Dental Enamel Defects Research Articles

The Effect of Celiac Disease on the Oral Cavity: A Review )

Celiac disease is characterized by a permanent autoimmune sensitivity to gluten that leads to a disorder of the small intestinal mucosa and affects several organs Alterations in the oral cavity are frequently observed in patients with celiac disease and may allow for early diagnosis and treatment Specifically dental enamel defects recurrent aphthous Stomatitis delayed eruption of teeth and malocclusion have been found to be more common in this patient population Therefore dental clinicians should be aware of the oral features of this condition in order to facilitate early diagnosis and prevent consequences that can affect the overall health status of the patient

Degree of severity of molar incisor hypomineralization and its relation to dental caries

Molar incisor hypomineralization is a developmental defect of dental enamel associated with rapid caries progression. In order to discover whether molar incisor hypomineralization predisposes to dental caries, a cross-sectional cohort study was conducted in a sample of 414 children aged between eight and nine years. It was found that 24.2% of the children presented molar incisor hypomineralization. Of these, 72% had a mild form and 28% a severe form. Caries prevalence was greater among the children with severe form (60.7%) than in those with mild form (43.1%) or no molar incisor hypomineralization (45.5%). The caries indices were higher in out molar incisor hypomineralization (1.18) or with mild form (1.08). The tooth-surface caries ratio was significantly higher in surfaces with severe hypomineralization than in those with no hypomineralization or mild hypomineralization. A linear regression model showed that cariogenic food intake and the presence of severe molar incisor hypomineralization were significantly associated with DMFS. Consequently, an association was found to exist between dental caries and the presence of surfaces affected by severe molar incisor hypomineralization, which should be considered a risk factor within the multifactorial etiology of caries.

Dental and oral manifestations of celiac disease.

BackgroundThe objective of this study was to evaluate the dental and oral manifestations in patients with celiac disease.Material and MethodsThe sample consisted of 40 patients with the disease and 40 without the disease matched by age in southern Brazil. The CD group included patients previously diagnosed by positive anti-endomysial (IgA) examination and confirmed by small intestine biopsy. The presence of dental enamel defects and dental caries was evaluated by a calibrated researcher according to AINE’s and WHO’s criteria, respectively. The history of recurrent aphthous ulcers and dry mouth was obtained through reporting. For the evaluation of the salivary flow, the saliva samples were obtained through the non-stimulated and stimulated saliva collection method.Results There was a significant association between CD and dental enamel defects (OR=2.38, P=0.045) and dry mouth (OR=9.15, P=0.002). No difference was found for the report of recurrent aphthous ulcers and caries experience between the two groups. Patients with CD had normal pattern of unstimulated and stimulated saliva flow rates (0.67 ± 0.38 ml / min and 1.14 ± 0.47 ml / min, respectively). A higher occurrence of dental enamel defects was observed in patients with classic CD (P=0.054). Of the 1,962 permanent teeth, 59 presented dental enamel defects, 71.8% of which were in patients with CD (P=0.001), predominantly in molars (P=0.009).ConclusionsCD increased the likelihood of dental enamel defects and dry mouth sensation. The oral examination can be an important auxiliary tool for the identification of cases of the disease. Key words:Celiac disease, oral manifestations, dental enamel hypoplasia.

ORAI1 mutations abolishing store-operated Ca2+ entry cause anhidrotic ectodermal dysplasia with immunodeficiency

