Enamel Opacities Research Articles

Influencia de diferentes opacidades y la técnica de estratificación de resinas compuestas de nanotecnología en la longitud de onda e intensidad de fluorescencia: estudio in vitro

Objective: To evaluate the influence of opacity and the layering technique on the fluorescence of different composite resins. Materials and Methods: Two opacities (enamel and dentin) and the layering technique (enamel + dentin) of the composite resins: Filtek® Z350 and Palfique LX5 were evaluated in vitro. Composite resin discs were fabricated using a preformed matrix of 10 mm diameter and 0.5 mm thick for the single opacity groups and 10 mm thick for the layering technique groups, using 2 layers of 0.5 mm thickness of each opacity (n = 5). Specimens were analyzed using the Raman spectroscopy method. Data were analyzed using the Kruskall-wallis and Mann-Whitney U tests. Results: When evaluating the intensity of fluorescence, no statistically significant difference was found when comparing the layering technique and enamel opacity (p2> 0.05) and an increase in the dentin opacity value for both brands of composite resin. Regarding wavelength, no statistically significant difference was found when comparing the layering technique with enamel opacity and dentin opacity for both Filtek® Z350 and Palfique LX5® composite resins (p2 > 0.05). Conclusions: The fluorescence intensity of the layering technique is similar to enamel opacity for both composite resins. Likewise, the wavelength of the layering technique is similar to the enamel opacity and dentin opacity for both brands.

Enamel Hypoplasia – A Clinical Review

As a result of congenital and developmental systemic diseases, errors in the growing enamel organ result in enamel abnormalities such as enamel hypoplasia or opacities. The great occurrence of these flaws shows how susceptible teeth are to alterations in the prenatal and postnatal environment. Enamel hypoplasia contributes to dental caries and tooth wear on teeth because it makes the enamel thinner, more plaque-retentive, and less resistant to acid decomposition than normal enamel. This article explored enamel hypoplasia’s causes and clinical manifestations and presented strategies for managing damaged teeth.

Predictors of Developmental Defects of Enamel in Primary Maxillary Central Incisors Using Bayesian Model Selection

Introduction: Localized non-inheritable developmental defects of tooth enamel (DDE) are classified as enamel hypoplasia (EH), opacity (OP), and post-eruptive breakdown (PEB) using the enamel defects index. To better understand the etiology of DDE, we assessed the linkages amongst exposome variables for these defects during the specific time duration for enamel mineralization of the human primary maxillary central incisor enamel crowns. In general, these two teeth develop between 13 and 14 weeks in utero and 3–4 weeks’ postpartum of a full-term delivery, followed by tooth eruption at about 1 year of age. Methods: We utilized existing datasets for mother-child dyads that encompassed 12 weeks’ gestation through birth and early infancy, and child DDE outcomes from digital images of the erupted primary maxillary central incisor teeth. We applied a Bayesian modeling paradigm to assess the important predictors of EH, OP, and PEB. Results: The results of Gibbs variable selection showed a key set of predictors: mother’s prepregnancy body mass index (BMI); maternal serum concentrations of calcium and phosphorus at gestational week 28; child’s gestational age; and both mother’s and child’s functional vitamin D deficiency (FVDD). In this sample of healthy mothers and children, significant predictors for OP included the child having a gestational period >36 weeks and FVDD at birth, and for PEB included a mother’s prepregnancy BMI <21.5 and higher serum phosphorus concentration at week 28. Conclusion: In conclusion, our methodology and results provide a roadmap for assessing timely biomarker measures of exposures during specific tooth development to better understand the etiology of DDE for future prevention.

Proteomic Analyses Discern the Developmental Inclusion of Albumin in Pig Enamel: A New Model for Human Enamel Hypomineralization.

