Enamel Defects Research Articles

The Oral-Dental Findıngs of Patients Treated with Antineoplastic Treatments Targeting Non-Head and Neck Tumors in Childhood

Aim This study investigates oral complications in pediatric oncology patients undergoing antineoplastic treatments for non-head and neck tumors, with a focus on their impact on tooth development. Material and method Twenty pediatric patients (aged 3 to 14) undergoing chemotherapy for non-head and neck tumors were examined clinically. Oral and perioral tissues were assessed, and specific complications were documented. Patient records were retrospectively reviewed to identify pre-existing oral issues. Results The study revealed significant oral complications associated with antineoplastic treatments, including enamel defects (60%), gingivitis (60%), delayed apexification (55%), and mucositis (30%). Additional complications such as lymphadenopathy, delayed eruption, and herpes simplex infection were also observed. Conclusion Antineoplastic treatments for non-head and neck tumors in pediatric patients can significantly affect tooth development, leading to various oral complications. Early detection and management of these complications are vital for treatment continuity and enhancing the quality of life for pediatric oncology patients.

Optical coherence tomography and gray scale digital analysis as noninvasive techniques for evaluating molar-incisor hypomineralization severity: A comparative study with microcomputed tomography.

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel characterized by demarcated opacities present in permanent first molars and other teeth. It is considered a major clinical challenge in dentistry because it makes affected teeth more susceptible to fractures and dental caries. Its diagnosis is mainly clinical and there are few technological resources that allow for a more accurate diagnosis, especially with respect to the depth of the defect in the dental enamel. In this context, optical coherence tomography (OCT), which is routinely used in ophthalmology, can produce images of the depth of the dental enamel, making it a promising method. In this study, 33 teeth with different MIH severities were evaluated using OCT and microcomputed tomography (microCT). Semi-quantitative methods of grayscale pattern analysis were used to compare images obtained from different severities of MIH with the mineral density obtained through microCT. MicroCT evaluation revealed that hypomineralized enamel had a significantly lower mineral density than intact enamel. However, this difference was not observed between the mild and severe MIH lesions. In the OCT evaluation, significant differences were observed between the intact and hypomineralized enamel, and the gray value comparison provided a method for quantitative differentiation between the two. This study suggests that OCT could be a useful adjunct to traditional diagnostic methods for MIH, offering a noninvasive approach to evaluate enamel defects. RESEARCH HIGHLIGHTS: Combining optical coherence tomography with grayscale digital analysis shows potential as a promising method for diagnosing molar-incisor hypomineralization and assessing its level of severity.

The association between Dental Fluorosis and COL1A2 gene polymorphism among a Tunisian Population

Dental fluorosis (DF) is a prevalent developmental defect of tooth enamel caused by exposure to excessive fluoride, with the severity dependent on various factors. This study aimed to investigate the association between DF and a specific genetic polymorphism (rs412777) in the COL1A2 gene among a Tunisian population. A case-control study was conducted from July to November 2022, involving a total of 95 participants including 51 cases and 44 controls. Dental examinations and genetic analysis were performed to assess the relationship between the COL1A2 gene polymorphism and DF.The results of allelic distribution revealed that A allele carriers were significantly protected against (DF) when compared to those with the C allele (C vs. A, p = 0.001; OR = 0.375 (0.207–0.672)). This suggests a strong correlation between the presence of the C allele and the risk of developing DF. Additionally, significant association between the CC genotype of rs412777 and an increased risk of DF was found under both codominant and dominant genetic models (P = 0.002 and P < 0.001 respectively).The findings suggest that genetic predisposition plays a relevant role in the development of DF. Further research is needed to explore the potential use of genetic markers for DF and their implications for public health. This study provides the first insights into the genetic factors associated with DF in the Tunisian population, contributing to our understanding of this prevalent dental condition.

Prenatal exposure to environmental toxins and comprehensive dental findings in a population cohort of children.

Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.

Preparation of calcium phosphate ion clusters through atomization method for biomimetic mineralization of enamel.

Dental enamel is a mineralized extracellular matrix, and enamel defect is a common oral disease. However, the self-repair capacity of enamel is limited due to the absence of cellular components and organic matter. Efficacy of biomimetic enamel mineralization using calcium phosphate ion clusters (CPICs), is an effective method to compensate for the limited self-healing ability of fully developed enamel. Preparing and stabilizing CPICs presents a significant challenge, as the addition of certain stabilizers can diminish the mechanical properties or biosafety of mineralized enamel. To efficiently and safely repair enamel damage, this study quickly prepared CPICs without stabilizers using the atomization method. The formed CPICs were evenly distributed on the enamel surface, prompting directional growth and transformation of hydroxyapatite (HA) crystals. The study revealed that the mended enamel displayed comparable morphology, chemical composition, hardness, and mechanical properties to those of the original enamel. The approach of repairing dental enamel by utilizing ultrasonic nebulization of CPICs is highly efficient and safe, therefore indicating great promise.

Linear enamel hypoplasia in Homo naledi reappraised in light of new Retzius periodicities.

Among low-latitude apes, developmental defects of enamel often recur twice yearly, linkable to environmental cycles. Surprisingly, teeth of Homo naledi from Rising Star in South Africa (241-335 kya), a higher latitude site with today a single rainy season, also exhibit bimodally distributed hypoplastic enamel defects, but with uncertain timing and etiology. Newly determined Retzius periodicities for enamel formation in this taxon enable a reconstruction of the temporal patterning of childhood stress. Using high resolution casts of 31 isolated anterior teeth from H. naledi, 82 enamel defects (linear enamel hypoplasia [LEH]) were identified. Seventeen teeth are assigned to three individuals. Perikymata in the occlusal wall of enamel furrows and between the onsets of successive LEH were visualized with scanning electron microscopy and counted. Defects were measured with an optical scanner. Conversion of perikymata counts to estimates of LEH duration and inter-LEH interval draws upon Retzius periodicities of 9 and 11 days. Anterior teeth record more than a year of developmental distress, expressed as two asymmetric intervals centered on 4.5 and 7.5 months bounded by three LEH. Durations, also, show bimodal distributions, lasting 3 or 12 weeks. Short duration LEH are more severe than long duration. Relative incisor/canine rates of formation are indistinguishable from modern humans. We invoke a disease and dearth model, with short episodes of distress reflecting onset of disease in young infants, lasting about 3 weeks, followed by a season of undernutrition, possibly intensified by secondary plant compounds, spanning about 12 weeks, inferably coincident with austral winter.

In Vitro Evaluation of Remineralization Potential: Whey Extract, Fluoride Varnish, and Fluoride Mouthwash on Bleached Enamel

Background: Extrinsic discoloration is treated with bleaching which increases enamel porosity and roughness. Remineralizing materials is applied to avoid the bleaching side effects. The current study aimed to evaluate time dependent safety of bleaching materials on enamel surfaces roughness, and to assess the remineralizing potential of whey extract as a natural product and to compare it with the commercially available fluoride varnish and fluoride mouthwash after maximum bleaching time (30 min.). Methods: Extracted human incisor teeth without cracks or any enamel defects were used in this study. Teeth were cleaned and decoronated at the level of the cementoenamel junction. A nail varnish was used to cover the entire surface of the crowns of each tooth, leaving a window measuring 4 mm × 4mm. Bleaching material was applied to the enamel of all teeth specimens. The Application of bleaching material was repeated 2 more times, each time for 10 minutes, which amounted in total to 30 min. The specimens in group 1 were soaked in artificial saliva, the specimens in group 2 were soaked in whey extract, the specimens in group 3 were treated with fluoride varnish and group 4 specimens were soaked in fluoride mouthwash. Results: The mean value of the surface roughness of all the teeth specimens was increased significantly after bleaching for 10 minutes, 20 minutes and 30 minutes (p=0.000) when compared with baseline mean value. As well, there was significant direct correlation between application time of bleaching material and mean value of surface roughness (r= 0.94). There were no significant differences (p&gt;0.05) between the specimens of the 4 groups when the mean value of surface roughness compared at baseline and after bleaching. But, after treatment, there was significant difference (p≤0.05) between the 4 groups, with the best result obtained from whey extract and fluoride varnish. Conclusions: The enamel surface roughness is significantly and directly correlated with prolonged application time of bleaching material. Remineralizing materials; whey extract, fluoride varnish and fluoride mouth wash had significantly decreased enamel surface roughness caused by bleaching. Whey extract has statistically the same effect as fluoride varnish on decreasing the surface roughness of bleached enamel surface.