Store-operated Ca2+ entry (SOCE) through Ca2+ release-activated Ca2+ channels is an essential signaling pathway in many cell types. Ca2+ release-activated Ca2+ channels are formed by ORAI1, ORAI2, and ORAI3 proteins and activated by stromal interaction molecule (STIM) 1 and STIM2. Mutations in the ORAI1 and STIM1 genes that abolish SOCE cause a combined immunodeficiency (CID) syndrome that is accompanied by autoimmunity and nonimmunologic symptoms. We performed molecular and immunologic analysis of patients with CID, anhidrosis, and ectodermal dysplasia of unknown etiology. We performed DNA sequencing of the ORAI1 gene, modeling of mutations on ORAI1 crystal structure, analysis of ORAI1 mRNA and protein expression, SOCE measurements, immunologic analysis of peripheral blood lymphocyte populations by using flow cytometry, and histologic and ultrastructural analysis of patient tissues. We identified 3 novel autosomal recessive mutations in ORAI1 in unrelated kindreds with CID, autoimmunity, ectodermal dysplasia with anhidrosis, and muscular dysplasia. The patients were homozygous for p.V181SfsX8, p.L194P, and p.G98R mutations in the ORAI1 gene that suppressed ORAI1 protein expression and SOCE in the patients' lymphocytes and fibroblasts. In addition to impaired T-cell cytokine production, ORAI1 mutations were associated with strongly reduced numbers of invariant natural killer T and regulatory T (Treg) cells and altered composition of γδ T-cell and natural killer cell subsets. ORAI1 null mutations are associated with reduced numbers of invariant natural killer T and Treg cells that likely contribute to the patients' immunodeficiency and autoimmunity. ORAI1-deficient patients have dental enamel defects and anhidrosis, representing a new form of anhidrotic ectodermal dysplasia with immunodeficiency that is distinct from previously reported patients with anhidrotic ectodermal dysplasia with immunodeficiency caused by mutations in the nuclear factor κB signaling pathway (IKBKG and NFKBIA).

Effects of environmental tobacco smoke on the oral health of preschool children.

This study investigated the association between the prevalence of oral health problems (caries, gingivitis, mucosal pigmentation and enamel defects in one to 5 year-old children exposed and not exposed to environmental tobacco smoke before and/or after birth. Exposure to environmental tobacco smoke (ETS) in childhood may have significant health effects. A structured questionnaire was used to collect data on a child's current and previous illnesses, oral health behaviours, dietary habits, parental smoking behaviours and parents' dental history. The intraoral examination recorded dental caries (dmfs), enamel defects, gingival health, melanin pigmentation and soft tissue health. Stimulated saliva was collected. Total sIgA levels were quantified using indirect competitive ELISA with a SalimetricsTM kit. The 44 children (aged 15-69months) recruited were divided into two groups: ETS and non-ETS (control). There were 22 children in each: 16 who were exposed to ETS during and after gestation were identified as the ETSB subgroup. Participants exposed to ETS were more likely to have had upper respiratory tract and middle ear infections during the neonatal period and had higher mean dmft, mean dmfs, mean percent of surfaces with demarcated opacities and mean GI than the non-ETS participants. The children exposed to ETS before and after birth had the highest occurrence of enamel opacities showed a higher risk for dental caries even though more children in this group used the recommended fluoride toothpaste (1000ppm fluoride). Mothers who smoked either never breastfed their children or breastfed their children for less than the recommended period of 6 months. Children exposed to ETS were shown to have higher mean total sIgA (μg/ml) than the children in the control group. Associations between ETS exposure before and after gestation and oral health, including salivary changes in young children were shown in the present study. Dental health professionals should include a question about household smoking in children's dental histories, which would allow opportunities to discuss the impact of smoking on child oral health. Longitudinal oral health studies should include a history of maternal smoking during pregnancy and afterwards.

Hypomineralized second primary molars: prevalence, defect characteristics and relationship with dental caries in Melbourne preschool children.

Dental caries and enamel defects (DDE) are prevalent amongst children. The presence of DDE, especially enamel hypomineralization, may increase caries experience. The reported prevalence of hypomineralized second primary molars (HSPM) is 2.7-21.8%, although the occurrence in Australian children remains unknown. These HSPM represent a potential predictive factor for molar-incisor hypomineralization (MIH). In total, 623 children aged 3-5years from 30 randomly selected kindergartens participated. The HSPM were recorded using an index combining the European Academy of Paediatric Dentistry MIH Judgment Criteria and modified DDE Index. Caries was recorded using International Caries Detection and Assessment System criteria. In total, 144 HSPM were observed in 88 of the 623 (14.1%) children, a tooth-level prevalence of 5.8%. The prevalence of dentinal carious lesions was 13.2%, and caries prevalence (d2-6 mft>0) was 36.4%. Cavitated carious lesions affected 30.7% of HSPM. The relationship between an increase in HSPM lesion extent and increasing number of HSPM per child was statistically significant. A positive association between HSPM severity and extent at tooth level existed (P<0.05). There was a positive relationship between the extent of HSPM and carious lesion severity (P<0.05). In this population, children with HSPM did not have overall greater caries experience.