Excess albumin in enamel is a characteristic of the prevalent developmental dental defect known as chalky teeth or molar hypomineralization (MH). This study uses proteomic analyses of pig teeth to discern between developmental origin and post-eruptive contamination and to assess the similarity to hypomineralized human enamel. Here, the objective is to address the urgent need for an animal model to uncover the etiology of MH and to improve treatment. Porcine enamel is chalky and soft at eruption; yet, it hardens quickly to form a hard surface and then resembles human teeth with demarcated enamel opacities. Proteomic analyses of enamel from erupted teeth, serum, and saliva from pigs aged 4 (n = 3) and 8 weeks (n = 2) and human (n = 4) molars with demarcated enamel opacities show alpha-fetoprotein (AFP). AFP expression is limited to pre- and perinatal development and its presence in enamel indicates pre- or perinatal inclusion. In contrast, albumin is expressed after birth, indicating postnatal inclusion into enamel. Peptides were extracted from enamel and analyzed by nano-liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS) after tryptic digestion. The mean total protein number was 337 in the enamel of all teeth with 13 different unique tryptic peptides of porcine AFP in all enamel samples but none in saliva samples. Similarities in the composition, micro-hardness, and microstructure underscore the usefulness of the porcine model to uncover the MH etiology, cellular mechanisms of albumin inclusion, and treatment for demarcated opacities.

A Case Series of Resin Infiltration as Minimally Invasive Method for Treatment of Enamel Opacities

A Case Series of Resin Infiltration as Minimally Invasive Method for Treatment of Enamel Opacities

Repeated Etching Cycles of Resin Infiltration up to Nine Cycles on Demineralized Enamel: Surface Roughness and Esthetic Outcomes-In Vitro Study.

Resin infiltration (RI) is used to mask enamel opacities. There are three recommended etching cycles. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles. This study aimed to evaluate the effects of repeated etching cycles during RI application on esthetic changes and surface roughness of demineralized enamel at multiple treatment stages. Artificial demineralization was prepared on the buccal surface of ninety sound extracted premolars. The teeth were divided into nine groups (n = 10); with each consecutive group having one additional etching cycle up to nine etching cycles. Resin infiltrant was performed twice, first for 3 min (Resin 1) and again for 1 min (Resin 2). Surface roughness and esthetic changes were assessed using a profilometer (Ambios XP-200) and Minolta spectrophotometer, respectively, at baseline (sound enamel), etching, resin 1, resin 2, 7 days, and 28 days post resin applications. Data were analyzed with two-way ANOVA (p < 0.05). There was a significant interaction between the different stages and various groups of etching cycles on surface roughness, F(48, 126) = 3.48, p < 0.001. There was a significant interaction between the different stages and various groups of etching cycles on color changes, F(4, 126) = 1.177, p = 0.045. The surface roughness of demineralized enamel infiltrated with RI was less than that of sound enamel (baseline). There is a significant difference in color changes between resin 1 and resin 2 (p < 0.05). After five etching cycles, RI improved the esthetic of the color of teeth similar to the baseline. Surface roughness and color changes remained constant for 28 days. RI can be considered an effective and predictable treatment option for the restoration of early enamel lesions owing to its better surface characteristics and reliable masking effects. The color stability and surface roughness stay unaltered for up to 28 days.

Oral health-related quality of life and oral manifestations of Syrian children with congenital heart disease: a case-control study

BackgroundThere was an immense need for studies evaluating the oral health status of Syrian children with congenital heart disease (CHD) and its impact on their quality of life. No contemporary data are available. The objective of this study was to investigate oral manifestations and oral health-related quality of life (OHRQoL) of children with CHD and compare them with healthy controls aged 4–12 years.MethodsA case-control study was undertaken. A total of 200 patients with CHD and 100 healthy children belonging to the same patient’s family were included. Decayed, missed, and filled permanent teeth index (DMFT) and decayed, missed, and filled primary teeth index (dmft), Oral Hygiene Index (OHI), Papillary Marginal Gingivitis Index (PMGI), and dental abnormalities were recorded. The Arabic version of the Child Oral Health-Related Quality of Life Questionnaire (COHRQoL, 36-item) which was divided into 4 different domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, Social Well-Being) were studied. Chi-square test and independent- t-test were used to perform statistical analysis.ResultsCHD patients experienced more periodontitis, dental caries, poor oral health, and enamel defects. The dmft mean was significantly higher in CHD patients than in healthy children (5.245 vs. 2.660, P < 0.05). No significant difference was found between patients and controls in the DMFT Mean (P = 0.731). There was a significant difference between CHD patients and healthy children in the mean of the OHI (5.954 vs. 1.871, P < 0.05), and PMGI (1.689 vs. 1.170, P < 0.05). CHD patients have significantly higher enamel opacities (8% vs. 2%) and hypocalcification (10.5% vs. 2%) than controls. Also, the 4 COHRQoL domains, showed significant differences between CHD children and controls.ConclusionsEvidence about the oral health and COHRQoL of children with CHD was provided. Further preventive measures are still required to improve the health and quality of life of this vulnerable group of children.