The effect of Vitamin D deficiency on the occurrence of enamel hypoplasia in babies: A review article

Background: Vitamin D is a steroid prohormone that can be obtained primarily from exposure to sunlight and can also be obtained from food or supplements. Vitamin D has an important role in various metabolisms and developments in the human body, including in the process of odontogenesis or tooth development. Vitamin D deficiency can be associated with various problems in the oral cavity, in this case it has the potential to trigger enamel hypoplasia. Enamel hypoplasia is a quantitative defect in enamel, which appears as pits, grooves, missing enamel or smaller teeth. This literature study will discuss the relationship between Vitamin D concentration and dental development in early childhood. Method: The method used is an article review that was conducted by analyzing various articles on related themes on virtual platforms such as PubMed, Google Scholar, ProQuest, and Science Direct. Results: Vitamin D significantly affects the development of teeth in fetuses to babies. Conclusion: Vitamin D plays an important role in various metabolisms and development of the human body. Vitamin D deficiency can cause developmental disorders and various diseases of the oral cavity such as enamel hypoplasia.

Celiac Disease-Related Enamel Defects: A Systematic Review.

This systematic review aims to elucidate the intricate correlation between celiac disease (CD) and dental enamel defects (DED), exploring pathophysiological mechanisms, oral health implications, and a dentist's role in early diagnosis. Following PRISMA guidelines, a comprehensive search from 1 January 2013 to 1 January 2024 across PubMed, Cochrane Library, Scopus, and Web of Science identified 153 publications. After exclusions, 18 studies met the inclusion criteria for qualitative analysis. Inclusion criteria involved study types (RCTs, RCCTs, case series), human participants, English language, and full-text available. The search yielded 153 publications, with 18 studies meeting the inclusion criteria for qualitative analysis. Notable findings include a high prevalence of DED in CD patients, ranging from 50 to 94.1%. Symmetrical and chronological defects, according to Aine's classification, were predominant, and significant associations were observed between CD severity and enamel defect extent. The early recognition of oral lesions, particularly through Aine's classification, may signal potential CD even in the absence of gastrointestinal symptoms. Correlations between CD and dental health conditions like molar incisor hypomineralization (MIH) emphasize the dentist's crucial role in early diagnosis. Collaboration between dentists and gastroenterologists is essential for effective monitoring and management. This review consolidates current knowledge, laying the groundwork for future research and promoting interdisciplinary collaboration for improved CD-related oral health outcomes. Further large-scale prospective research is recommended to deepen our understanding of these issues.