Oral Manifestations in Pediatric Patients with Coeliac Disease - A Review Article.

Background:Coeliac disease is a chronic enteropathy that remains a challenge for the clinician, due to its atypical manifestations and etiopathogenic complexity.Objective:This article intends to describe the oral characteristics of Coeliac Disease in children in order to facilitate their management in the dental office.Methods:A review of the literature was performed electronically in PubMed (PubMed Central, and MEDLINE) for articles published in English from 2000 to April of 2017. The article is also based on the authors' clinical experience with children with coeliac disease. The searched keywords were “coeliac disease “,”oral manifestations “, “dental enamel defects”, “recurrent aphthous stomatitis” and “oral aphthous ulcers”.Results:There are some oral manifestations which are strictly related to coeliac disease: dental enamel defects, recurrent aphthous stomatitis, delayed tooth eruption, multiple caries, angular cheilitis, atrophic glossitis, dry mouth and burning tongue.Conclusion:The complete knowledge of the oral manifestations of coeliac disease can trigger an effective change in the quality of life of the patients with this disease.

Assessing the proposed association between DED and gluten-free diet introduction in celiac children.

A strong association between celiac disease (CD) and dental enamel defects (DEDs) have been extensively reported, however, the nature of this relationship is still unclear. The aim of this study was to evaluate DEDs phenotype in CD individuals according to the time they were introduced to a gluten-free diet (GFD). Forty-five CD individuals were examined by a pediatric dentist. DEDs were classified according to the type of affected teeth. CD individuals were classified into two groups (with or without DEDs) and the differences between these groups were tested using chi-square or Fisher´s exact tests and t-test to compare differences between means. The Pearson coefficient test was used to evaluate the degree of the correlation between the age of GFD introduction and number of affected teeth. Individuals with MIH were introduced earlier to the GFD (p = 0.038). An association was also observed for molar DED (p = 0.013). In conclusion, our study suggested an association between a specific type of DED and the time that CD individuals were introduced to a GFD.

Tendências de busca na internet sobre cárie dentária e defeitos de desenvolvimento de esmalte no período de 2004 a 2015

Objetivo: avaliar tendências de busca dos usuários da internet por informações sobre cárie dentária e defeitos de esmalte. Material e Métodos: trata-se de estudo retrospectivo que utilizou a ferramenta Google Trends Search Application como instrumento de busca. Foram utilizados os descritores “dental caries” e “enamel defects” para obtenção de informações no período de janeiro de 2004 e dezembro de 2015. Os resultados foram expressos pelo índice Search Volume Index. Foram utilizados os testes Kruskal-Wallis e pós-teste de Dunn, com nível de significância de 5%, para a análise dos dados. Resultados: para o termo “dental caries”, os maiores volumes de busca foram observados nos meses de março, abril e maio (62.33 ± 14.73, 63.58 ± 13.19, 63.00 ± 13.24, respectivamente) e os menores, nos meses de julho, agosto e dezembro (44.92 ± 8.82, 46.83 ± 9.94, 40.67 ± 5.55) (p &lt; 0,001). Não foram observadas diferenças no volume de buscas entre meses do ano para o termo “enamel defects” (p = 0,694). Na análise por ano, foram observadas diferenças significativas para cárie dentária (p &lt; 0,001), a partir de 2007 o volume de busca reduziu significativamente quando comparado aos anos anteriores. O mesmo não foi observado para defeitos de esmalte (p = 0,492). Conclusão: houve tendência de diminuição no número de buscas por informações sobre cárie dentária, ao passo que se mantêm constantes as buscas sobre defeitos de esmalte.

Store-operated Ca2+ entry controls ameloblast cell function and enamel development.