Enamel Hypoplasia and Dental Fluorosis in Children With Special Healthcare Needs: An Epidemiological Study.

Background Children with cerebral palsy, intellectual difficulties, or hearing deficiencies may have enamel hypoplasia. Moreover, as the child begins to walk, the fluorosis progresses to bone malformations in the lower limbs, and it fully manifests as the child grows up. Methodology An epidemiological study was conducted to assess the prevalence of dental caries, oral hygiene status,enamel opacities, and oral hygiene habits among children 4-15 years of age from various schools for special healthcare needs including government schools and non-government organizations. Results The study sample comprised 1,047 children with special healthcare needs in the age group of 4-15 years, with 608 males and 439 females. It was seen that 29.79% of vegetarian children were affected with caries, while only 16.14% of children with a mixed diet were affected with caries. Conclusions There is no significant association between enamel hypoplasia and the physical and mental disabilities of children with special healthcare needs.

Assessment of early childhood caries using ICDAS and Snyder caries activity test among preschool children: a cross-sectional study.

The aim of the present study was to elucidate the correlation between the International Caries Detection and Assessment System (ICDAS) and the Snyder caries activity test (SCAT) for the assessment of early dental caries in preschool children. Dental health status of 153 children aged 3-5 years was evaluated by oral examination. The ICDAS stage (enamel opacity stage to cavitated dentine caries stage (stages 1-6)) was assigned based on the evaluation of each tooth surface by a trained dentist based on the number of decayed (d) and filled teeth (ft). In this study, scores of d3-6t (t, teeth), d3-6s (s, tooth surface), d3-6ft and d3-6fs were the cut-off points for enamel caries, set to ICDAS code 3 (d3). SCAT score was assigned based on the acid production level of lactic acid bacteria in plaque (scores: 1-4). Linear correlation analysis was used to determine the correlation between ICDAS and SCAT scores. The proportion of children for each of the dental caries status were as follows: d0, 46.4%; d1-2, 28.1%; d3-4, 9.8%; d5-6, 15.7%. Regarding SCAT scores, 30%, 30.1%, 26.8% and 12.4% children had no, mild, moderate and severe caries activity, respectively. The d3-6t, d3-6s, d3-6ft and d3-6fs indices increased with age and were 0.56, 0.82, 2.03 and 5.05, respectively. Children with a higher SCAT score had higher ICDAS scores (p < 0.05). Our findings suggest that a combination of ICDAS and SCAT scores is beneficial for diagnosing caries progression and highly active caries. Early childhood caries should be managed early to prevent the enamel opacity stage to progress to cavitation.

Molar Incisor Hypomineralization: Current Knowledge, Clinical Experience, and Perception among General Dental Practitioners, Pediatric Dentists, and Other Dental Specialists in Northern India – A Cross-sectional Study

Background: Molar incisor hypomineralization (MIH) is the hypomineralization of systemic origin of one to four permanent first molars, frequently associated with affected incisors. It is presented as demarcated enamel opacities of different colors, occasionally undergoing posteruptive breakdown. The characteristic feature of MIH is the clear demarcation between the affected and sound enamel. There is an asymmetry of defects present in the molars and incisors where one molar or incisor can be severely affected, while the contralateral tooth may be clinically sound or have only minor defects. Aim: The study aimed to assess and compare the knowledge, perceptions, and clinical experience of general dental practitioners (GDPs), pediatric dentists (PDs), and other dental specialists (DSs) in Northern India about MIH. Methodology: Online survey methods were used to collect the responses from Northern Indian dentists regarding their knowledge and perceptions about MIH. The survey tool focused on participants’ sociodemographics, clinical experience, perceptions, clinical management, and preferences for further training. The level of knowledge regarding MIH was compared among the three groups. Data analysis utilized Chi-square and one-way analysis of variance followed by Tukey’s post hoc test using SPSS Statistics version 26. Results: The majority of respondents had observed MIH in their practice (77.3%). The participants who had a postgraduate degree had a significantly higher knowledge score value than GDPs (P &lt; 0.001). Conclusion: Dissemination of evidence on MIH to dental practitioners, especially to GDPs, is highly needed to assure confidence in MIH diagnosis at an early stage when it can be best managed.