Examine the Relationship between DMFT Index, Enamel Defects, and Oral Health-Related Quality of Life in Children with Celiac Disease

Background: Celiac disease (CD) is an autoimmune disorder that harms the epithelium and lamina propria of the small intestine in genetically predisposed individuals. Celiac disease negatively affects oral and dental health. Objectives: This research explored the DMFT index and enamel defects (ED), as well as their association with oral health-related quality of life in children with CD. Methods: In this descriptive-analytical cross-sectional study, 50 children with CD (case group) and 50 healthy children (control group) were examined. The World Health Organization criteria were used to determine the DMFT index. Aine's classification was employed to diagnose ED, and the standard CHILD-Oral Impacts on Daily Performances scale was used to assess child oral health-related quality of life (COHRQoL). The Chi-Square test and Mann-Whitney test were utilized for data comparison. P-values &lt; 0.05 were considered statistically significant. Results: The average DMFT was 2.58 ± 2.39 in the case group and 2.08 ± 1.61 in the control group. According to the Mann-Whitney U test, this difference was not statistically significant (P = .223). The frequency of ED in the case group was significantly higher at 52%, compared to 16% in the control group (P &lt; .001). Additionally, there was a significant difference in the frequency of ED between boys and girls in the two groups (P &lt; .001). The COHRQoL score in the case group, with an average of 24.44 ± 19.91, was significantly higher than that in the control group, which had an average of 13.35 ± 13.65 (P = .002). In both the case and control groups, a significant positive relationship was observed between the COHRQoL score in children and the DMFT index (P &lt; .001). There was also a significant relationship between the COHRQoL score in children with ED in both the case and control groups (P = 0.004). Conclusions: According to the results, there was no difference in the DMFT index between the 2 groups. However, as the DMFT index increased in both groups, the COHRQoL score also increased. The number of ED cases was higher in celiac patients, and this had a significant effect on the COHRQoL score. Additionally, the COHRQoL score was higher in celiac patients compared to the control group.

Possible Etiological Factors for the Development of Molar Incisor Hypomineralization (MIH) in Austrian Children.

Molar incisor hypomineralization (MIH) is a developmental enamel defect that primarily affects the first permanent molars and sometimes the incisors. Its increasing prevalence worldwide has raised clinical concerns, yet its exact cause remains unknown. This study aimed to assess potential factors influencing MIH development by analyzing the medical history of children aged 6 to 12 years using a questionnaire. This study included 100 children aged 6-12 years diagnosed with MIH during dental examination, and 100 age-matched children in the non-MIH (healthy) group from the Department of Pediatric Dentistry, University Clinic of Dentistry, Medical University of Vienna. The parents of the participants completed a two-page questionnaire regarding possible etiological factors of MIH. The data analysis involved 100 children with MIH (mean age 8.5; ±1.3; 52% female) and 100 children in the healthy group (mean age 9.2; ±1.3; 42% female). The optimized binary logistic regression analysis revealed a significant association between MIH development and cesarean-section delivery (OR = 3; CI = [1.5-6.2]) and sixth disease (roseola) (OR = 3.5; CI = [1.5-8.0]). This study suggests that cesarean-section delivery and sixth disease (roseola) might increase the likelihood of MIH development in children.

The prevalence of developmental defects of enamel in a cohort of adults with cystic fibrosis – A cross sectional study

ObjectivesCystic Fibrosis is an autosomal recessive condition. It is a multisystem disease treated with a broad range of pharmacological therapies, diet and nutrition, and physiotherapy. Previous studies suggest that people with cystic fibrosis have a higher prevalence of developmental defects of enamel which may place this population at a greater risk of developing oral diseases such as caries. The aim of this study was to assess a cohort of people with cystic fibrosis (PwCF) for the presence of developmental defects of enamel and compare the results with a control group of people without cystic fibrosis. MethodsA cross sectional study involving 92 participants with cystic fibrosis and 92 controls was conducted in Cork University Dental School & Hospital. All participants completed a detailed questionnaire prior to undergoing a full clinical examination. The Developmental Defect of Enamel Index was used as a measurement index. All data was statistically analysed with the help of statisticians from Cystic Fibrosis Registry of Ireland. Results64 % (n = 59) of PwCF had enamel defects compared to just 30 % (n = 28) of people without cystic fibrosis. The median number of teeth affected by enamel defects in the study group was 1.5, compared to 0 in the control group. ConclusionIn this study the cohort of PwCF had more enamel defects than people without CF. Further research is required to investigate the aetiology of these findings. Clinical significanceClinicians should be vigilant after teeth have erupted in PwCF as they may have an increased susceptibility to developmental defects of enamel.