Loss-of-function mutations in stromal interaction molecule 1 (STIM1) impair the activation of Ca2+ release-activated Ca2+ (CRAC) channels and store-operated Ca2+ entry (SOCE), resulting in a disease syndrome called CRAC channelopathy that is characterized by severe dental enamel defects. The cause of these enamel defects has remained unclear given a lack of animal models. We generated Stim1/2K14cre mice to delete STIM1 and its homolog STIM2 in enamel cells. These mice showed impaired SOCE in enamel cells. Enamel in Stim1/2K14cre mice was hypomineralized with decreased Ca content, mechanically weak, and thinner. The morphology of SOCE-deficient ameloblasts was altered, showing loss of the typical ruffled border, resulting in mislocalized mitochondria. Global gene expression analysis of SOCE-deficient ameloblasts revealed strong dysregulation of several pathways. ER stress genes associated with the unfolded protein response were increased in Stim1/2-deficient cells, whereas the expression of components of the glutathione system were decreased. Consistent with increased oxidative stress, we found increased ROS production, decreased mitochondrial function, and abnormal mitochondrial morphology in ameloblasts of Stim1/2K14cre mice. Collectively, these data show that loss of SOCE in enamel cells has substantial detrimental effects on gene expression, cell function, and the mineralization of dental enamel.

Stressing out in medieval Denmark: An investigation of dental enamel defects and age at death in two medieval Danish cemeteries

The influence of early life stress on later life experiences has become a major focus of research in medicine and more recently in bioarchaeology. Dental enamel, which preserves a record of childhood stress events, represents an important resource for this investigation when paired with the information from adult skeletal remains, such as age at death. The purpose of this research was to use a life history approach to the exploration of sex differences in the relationship between childhood stress and adult longevity by examining accentuated striae of Retzius (AS). A medieval Danish sample (n=70) drawn from the rural cemetery of Sejet and the urban cemetery of Ole Wormsgade was considered for AS and age at death. The results suggest sex differences in survivorship, with more stress being associated with reduced survivorship in males and increased survivorship in females. A consideration of AS formation time also suggests a difference in the impact of developmental timing between males and females. These results are interpreted in terms of differential frailty and selective mortality, drawing in both biomedical and cultural perspectives.

Applying standard perikymata profiles to Pongo pygmaeus canines to estimate perikymata counts between linear enamel hypoplasias

Recently, studies have interpreted regular spacing and average number of perikymata between dental enamel defects in orangutans to reflect seasonal episodes of physiological stress. To estimate the amount of time between developmental defects (enamel hypoplasia), studies have relied on perikymata counts. Unfortunately, perikymata are frequently not continuously visible between defects, significantly reducing data sets. A method is presented here for estimating the number of perikymata between defects using standard perikymata profiles (SPP) that allow the number of perikymata between all pairs of defects across a tooth to be analyzed. The SPP method should allow the entire complement of defects to be analyzed within the context of an individual's crown formation time. The average number of perikymata were established per decile and charted to create male and female Pongo pygmaeus SPPs. The position of the beginning of each defect was recorded for lower canines from males (n = 6) and females (n = 17). The number of perikymata between defects estimated by the SPP was compared to the actual count (where perikymata were continuously visible). The number of perikymata between defects estimated by the SPPs was accurate within three perikymata and highly correlated with the actual counts, significantly increasing the number of analyzable defect pairs. SPPs allow all defect pairs to be included in studies of defect timing, not just those with continuously visible perikymata. Establishing an individual's entire complement of dental defects makes it possible to calculate the regularity (and potential seasonality) of defects.

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

The impact of enamel defects of the first permanent molars on caries experience and child oral health-related quality of life was evaluated in a cohort study. Children who participated in a study of enamel defects of the first permanent molars 8years earlier were invited for a follow-up assessment. Consenting children completed the Child Perception Questionnaire and the faces Modified Child Dental Anxiety Scale, and were examined by two calibrated examiners. ANOVA, Kruskal-Wallis, negative binomial and logistic regression were used for data analyses. One hundred and eleven children returned a completed questionnaire and 91 were clinically examined. Negative binomial regression found that oral health impacts were associated with gender (boys, risk ratio (RR)=0.73, P=0.03) and decayed, missing or filled permanent teeth (DMFT) (RR=1.1, P=0.04). The mean DMFT of children were sound (0.9, standard deviation (SD)=1.4), diffuse defects (0.8, SD=1.7), demarcated defects (1.5, SD=1.4) and pit defects (1.3, SD=2.3) (Kruskal-Wallis, P=0.05). Logistic regression of first permanent molar caries found higher odds of caries experience with baseline primary tooth caries experience (odds ratio (OR)=1.5, P=0.01), the number of teeth affected by enamel defects (OR=1.9, P=0.05) and lower odds with the presence of diffuse enamel defects (OR=0.1, P=0.04). The presence of diffuse enamel defects was associated with lower odds of caries experience.