Relationship between preterm, low birth weight, and development defects of enamel in the primary dentition: A meta-analysis.

This study aimed to systematically analyze the relationship between preterm (PT), low birth weight (LBW), and developmental defects of enamel (DDE) in the primary dentition. Following the retrieval of the databases, case-control studies, cross-sectional studies, and cohort studies on the relationship between PT, LBW and DDE, which had been published in English or Chinese up to January 2022 were included. The data about odds ratio (OR) and 95% confidence interval (95% CI) were extracted and calculated using STATA 12.0 Software. Case-control studies were evaluated using the Newcastle-Ottawa Scale (NOS), while cross-sectional studies and cohort studies were evaluated using the JBI scale. The heterogeneity of each study was evaluated using the Q test. A total of 15 studies were included, of which 8 studied the relationship between PT and DDE, and 13 explored the relationship between LBW and DDE including three about the relationship between very low birth weight (VLBW) and DDE. Seven studies explored the relationship between PT, LBW, and DDE. The results of this meta-analysis showed that both PT and LBW especially VLBW (OR = 7.19, 95% CI: 4.98-10.38) were risk factors for DDE in the primary dentition (OR = 2.33, 95% CI: 1.55-3.51) (OR = 1.67, 95% CI: 1.08-2.59). The subgroup results showed that PT and LBW were both associated with the occurrence of enamel hypoplasia (EHP) (OR = 6.89, 95% CI: 3.33-14.34; OR = 2.78, 95% CI: 2.10-3.68) rather than enamel opacity (OR = 0.94, 95% CI: 0.55-1.61; OR = 1.03, 95% CI: 0.66-1.61). There was no publication bias about the included studies (P = 0.75 > 0.05; P = 0.47 > 0.05). This meta-analysis demonstrated that both PT and LBW especially VLBW are associated with a higher risk of DDE in the primary dentition. PT and LBW are both related to the occurrence of EHP. However, the relationship between PT, LBW, and enamel opacity has not been verified. https://www.crd.york.ac.uk/prospero/display_record.php?, identifier: CRD42021262761.

Evaluation of the Efficacy of CPP-ACP Remineralizing Mousse in MIH White and Yellow Opacities-In Vitro Vickers Microhardness Analysis.

Remineralization of tooth enamel can be partially achieved by the application of a casein phosphopeptides and amorphous phosphate (CPP-ACP) complex. However, evidence to support its effectiveness in Molar-incisor-hypomineralization (MIH)-affected teeth is scarce. The study’s aim is to evaluate the efficacy of CPP-ACP mousse in remineralizing MIH-affected enamel using a Vickers microhardness test. Two groups of enamel opacities of hypomineralized permanent teeth, white (group A) and yellow (group B) lesions (n = 14), went through a 28-day treatment protocol with GC Tooth Mousse. Before and after treatment, microhardness was measured in three different areas of each tooth (hypomineralized, transition, and outside the hypomineralized area). Data were analyzed using parametric and non-parametric tests with a significance of p < 0.05. The mean microhardness values increased in the hypomineralized and transition areas in both groups after the treatment protocol (in group A, 105.38 ± 11.70 to 158.26 ± 37.34; 123.04 ± 22.84 to 156.33 ± 35.70; in group B, 108.63 ± 14.66 to 143.06 ± 22.81; 132.55 ± 20.66 to 146.00 ± 12.88) and the differences pre/post-treatment were statistically significant within each group (p < 0.001 for both groups). Between groups, there was a statistically significant difference in the same areas (hypomineralized: p = 0.003; transition: p = 0.008) with a higher improvement in enamel hardness in group A. Topical application of CPP-ACP showed an increase in the physical strength of the hypomineralized and transition areas of MIH-affected enamel, likely due to an increase in mineral content.

