Developmental Defects Of Enamel Research Articles

Rebuilding the Strength of Hypomineralized Enamel – An In-Depth Systematic Literature Review

Molar Incisor Hypomineralization (MIH) is a prevalent developmental enamel defect characterized by qualitative changes in the enamel of one or more first permanent molars, often accompanied by similar defects in the incisors. This condition leads to significant dental challenges, including soft, porous enamel, which is more susceptible to damage and caries than non-MIH teeth. The affected teeth exhibit lower mineral concentration, higher porosity, and altered mechanical properties, contributing to their increased vulnerability to decay and restoration failures. Research indicates that MIH-affected teeth often require more extensive dental treatments due to compromised structural integrity. The enamel defects associated with MIH manifest as well-demarcated opacities, which can lead to hypersensitivity and aesthetic concerns for patients, particularly children. However, there is hope in the form of various remineralization strategies that have been explored to address MIH's challenges. These strategies, including recent clinical trials, have demonstrated the efficacy of remineralization agents in restoring some of the lost enamel properties, which is crucial for managing MIH effectively. This potential for restoration through remineralization strategies offers a hopeful outlook for improving patient outcomes with MIH.

Diagnosing celiac disease in children using oral manifestations

PurposeCeliac disease (CD) may be frequently undiagnosed due to the absence of characteristic gastroenterologic symptoms in many CD patients. Our objective was to diagnose CD by utilizing documented oral manifestations such as Recurrent Aphthous Stomatitis (RAS) and Molar-Incisor Hypomineralization (MIH).MethodsThe study comprised sixty children who presented with complaints of RAS lesions. The MIH group consisted of 40 children, while the control group comprised 20 children without MIH lesions, ranging in age from 7 to 13 years. After the dental examination, all children were given a questionnaire to assess whether they had any previous history of general symptoms related to CD. Following that, diagnostic testing for celiac disease were conducted, including serological tests such as Tissue transglutaminase IgA (tTG-IgA), Endomysium Antibody (EMA), and Total IgA, as well as genetic tests for HLA-DQ2 and HLA-DQ8.ResultsThe statistical analysis, conducted using Fisher’s Exact, Yates’ Continuity Correction, Fisher Freeman Halton, and Student’s t tests, revealed no significant differences between the groups (p < 0.05). Within the MIH group, 3 children exhibited border tTG-IgA values, while another 3 had positive tTG-IgA results. Two of these 6 children had also positive EMA and HLA results. Following a biopsy procedure, these two children were ultimately diagnosed with celiac disease (CD).ConclusionsIn this study, while children initially presented to the clinic with complaints of recurrent aphthous stomatitis (RAS), 2 children (5% of the MIH group) were diagnosed with CD shortly after the onset of MIH lesions. CD enhanced the likelihood of observing some oral manifestations particularly recurrent aphtous stomatitis and developmental enamel defects. We recommend that dentists be cautious about diagnosing CD when RAS lesions and DEDs and/or MIH lesions are present, whether or not other indications of this systemic disease exist.

Prevalence of hypomineralized second primary molars and association with socioeconomic characteristics and dental caries in a Brazilian population of preschoolers: a cross-sectional study.

To analyze the prevalence of hypomineralized second primary molar (HSPM) and its association with socioeconomic characteristics and dental caries in a Brazilian population of preschoolers. 603 preschoolers, enrolled in public preschools in Itajaí (state of Santa Catarina, Brazil), took part in the study. To assess the participants' socio-economic characteristics, an original questionnaire was formulated and sent to the children's parents. The clinical evaluation was carried out by a calibrated examiner using the deft/DMFT index for dental caries and Ghanim et al. (Ghanim et al., Eur Arch Paediatr Dent, 2015) criteria for HSPM. The data were analyzed through Poisson regression, using STATA statistical software, and the association analyses were presented by prevalence ratios (PR). The prevalence of at least one HSPM-affected second molar was 24.5%. The prevalence of HSPM was associated to the city's geographical regions of the Educational hubs (p < 0.001). A significant association was found between dental caries and HSPM (p = 0.003; PR: 1.31; 95% CI 1.09-1.56). Children with HSPM were 31% more likely to experience dental caries than children without HSPM. Geographical regions of educational hubs were also significantly associated with HSPM (p < 0.001). None of the socioeconomic characteristics was associated with HSPM (p > 0.05). HSPM is a common developmental defect of enamel in children in our study. The HSPM distribution was associated with the city's geographic regions. Children with HSPM are more likely to experience dental caries. Socioeconomic characteristics were not associated with HSPM.

Pretreatments to bonding on enamel and dentin disorders: a systematic review.