Prevalence and Associated Factors of Tooth Erosion in 8 -12-Year-Old Brazilian Schoolchildren.

This study estimated the prevalence, distribution and associated factors of tooth erosion in Brazilian schoolchildren. A cross-sectional study was carried out in a representative sample of children aged 8-12-years-old from public and private schools. Six calibrated examiners assessed tooth erosion (O'Sullivan index) and other oral conditions (dental trauma, enamel defects, plaque, dental caries and dental crowding). Socio-demographic and behavioral data were collected using questionnaires. Interviews were conducted in children and in parents. Data were analyzed using Poisson regression model considering the cluster sample (Prevalence Ratio-PR; 95% Confidence Interval-CI). A total of 1,210 children participated and were examined. Tooth erosion was observed in 25.1% of the children. Lesions were mostly observed in enamel and less than a half of the buccal surface was affected. The type of school and age were significant associated with higher prevalence of tooth erosion and dental crowding was associated with less probability of tooth erosion significantly. Acidic food or drinks were not associated with dental erosion. The prevalence of tooth erosion in the studied population was high. Erosive lesions were not severe, confined in enamel. Tooth erosion was associated with age, type of school, socioeconomic level and dental crowding.

Oral Pathology unmasking Gastrointestinal Disease

Abstract Different ggastrointestinal disorders, such as Gastroesophageal Reflux Disease (GERD), Celiac Disease (CD) and Cohn’s disease, may manifest with alterations of the oral cavity but are often under and misdiagnosed both by physicians and dentists. GERD can cause dental erosions, which are the main oral manifestation of this disease, or other multiple affections involving both hard and soft tissues such as burning mouth, aphtous oral ulcers, erythema of soft palate and uvula, stomatitis, epithelial atrophy, increased fibroblast number in chorion, xerostomia and drooling. CD may be responsible of recurrent aphthous stomatitis (RAS), dental enamel defects, delayed eruption of teeth, atrophic glossitis and angular chelitis. Crohn's disease can occur with several oral manifestations like indurated tag-like lesions, clobbestoning, mucogingivitis or, less specifically, with RAS, angular cheilitis, reduced salivation, halitosis, dental caries and periodontal involvement, candidiasis, odynophagia, minor salivary gland enlargement, perioral erythema with scaling, recurrent buccal abscesses, glossitis, mucosal discoloration, lichen planus, and metallic dysgeusia. A prompt detection of the oral signs of these systemic diseases allows an early diagnosis and treatment and could prevent related long-term complications.

Prevalence of developmental defects of the enamel in primary dentition in a bogotan population

To determine in an area with systemic fluoridation, the prevalence of development of enamel defects in children's primary teeth between 4-6 years old from a public school in Bogota, Colombia. A simple random sample was conducted in 153 students, obtaining 62 healthy children, detailed dental clinical assesment were performed in them. The examiner was calibrated by an expert in the modified index of Dental Enamel Defects from the International Dental Federation obtaining a kappa inter-examiner and intra-examiner measures of 0.9 and 0.8, respectively. An informed consent and approval of the study by the Ethical Committee of the School of Dentistry at the Universidad Nacional de Colombia were obtained. The prevalence of dental enamel defects was 74.2 % (62.1 - 83.4) 95 % CI, distributed in: demarcated opacities 86.9 % (74.3-93.3) 95 % CI, diffuse opacities 76.1 % (62.4-85.7) 95 % CI and hypoplasia 2.2 % (0.4-11.1) 95 % CI. The most frequent combination of defects in an individual was demarcated and diffuse opacities. The most affected maxilla was the superior 54.6 % and the most compromised teeth were the second molar 56 %. The average teeth affected with dental enamel defects per individual was 4.7 ± SD 2.6. The high prevalence of dental enamel defects found, despite low severity, suggests more attention of the health authorities leading preventive programs. More studies should be done with standardized methodologies in order to estimate the overall prevalence of the defects.