The erosion/infiltration technique made by a polymer based on TEGDMA to mask the white lesions of the tooth

It is common to observe anterior teeth that present white opacities of enamel in relation to hypomineralization. These lesions alter social life of children and adults. There is a recent non-invasive treatment that can remove these stains without loss of substance, keeping tooth structure intact. This treatment modifies the optical properties of the white spot by infiltrating a polymer based on trimethylene glycol dimethacrylate (TEGDMA). This short article presents a method called erosion/ infiltration, which our team first described. Dentists must be aware of it, in order to treat patients with either fluorosis, MIH or trauma, so that much more invasive treatments such as veneers and crown can be avoided.

New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden.

This review highlights oral anomalies with major clinical impact in Addison disease (AD), including dental health and dermatologic features, through a dual perspective: pigmentation issues and AD comorbidities with oral manifestations. Affecting 92% of AD patients, cutaneomucosal hyperpigmentation is synchronous with or precedes general manifestations by up to a decade, underlying melanocytic infiltration of the basal epidermal layer; melanophages in the superficial dermis; and, rarely, acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis. Intraoral pigmentation might be the only sign of AD; thus, early recognition is mandatory, and biopsy is helpful in selected cases. The buccal area is the most affected location; other sites are palatine arches, lips, gums, and tongue. Pigmented oral lesions are patchy or diffuse; mostly asymptomatic; and occasionally accompanied by pain, itchiness, and burn-like lesions. Pigmented lingual patches are isolated or multiple, located on dorsal and lateral areas; fungiform pigmented papillae are also reported in AD individuals. Dermoscopy examination is particularly indicated for fungal etiology; yet, it is not routinely performed. AD’s comorbidity burden includes the cluster of autoimmune polyglandular syndrome (APS) type 1 underlying AIRE gene malfunction. Chronic cutaneomucosal candidiasis (CMC), including oral CMC, represents the first sign of APS1 in 70–80% of cases, displaying autoantibodies against interleukin (IL)-17A, IL-17F ± IL-22, and probably a high mucosal concentration of interferon (IFN)-γ. CMC is prone to systemic candidiasis, representing a procarcinogenic status due to Th17 cell anomalies. In APS1, the first cause of mortality is infections (24%), followed by oral and esophageal cancers (15%). Autoimmune hypoparathyroidism (HyP) is the earliest endocrine element in APS1; a combination of CMC by the age of 5 years and dental enamel hypoplasia (the most frequent dental complication of pediatric HyP) by the age of 15 is an indication for HyP assessment. Children with HyP might experience short dental roots, enamel opacities, hypodontia, and eruption dysfunctions. Copresence of APS-related type 1 diabetes mellitus (DM) enhances the risk of CMC, as well as periodontal disease (PD). Anemia-related mucosal pallor is related to DM, hypothyroidism, hypogonadism, corresponding gastroenterological diseases (Crohn’s disease also presents oral ulceration (OU), mucogingivitis, and a 2–3 times higher risk of PD; Biermer anemia might cause hyperpigmentation by itself), and rheumatologic diseases (lupus induces OU, honeycomb plaques, keratotic plaques, angular cheilitis, buccal petechial lesions, and PD). In more than half of the patients, associated vitiligo involves depigmentation of oral mucosa at different levels (palatal, gingival, alveolar, buccal mucosa, and lips). Celiac disease may manifest xerostomia, dry lips, OU, sialadenitis, recurrent aphthous stomatitis and dental enamel defects in children, a higher prevalence of caries and dentin sensitivity, and gingival bleeding. Oral pigmented lesions might provide a useful index of suspicion for AD in apparently healthy individuals, and thus an adrenocorticotropic hormone (ACTH) stimulation is useful. The spectrum of autoimmune AD comorbidities massively complicates the overall picture of oral manifestations.