This systematic review focuses on structural anomalies of enamel and dentin such as fluorosis (F), molar-incisor hypomineralization (MIH), amelogenesis imperfecta (AI), dentinogenesis imperfecta (DI), osteogenesis imperfecta (OI), and X-linked hypophosphatemia (XLH). These pathologies affect up to 31% of the population, posing challenges in the adhesion of direct restorations. The primary objective of this analysis is to examine the survival rate and/or bonding resistance of direct restorations on tissues affected by enamel and dentin disorders in humans. We aim to provide precise clinical recommendations for dentists to choose the appropriate bonding pretreatment for various enamel and dentin disorders. We systematically searched the medical literature to identify abstracts of interest indexed between 1993 and May 2024, from 4 databases (PubMed, PMC-PubMed, Web of Science and Cochrane Library). The results are reported following the PRISMA statement. The GRADE approach was used to assess the risk of bias. The two authors included 27 studies out of the 600 identified. The data extracted from these studies are highly heterogeneous, and the mentioned bonding protocols are all different. 15 articles pertain to F, 7 to MIH, 5 to AI, and none focus on HSPM, dentin disorders and XLH. We identified 12 pretreatments of enamel or dentin (7 for F, 2 for MIH, and 3 for AI), including 3 strong recommendations. Additional studies are necessary to confirm the effectiveness of certain pretreatments. In developmental enamel defects, the main recommendation we collected is to bond on enamel with an etch-and-rinse technique on F and MIH. Considerations with lower strength of evidence include a deproteinization step on enamel on F, MIH and AI and modifications of the etching parameters on F and AI. The research strategy was registered on the Prospero platform (CRD42023447502).

Developmental defects of enamel in childhood cancer survivors: A systematic review and meta-analysis.

The present systematic review and meta-analysis (Prospero registration number: CRD42023472016) aims to assess the prevalence of developmental defects of enamel (DDEs), qualitatively and/or quantitatively, in childhood cancer survivors (CCS) and evaluate, when possible, these data in comparison with those found in healthy children. Three electronic databases (PubMed, Embase, Scopus) were searched from January 2003 to January 2024 for studies reporting on DDEs in children with a mean age not exceeding 16 years at the time of the study who underwent antineoplastic therapy. The ROBINS-I and the Joanna Briggs Institute (JBI) tools were used to assess the risk of bias. Included studies with comparable outcomes underwent random effects models meta-analysis using Stata®18. CCS showed a higher prevalence of DDEs, both qualitative and quantitative, compared to healthy children. The meta- analysis showed higher odds of developing qualitative defects over quantitative defects in CCS. Conclusions regarding the association between the type of therapy administered, age of therapy initiation, and prevalence of DDEs could not be drawn due to insufficient data. A lack of a standardized method of detecting enamel defects posed a challenge in the qualitative and quantitative analysis.

Genetic polymorphisms associated with developmental defects of enamel: A systematic review

AbstractBackgroundPolymorphisms in genes related to enamel formation and mineralization may increase the risk of developmental defects of enamel (DDE).AimTo evaluate the existing literature on genetic polymorphisms associated with DDE.DesignThis systematic review was registered in the PROSPERO (CRD42018115270). The literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. Observational studies assessing the association between DDE and genetic polymorphism were included. The Newcastle–Ottawa Scale was used to assess the risk of bias.ResultsOne thousand one hundred and forty‐six articles were identified, and 28 met the inclusion criteria. Five studies presented a low risk of bias. Ninety‐two genes related to enamel development, craniofacial patterning morphogenesis, immune response, and hormone transcription/reception were included. Molar–incisor hypomineralization (MIH) and/or hypomineralization of primary second molars (HPSM) were associated with 80 polymorphisms of genes responsible for enamel development, immune response, morphogenesis, and xenobiotic detoxication. A significant association was found between the different clinical manifestations of dental fluorosis (DF) with nine polymorphisms of genes responsible for enamel development, craniofacial development, hormonal transcription/reception, and oxidative stress. Hypoplasia was associated with polymorphisms located in intronic regions.ConclusionMIH, HPSM, DF, and hypoplasia reported as having a complex etiology are significantly associated with genetic polymorphisms of several genes.