Melatonin ameliorates inflammation-induced developmental defects of enamel by upregulating regulator of G protein signaling 2

Background/purposeDevelopmental defects of enamel (DDE) is a dental disease with a high prevalence and no effective means of prevention. One of the major causes of DDE is infection, but the pathogenesis is still unclear. Melatonin is known for its anti-inflammatory and mineralization-promoting activities. However, the effects of melatonin on inflammation-induced DDE remain unknown. Here, we investigated the pathogenesis and potential therapeutic targets of inflammation-induced DDE. Materials and methodsFirst, the effect of lipopolysaccharide-induced inflammation in pregnant mice on the enamel mineralization of the offspring was detected by 3D X-ray microscope analysis, immunohistochemical assays, and quantitative real-time polymerase chain reaction (qRT-PCR). Then, the ameloblastic differentiation ability of ameloblast lineage cells (ALCs) in macrophage conditioned medium (CM) was detected. Subsequently, ameloblastic mineralization after melatonin administration was studied both in vivo and in vitro. The underlying mechanism of melatonin was investigated by RNA sequencing and small interfering RNA transfection. ResultsEnamel mineralization was decreased in the inflammatory environment both in vivo and in vitro. Furthermore, melatonin treatment ameliorated these defects. RNA sequencing analysis revealed that regulator of G protein signaling 2 (Rgs2) was downregulated in the inflammation group, whereas it was upregulated after the addition of melatonin. Further studies showed that Rgs2 knockdown resulted in decreased ameloblastic mineralization in ALCs. After Rgs2 knockdown of ALCs in M1-CM with melatonin, the effect of melatonin-mediated attenuation of DDE was greatly reduced. ConclusionOur results demonstrate that melatonin ameliorates inflammation-induced DDE by upregulating RGS2, suggesting that RGS2 is a potential therapeutic target for inflammation-induced DDE.

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.

Association of Three Genetic Loci with Molar Incisor Hypomineralization in Polish Children

Background: Molar incisor hypomineralization (MIH) is a qualitative, demarcated enamel defect of hypomineralization affecting one to four first permanent molars, often with incisor involvement. Its etiology is complex. However, evidence suggests the influence of genetic factors, potentially including the single nucleotide polymorphisms (SNPs) rs2889956, rs4811117 and rs13058467, which were previously linked to MIH in a genome-wide association study of German children. The aim was to replicate analyses of possible associations between the SNPs and molar incisor hypomineralization in Polish children. Methods: The final study group consisted of 778 children aged 126–168 months old. Saliva samples were taken, and genomic DNA was extracted and genotyped using beadchip microarrays. Results: Among the 778 subjects, there were 68 (8.7%) subjects with MIH and 710 (91.3%) subjects without MIH. There were no significant differences in distributions in age, sex, or the frequency of caries in permanent dentition between the MIH and non-MIH groups. The rs2889956, rs4811117, and rs13058467 genotype distributions in the studied group conformed to the expected Hardy–Weinberg equilibria, and there were no significant differences in the distributions of their alleles or genotypes between the MIH and non-MIH groups. Conclusion: Our replication study did not confirm highly significant associations between the single nucleotide polymorphisms rs2889956, rs4811117, and rs13058467 with molar incisor hypomineralization in Polish children.