Masking ability of resin composites: Effect of the layering strategy and substrate color.

To evaluate the effect of layering strategy and substrate color on the masking ability of resin composites. A1-shaded specimens from Charisma Diamond and Filtek Z350XT were produced using different layering strategies. Color measurements were made by a reflectance spectrophotometer over A2, C2, A3.5, C3, C4 substrates. Color differences were calculated and interpreted by the 50%:50% perceptibility and acceptability visual thresholds. Data was analyzed by Kruskal-Wallis and Dunn post hoc test. Chi-square test was used to determine the association between masking ability, and independent variables. Color differences were significantly lower on A2 and C2 in comparison with C4 for the majority of the layering strategies. Acceptable matches were observed on most of the combinations over A2. Moderately unacceptable mismatches were observed in most of the combinations over C2 and A3.5. Clearly unacceptable mismatches were observed on the C3 and C4. The ΔE00 color shifts were predominantly influenced by ΔL00 for all layering strategies and substrate colors. Masking ability was affected by the layering strategy and substrate color. Acceptable masking was associated with A2 and C2, and with layering strategy composed of 0.5 mm enamel opacity and 1.0 mm dentin opacity thicknesses, using the Filtek Z350XT. Resin composites-shade A1-applied by different layering strategies with a final thickness of 1.5 mm were able to mask mild and moderately discolored substrates. Severely discolored substrates were not masked effectively.

Making white spots disappear! Do minimally invasive treatments improve incisor opacities in children with molar-incisor hypomineralisation?

Children with molar-incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly, few studies have evaluated the clinical success of such interventions. To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH. This in vitro study used digital clinical images of 23 children aged 8-16years with MIH who underwent microabrasion and/or resin infiltration for the management of incisor opacities. Standard images were taken pre-treatment and 6months post-treatment. Image software (Image-Pro Plus® V7) was employed to convert 24-bit RGB images to 16-bit greyscale and 145× magnification. Measurement repeatability was assessed using intra-class correlation coefficients (ICCs). Post-treatment changes in visible opacity area (mm2 ) and brightness (greyscale value) were tested using the Wilcoxon signed-rank test for related samples. The mean total opacity surface area significantly reduced from 14.3mm2 (SD=7.5) to 9.4mm2 (SD=9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD=10.5) to 14.7% (SD=12.7). The mean maximum opacity brightness significantly reduced from 53066 greyscale value (SD=4740) to 49040 (SD=3796). ICC was good/excellent (0.75-1.0). Minimally invasive treatment is effective in reducing the size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes.

Microabrasion plus resin infiltration in masking white spot lesions.

Enamel opacities or white spot lesion is a result of enamel demineralization due to cariogenic activity or fluorosis, or enamel hypo-plastic/hypo-mineralized, which are an esthetic concern. A recent evidence base of dentistry has been focused on the Minimal Invasive Dental (MID) approach for treating such lesions. The aim of the study is to evaluate the esthetic improvement of white spots lesion using microabrasion and resin infiltration in upper permanent incisors, immediately and up to six months follow-up. For the present case with enamel opacities, the minimal invasive therapy resin infiltration was chosen, preceded by microabrasion technique, to improve the teeth aesthetic appearance of the affected teeth. An excellent improvement in 11 and 21 teeth esthetic. However, we still found good outcome in the enamel surfaces after six months follow-up, which became hard to detect, except in the near inspection. The patient was delighted with the well-defined enhancement in his esthetics smile and was mentioned no postoperative sensitivity immediately or in the recall evaluation. The resin infiltration showed significant teeth esthetic improvement immediately and good follow-up outcome for six months, preceded by microabrasion. More high-quality and long-term clinical studies are needed to verify durability and factors that may affect treatment quality.

Aesthetic dental challenges for the paediatric patient

Advancements in material science have contributed greatly towards aesthetic dentistry. However, achieving satisfactory aesthetics for children in the developing dentition poses unique challenges. Challenges include, but are not limited to: (1) patient co-operation; (2) optimum moisture control; (3) continuing gingival maturation and bone growth; and (4) the increased need for minimally invasive and non-irreversible techniques to maintain future treatment options. This article addresses the common paediatric dental aesthetic challenges of uncomplicated crown fractures (ie those confined to enamel and dentine), localized, discrete enamel opacities and intrinsic discolouration of anterior, root canal-treated teeth. Treatment techniques and helpful tips for the general dental practitioner are presented. CPD/Clinical Relevance: This article focuses on common dental aesthetic challenges that present in the paediatric dental population and suggests methods to manage this effectively in primary and secondary care.