FLUOROSIS PREVALENCE AT DIFFERENT REGIONS OF THE EARTH (LITERATURE REVIEW)

The aim of the study is to analyze the literature about the fluorosis prevalence and the factors which lead to dental and bone fluorosis. The search for articles published in 2016-2023 was conducted by the authors in Scopus and Web of Science scientific data bases using the keywords “fluorosis”, “dental fluorosis”. To classify the severity of dental fluorosis, the index of developmental defects of enamel (DDE), the index of tooth surface fluorosis (TSIF), and mostly Dean’s index Thylstrup &amp; Fejerskov Index (TFI) are used. The risk factors for dental fluorosis include living in regions with high level of fluoride, drinking water with high level of fluoride or salt fluoridation, drinking bottled water, use of fluoride toothpastes among preschool children, early weaning, and use of infant formula for long time, and, as well as, a hot climate and high fluoride content in soil and food. The studies from India and China demonstrated that the average concentration of dental fluorosis and skeletal fluorosis at fluoride contained 6 mg/l. The prevalence of dental fluorosis in NorthernTanzania, where the fluorine content in daily drinking water is 3.6 mg/l, reaches 75,22%. In Ethiopia, where fluorine content is 5.09 mg/l, the prevalence of skeletal fluorosis ranges from 55.1% to 72.4%. In Kenya, the fluoride content in drinking water reaches 72 mg/l, so the prevalence of dental fluorosis is 80%. The prevalence of dental fluorosis is lower in South Western Saudi Arabia and Iran where fluoride level is lower. In Jordan, the prevalence of dental fluorosis reaches 39.9% due to the high fluoride content in miner rocks. Skeletal fluorosis is wide spread in some areas of Pakistan due to the contamination of ground water by industrial production. The prevalence of mild dental fluorosis is 39% in New castle where water is fluoridated, and 24% in non-fluoridated Manchester in England. Dean’s index and TFI index are mostly used to classify these variety of fluorosis. Various factors affect the appearance of dental and bone fluorosis worldwide, so the prevalence of fluorosis varies from 11,1 up to 100%.

Dental caries and developmental defects of enamel in cerebral palsy: A meta-analysis.

This systematic review and meta-analysis aimed to compare the occurrence of dental caries and developmental defects of enamel (DDE) in individuals with and without cerebral palsy (CP). We conducted searches across five databases and the grey literature. Data were organized using EndNote 20. Reporting followed the MOOSE checklist. A random-effects model meta-analyses were conducted using RStudio, presenting results as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The risk of bias of studies was analyzed using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using GRADE. Among 1336 identified records, 25 studies involving 59,997 participants (mean age: 11.1 years) were included. Data of 12 were pooled into meta-analyses. No significant differences were found between CP and non-CP individuals across indices: DMFT (k = 7) (MD = 0.31; 95% CI [-0.42-1.05]), dmft (k = 4) (MD = 0.31; 95% CI [-0.50-1.14]), DMFS (k = 2) (MD = -0.61; 95% CI [-20.56-19.33]), dmfs (k = 3) (MD = 0.54; 95% CI [-1.09-2.17]), and DDE (k = 3) (OR = 0.80, 95% CI [0.09-7.31]). The certainty of evidence was very low. Individuals with CP do not appear to differ significantly from those without CP in terms of dental caries experience and DDE.

Bayesian modeling of spatially differentiated multivariate enamel defects of the children’s primary maxillary central incisor teeth

BackgroundThe analysis of dental caries has been a major focus of recent work on modeling dental defect data. While a dental caries focus is of major importance in dental research, the examination of developmental defects which could also contribute at an early stage of dental caries formation, is also of potential interest. This paper proposes a set of methods which address the appearance of different combinations of defects across different tooth regions. In our modeling we assess the linkages between tooth region development and both the type of defect and associations with etiological predictors of the defects which could be influential at different times during the tooth crown development.MethodsWe develop different hierarchical model formulations under the Bayesian paradigm to assess exposures during primary central incisor (PMCI) tooth development and PMCI defects. We evaluate the Bayesian hierarchical models under various simulation scenarios to compare their performance with both simulated dental defect data and real data from a motivating application.ResultsThe proposed model provides inference on identifying a subset of etiological predictors of an individual defect accounting for the correlation between tooth regions and on identifying a subset of etiological predictors for the joint effect of defects. Furthermore, the model provides inference on the correlation between the regions of the teeth as well as between the joint effect of the developmental enamel defects and dental caries. Simulation results show that the proposed model consistently yields steady inferences in identifying etiological biomarkers associated with the outcome of localized developmental enamel defects and dental caries under varying simulation scenarios as deemed by small mean square error (MSE) when comparing the simulation results to real application results.ConclusionWe evaluate the proposed model under varying simulation scenarios to develop a model for multivariate dental defects and dental caries assuming a flexible covariance structure that can handle regional and joint effects. The proposed model shed new light on methods for capturing inclusive predictors in different multivariate joint models under the same covariance structure and provides a natural extension to a nested hierarchical model.