Treatment Strategies for Incisors of Children Affected by Molar Incisor Hypomineralization: A Narrative Review

Today, molar incisor hypomineralization (MIH), which affects approximately one in seven children, is defined as a hypomineralized developmental enamel defect that often impacts at least one permanent first molar and frequently affects permanent incisors as well. Symptoms and signs include demarcated opacities of various colors, post-eruptive enamel deterioration, atypical caries and restorations, hypersensitivity, tooth loss due to MIH, and difficulty in achieving anesthesia. A detailed review of the scientific literature shows that there are many studies evaluating different treatment approaches for permanent first molars affected by MIH. On the other hand, there are very few scientific studies evaluating treatment approaches for affected incisors in patients with MIH. Most of these studies consist of case reports or series. White/creamy and/or yellow/brown demarcated opacities are commonly observed in affected incisors in patients with MIH. While these opacities increase the susceptibility of enamel to deterioration and dental caries, they also cause aesthetic problems and related psychosocial consequences. Treatment methods, such as resin infiltration, microabrasion, and/or dental bleaching, have been proposed for aesthetic and restorative purposes in affected incisors in patients with MIH. Additionally, various approaches to increase mineral content and relieve hypersensitivity have been recommended. The number of randomized controlled and prospective studies is quite low, but many case reports and case series have been encountered. The purpose of this review was to provide a comprehensive overview of the different treatment management modalities for permanent incisors affected by MIH. As a result, while resin infiltration, dental bleaching, microabrasion, and/or etch–bleach–seal techniques are preferred for aesthetic and restorative purposes in these teeth, it has been observed that agents containing casein phosphopeptide amorphous calcium phosphate, casein phosphopeptide amorphous calcium fluoride phosphate, fluoride, and calcium glycerophosphate increase the mineral content. Additionally, studies have reported that ozone and low-level laser therapy, in addition to these remineralizing agents, reduce hypersensitivity in these teeth. Although the findings of this review indicate that the level of evidence for current approaches is not high, clinicians may prefer one or more of the treatment approaches mentioned in this article based on experience and patient expectations.

Evaluation of the remineralizing effect of the chicken eggshell paste after removal of the fixed orthodontic appliance: An in vitro study.

Demineralization of the enamel surface, which appears as white spot lesions during and after removal of the fixed orthodontic appliance, is the most common disadvantage of the orthodontic treatment course. Using the remineralizing agents during and after orthodontic treatment helps to avoid those enamel defects. The present study aims to assess the remineralizing effect of the chicken eggshell powder on the demineralized enamel surfaces after debonding the orthodontic bracket system. The current study was performed on 80 prepared premolar crowns embedded into acrylic molds. The samples were prepared to receive routine steps of the bonding process for the bracket system. The paste of the chicken eggshell powder was added to the samples after the debonding process. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) were used to evaluate the remineralization effect of the chicken eggshell powder. Also, the Vickers microhardness tester was used to assess the enamel surface microhardness. It was found that the mean value of the Ca/P ratio for the samples before bonding of the orthodontic bracket system was (4.17 ± 2.2). This value significantly decreased to (2 ± 1.3) after debonding of the orthodontic bracket system and then showed a significant increase to (4.79 ± 2.65) after remineralization. These results were assured by the values of the Vickers microhardness tester. The chicken eggshell powder has an excellent remineralization effect for the demineralized enamel surface after debonding the orthodontic enamel surface.

A Minimally Invasive Esthetic Approach for Teeth with Molar Incisor Hypomineralization: a Clinical Case Report

Molar incisor hypomineralization (MIH) is a qualitative defect of enamel, clinically characterized by white or yellow/brownish demarcated opacities that affect permanent molars, often associated with permanent incisors. The etiology is multifactorial, including systemic and genetic/epigenetic factors. Defects of anterior teeth can negatively impact children since they might present lower self-esteem and socialization problems. Purpose: To describe a minimally invasive treatment for anterior teeth affected by molar incisor hypomineralization, performed with direct composite resin restoration and a universal adhesive system. Case Report: An 8-year-old patient sought dental care with complaints about her dental appearance, reporting suffering from school bullying. She presented a white-yellowish opacity on the maxillary right central incisor. After a clinical examination, she was diagnosed with molar incisor hypomineralization. To improve dental esthetics, a direct composite resin restoration was proposed. The enamel surface was prepared and etched with 35% phosphoric acid etchant solution for 15 seconds before applying the universal adhesive system. Two different shades of the composite were used for layering the material to disguise the defect without extensive removal of the dental structure. The result was satisfactory as it was possible to mask the opacity, reestablish enamel thickness, and improve the patient's quality of life. Conclusion: Conservative restorations comprising a universal adhesive system seem to bring desirable esthetic results for anterior teeth with molar incisor hypomineralization.