Author's response to comment on “Accuracy of dental images for the diagnosis of dental caries and enamel defects in children and adolescents: A systematic review”

Author's response to comment on “Accuracy of dental images for the diagnosis of dental caries and enamel defects in children and adolescents: A systematic review”

Dental enamel defects in German medieval and early-modern-age populations.

Aim of this study was to investigate the frequency and type of developmental defects of enamel (DDE) in a medieval and an early-modern-age population from Thuringia, Germany. Sixty-six skeletons subdivided into 31 single burials (12th/13th c.) and 35 individuals buried in groups (15th/16th c.) were examined. DDE were classified on 1,246 teeth according to the DDE index. Molar-incisor-hypomineralisation (MIH), a special type of DDE, was recorded according to the European Academy of Paediatric Dentistry (EAPD) criteria. DDE was found in 89.4% of the individuals (single burials 90.3% and group burials 88.6%). Hypoplastic pits were the most frequent defect in primary teeth and linear enamel hypoplasia (LEH) in permanent teeth. 13 individuals (24.1%) showed at least one hypomineralised permanent tooth, 12.2% had MIH on at least one first permanent molar and 10.0% in permanent incisors. Second primary molars were affected in 8.0% of the children and juveniles. No individual suffered from affected molars and incisors in combination. Endogenous factors like nutritional deficiencies and health problems in early childhood could have been aetiological reasons of DDE and MIH. The frequency of DDE and MIH might have been masked by extended carious lesions, dental wear and ante-mortem tooth loss.

Prevalence of early childhood caries and enamel defects in four and five-year old Qatari preschool children.

BackgroundDental caries is the most prevalent chronic disease in early childhood in most communities worldwide. Several studies conducted in the Gulf Cooperation Council countries have documented a high prevalence of early childhood caries (ECC). To date, no studies have been conducted in Qatar to examine the prevalence of ECC and enamel developmental defects in preschool children. The present study aimed to determine the prevalence of ECC and enamel defects in preschool children aged four and five years attending kindergartens in Qatar.MethodsA descriptive cross-sectional study was performed among 250 children randomly selected from 16 public kindergartens. Caries experience was measured using the World Health Organization caries criteria (dmft) for tooth rather than surface; enamel defects were scored by the modified developmental defects of enamel index. Descriptive statistics and Chi-Square test of relatedness were used.ResultsA response rate of 63 % was reported. The overall caries prevalence of the study sample was 89.2 %; 15.6 % of the examined children had ECC and 73.6 % had severe ECC. Developmental enamel defects were present in 39 % of children and 27 % had demarcated enamel opacities.ConclusionThe high rate of dental caries and enamel defects recorded in this study for this young age group has strongly emphasized the necessity of community-based preventive programs and professional care that should begin during pregnancy and in early childhood.

Hypomineralized Second Primary Molars as Predictor of Molar Incisor Hypomineralization.

Molar incisor hypomineralization (MIH) is a developmental defect of dental enamel that shares features with hypomineralized second primary molars (HSPM). Prior to permanent tooth eruption, second primary molars could have predictive value for permanent molar and incisor hypomineralization. To assess this possible relationship, a cross-sectional study was conducted in a sample of 414 children aged 8 and 9 years from the INMA cohort in Valencia (Spain). A calibrated examiner (linear-weighted Kappa 0.83) performed the intraoral examinations at the University of Valencia between November 2013 and 2014, applying the diagnostic criteria for MIH and HSPM adopted by the European Academy of Paediatric Dentistry. 100 children (24.2%) presented MIH and 60 (14.5%) presented HSPM. Co-occurrence of the two defects was observed in 11.1% of the children examined. The positive predictive value was 76.7% (63.9–86.6) and the negative predictive value 84.7% (80.6–88.3). The positive likelihood ratio (S/1-E) was 10.3 (5.9–17.9) and the negative likelihood ratio (1-S/E) 0.57 (0.47–0.68). The odds ratio was 18.2 (9.39–35.48). It was concluded that while the presence of HSPM can be considered a predictor of MIH, indicating the need for monitoring and control, the absence of this defect in primary dentition does not rule out the appearance of MIH.