The prevalence of developmental defects of enamel in people with cystic fibrosis: a systematic review

BackgroundOral health impacts systemic health, individual well-being, and quality of life. It is important to identify conditions that may exacerbate oral disease to aid public health and policy development and promote targeted patient treatment strategies. Developmental defects can increase an individual’s risk of dental caries, hypersensitivity, premature tooth wear, erosion, and poor aesthetics. As part of an ongoing study assessing oral health in adults with cystic fibrosis at Cork University Dental School and Hospital, a systematic review of available literature was conducted to assess the prevalence of enamel defects in people with cystic fibrosis.AimsTo critically evaluate the literature to determine if the prevalence of developmental defects of enamel is higher in people with cystic fibrosis (PwCF).MethodsData Sources: Three online databases were searched Embase, Scopus, and Web of Science Core Collection. Studies that examined an association between cystic fibrosis and developmental defects of enamel were included in this systematic review.ResultsThe initial search identified 116 publications from the following databases Embase, Web of Science Core Collection, and Scopus. Eleven studies were included for qualitative analysis. Nine studies concluded that PwCF had a higher prevalence of enamel defects than control people and one study found no difference in cystic fibrosis (CF) status. All studies had a risk of bias that may influence study results and their interpretation.ConclusionsThe results of the systematic review show a consistent pattern that PwCF have a higher prevalence of DDE than people without CF. Genetic dysfunction, chronic systemic infections, and long-term antibiotic use are possible aetiological causes. This review highlights the need for future studies to investigate if DDEs are caused by the underlying CFTR mutation or as a consequence of disease manifestations and/or management.

Is Italian Dentists’ Knowledge of Enamel Development Defects Adequate? A Nationwide Survey

ObjectivesCorrect identification and management of Developmental Defects of Enamel (DDEs) are essential to provide the best possible treatment. The present survey aims to investigate Italian dentists’ knowledge of DDEs, their ability to recognise the different clinical pictures, and to choose the most appropriate clinical approach. MethodsA cross-sectional survey was planned based on a questionnaire including 27 closed-ended questions, and that proposed 4 clinical pictures, molar incisor hypomineralisation (MIH), amelogenesis imperfecta (AI), dental fluorosis (DF), and an initial caries lesion (ICL). It was distributed by e-mail to all Italian dentists (N = 63,883) through the Italian Federation of Doctors and Dentists. Discrete variables were expressed as absolute and relative frequencies (%). A multivariate analysis assessed whether socio-demographic variables correlated with the answers’ truthfulness. ResultsAbout 5017 questionnaires were included and analysed. Although 90.19% of the sample stated that they had received information on DDEs, a significant percentage did not recognise MIH (36.36%), AI (48.34%), DF (71.50%), and ICL (46.62%). Only 57.07% correctly classified enamel hypomineralisation as a qualitative defect, and even fewer, 54.45%, classified enamel hypoplasia as a quantitative defect. According to the logistic regressions, female dentists, dentists who treat mainly children and received information about DDEs, were more likely to recognise the 4 clinical pictures (P < .01). ConclusionsItalian dentists showed many knowledge gaps on DDEs that need to be filled; those who received formal training were more capable of correctly identifying the defects and were more likely to prescribe an appropriate management approach for the defects. Clinical significanceIncreasing university courses and continuing education on diagnosing and managing DDEs seems reasonable to fill the knowledge gap on DDEs.

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.

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.

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.

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.

Natal factors affecting developmental defects of enamel in preterm infants: a prospective cohort study

This study investigated natal factors influencing developmental defects of enamel (DDE) in premature infants using a newly refined preterm developmental defects of enamel (PDDE) index. Dental examinations were conducted on a cohort of 118 preterm infants (average age 3.5 ± 1.4 years) to record PDDE scores, while reviewing their medical records to examine natal factors. According to the logistic regression analysis, factors related to DDE prevalence were advanced maternal age, gestational age < 28 weeks, birth weight < 1000 g, 1 min APGAR score < 7, and hospitalization period > 2 months, which were significantly higher by 2.91, 5.53, 7.63, 10.02, and 4.0 times, respectively. According to regression analysis with generalized linear models, the PDDE scores were approximately 7.65, 4.96, and 15.0 points higher in premature children diagnosed with bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis, respectively. When endotracheal intubation was performed, the PDDE score was 5.06 points higher. The prevalence of PDDE was primarily observed bilaterally in the maxillary anterior teeth. Extremely preterm infants showed significantly delayed tooth eruption, suggesting that the influence of gestational age on dental development rates. Identifying the factors related to DDE in premature children can inform early dental interventions to support the oral health of high-risk children.