Maternal Diet Associates with Offspring Bone Mineralization, Fracture Risk and Enamel Defects in Childhood and Influences the Prenatal Effect of High-Dose Vitamin D Supplementation.

We previously demonstrated a beneficial effect of high-dose vitamin D in pregnancy on offspring bone and dental health. Here, we investigated the effect of maternal dietary patterns during pregnancy on the risk of bone fractures, bone mineralization and enamel defects until age 6 years in the offspring. Further, the influence of diet on the effect of high-dose vitamin D was analyzed in the COPSAC2010 mother-child cohort including 623 mother-child pairs. A weighted network analysis on FFQs revealed three specific maternal dietary patterns that associated (Bonferroni p < 0.05) with both offspring bone and dental health. The effect of prenatal high-dose (2800 IU/day) vs. standard-dose (400 IU/day) vitamin D on offspring bone mineral content (adjusted mean difference (aMD): 33.29 g, 95% CI: 14.48-52.09, p < 0.001), bone mineral density (aMD: 0.02 g/cm2 (0.01-0.04), p < 0.001), fracture risk (adjusted incidence rate ratio: 0.36 (0.16-0.84), p = 0.02), and enamel defects in primary (adjusted odds ratio (aOR): 0.13 (0.03-0.58), p < 0.01) and permanent molars (aOR: 0.25; (0.10-0.63), p < 0.01) was most pronounced when mothers had lower intake of fruit, vegetables, meat, eggs, sweets, whole grain, offal and fish. This study suggests that prenatal dietary patterns influence offspring bone and dental development, and should be considered in order to obtain the full benefits of vitamin D to enhance personalized supplementation strategy.

A novel CTBP1 variant in a Chinese pediatric patient with a phenotype distinct from hypotonia, ataxia, developmental delay, and tooth enamel defect syndrome.

Hypotonia, Ataxia, Developmental Delay, and Tooth Enamel Defect Syndrome (HADDTS) is an exceptionally rare disorder resulting from a heterozygous variant in the C-terminal binding protein 1 (CTBP1) gene. To date, a mere two variants (14 patients) have been documented on a global scale. The aim of this study was to identify a causative CTBP1 variant in a Chinese patient, and to determine the potential pathogenicity of the identified variant. Here, Whole-exome sequencing (WES) was conducted on the proband to pinpoint the candidate variant. Following this, Sanger sequencing was employed to validate the identified candidate variant and examine its co-segregation within the available family members. Employing both in silico prediction and three-dimensional protein modeling, we conducted an analysis to assess the potential functional implications of the variant on the encoded protein. Our investigation led to the identification of a novel heterozygous variant in the CTBP1 gene, namely, c.371 C>T (p.Ser124Phe), in a Chinese patient. This case represents the first confirmed instance of such a variant in a Chinese patient. When comparing the patient's clinical symptoms with those reported in the literature, notable distinctions were observed between her primary symptoms and those associated with HADDTS. She showed other signs such as microcephaly, coarse facial features, single transverse palmar crease, visible beard, myopia, coarse toenail and skeletal anomalies. This study enriching the spectrum of genetic variants observed in different ethnic populations and expanding the phenotypic profile associated with this gene. These findings are expected to contribute to the enhancement of future variant-based screening and genetic diagnosis, while also providing further insights into the pathogenic mechanisms underlying CTBP1-related conditions.