns of dental attendance and duration of breastfeeding. Oral hygiene, dental caries, dental anomalies and malocclusion were assessed through dental examinations. The relationships between variables were estimated through Pathway analysis using the maximum likelihood method. RESULTS Rare genetic diseases affecting skeletal development were directly associated with dental caries (β = 0.22), dental anomalies (β = 0.36) and malocclusion (β = 0.29). They were also inversely linked to a preventive pattern of dental attendance (β = -0.25). Rare genetic diseases affecting skeletal development were associated with poor oral hygiene (β = 0.28) and shorter breastfeeding duration (β = -0.21). Rare genetic diseases affecting skeletal development were linked indirectly with dental caries, a reduced pattern of dental attendance and poor oral hygiene (β = 0.43). Patterns of dental attendance mediated the link between rare genetic diseases affecting skeletal development and malocclusion (β = -0.05). CONCLUSION Rare genetic diseases affecting skeletal development were associated with poor oral health. Patterns of dental attendance and poor oral hygiene mediated the link between rare genetic diseases affecting skeletal development and dental clinical measures.
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Affiliation(s)
- Mario Vianna Vettore
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Ana Cristina Borges-Oliveira
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Heloisa Vieira Prado
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gabriela de Almeida Lamarca
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Janine Owens
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Marçal FF, Ribeiro EM, Costa FWG, Fonteles CSR, Teles GS, de Barros Silva PG, Chaves Junior CM, Ribeiro TR. Dental alterations on panoramic radiographs of patients with osteogenesis imperfecta in relation to clinical diagnosis, severity, and bisphosphonate regimen aspects: a STROBE-compliant case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:621-630. [PMID: 31399368 DOI: 10.1016/j.oooo.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to assess the prevalence of dental findings on panoramic radiographs (PRs) of patients with osteogenesis imperfecta (OI) and correlate these results with epidemiologic and medical data. STUDY DESIGN A case-control study was conducted with 24 patients with OI and 48 sex- and age-matched controls. Demographic, clinical, and bisphosphonate regimen-related data were recorded. The outcome variables were the presence or absence of dental alterations in PRs. Mann-Whitney U test, Pearson's χ2 test, and multinomial logistic regression analysis (95% confidence interval) were used (significance level of 5%). RESULTS OI type 4 demonstrated a high prevalence (62.5%), followed by type 1 (37.5%). With regard to prevalence associated with severity, the moderate form was the most prevalent (P = .028). The mean time of intravenous pamidronate regimen was 6.6 ± 4.4 years. Dentinogenesis imperfecta was observed in 75% of patients with OI, and this group showed a high prevalence of dental abnormalities in comparison with controls (P < .05). Bisphosphonate therapy was associated with ectopic teeth (P = .007) and tooth impaction (P = .033). Pulp obliteration was significant with bisphosphonate treatment over a period of 7 years (P = .026). CONCLUSIONS This study found a significant prevalence of dental alterations in patients with OI, and certain alterations were associated with bisphosphonate therapy, indicating its influence on the dentin-related physiopathology.
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Affiliation(s)
- Felipe Franco Marçal
- Postgraduate Program in Dentistry, Department of Clinical Dentistry, Federal University of Ceará, Fortaleza, Brazil; Professor, School of Dentistry, Christus University Center, Fortaleza, Brazil
| | - Erlane Marques Ribeiro
- Professor, School of Medicine, Christus University Center, Fortaleza, Brazil; Division of Genetics, Children's Hospital Albert Sabin, Fortaleza, Brazil
| | | | | | - Gabriela Silva Teles
- Graduate Student, School of Medicine, Christus University Center, Fortaleza, Brazil
| | - Paulo Goberlânio de Barros Silva
- Postgraduate Program in Dentistry, Department of Clinical Dentistry, Federal University of Ceará, Fortaleza, Brazil; Professor, School of Dentistry, Christus University Center, Fortaleza, Brazil
| | - Cauby Maia Chaves Junior
- Full Professor, Department of Clinical Dentistry, Federal University of Ceará, Fortaleza, Brazil
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