The use of transillumination in mapping demarcated enamel opacities in anterior teeth: A cross-sectional study.

Despite intensive efforts for categorizing demarcated enamel opacities, often related to molar incisor hypomineralization (MIH), there is a lack of descriptive criteria aiming to describe them physically outside the scope of color and size. This is most likely due to the indices focusing on molar, not anterior, teeth. To map and classify demarcated lesions on permanent anterior teeth using reflected and transilluminated light. The association between classification and related lesion characteristics was also examined. Permanent anterior teeth with demarcated opacities related to MIH were selected. For each tooth, standardized photographs were taken using transmitted and reflected light. Each lesion was mapped and classified according to its color, lesion size, surface integrity, and type. The data were analyzed using the chi-square and Fisher's exact tests. A logistic regression analysis was performed to identify the risk of PEB. There were significant relationships between lesion size, color, and type with surface integrity. Lesion type and size were more important than lesion color for assessing the risk of PEB. There was also a significant relationship between lesion size and lesion color. Lesion size and type are significant clinical parameters for assessing the risk of PEB on enamel opacities related to MIH.

Differential diagnosis of developmental defects of enamel: a review

Introduction Developmental defects of enamel (D.D.E.) are a change resulting from any disturbance during tooth formation. They may manifest has quantitative defect, hypoplasia, presenting deficit of enamel thickness, or qualitative defect, hypomineralization, which expresses itself as diffuse or unmarked opacity of enamel [1,2]. Their approach and treatment imply a correct diagnosis, so it is essential to distinguish between them and know how to discern from other clinical entities. Materials and methods PubMed search with MeSH "enamel hypoplasia" and “differential diagnosis” with the limits: abstract available, humans and 2000-2019. After selecting 19 articles, other PubMed searches were made with: “molar incisor hypomineralization”, “dental fluorosis”, “amelogenesis imperfecta”, “white spot lesions”, “dental erosion” and “attrition”, combined with “differential diagnosis” and same limits. 49 articles were selected. The exclusion criteria were non-existent full-article and articles repeated. Results D.D.E. manifest in 3 forms either isolated or in combination: Demarcated opacity: white or discoloured area of enamel, well demarcated from the sound smooth enamel of normal thickness; Diffuse opacity: abnormality translucence of normal thickness enamel without defined margins that manifests as patchy, irregular or cloudy areas that follow the pattern of the perikymata; Hypoplasia: areas of reduced thickness of enamel that can take the form of pits, grooves until complete absence of it [1]. D.D.E. may affect one tooth, a set or all of them [3]. They may affect temporary or permanent teeth or both [2–6]. According D.D.E.’s manifestation and associated aetiology we can distinguish different clinical entities: hypoplasia [2,7–10]; diffuse opacity [7,9]; demarcated opacity [7]; fluorosis [2,8,11]; hypomineralization of 2nd primary molar [7,9]; molar-incisor hypomineralization [5,7–11]; amelogenesis imperfecta [5,7–10]; and D.D.E. associated with inherited systemic disorders [3,4,6]. The D.D.E. result as pre-eruptive lesion to the tooth [11]. Thus, if the lesion occurs post-eruptively, we should admit other clinical entities such as white spot lesion [2,7–9,11] or tooth wear (erosion or attrition) [12]. Discussion and conclusions D.D.E. exhibit different topographical forms and each call for specific therapeutic approach. Thus, its diagnosis is essential to establish the proper treatment. Furthermore, they may have a significant impact on oral health. They are risk factors of dental caries [1,4,6,8] and erosion [5,9]. They may alter occlusal functions [5], cause of hypersensitivity [5,6,8,9] and compromise aesthetics [5,6,9]. The patient’s cooperation may be impaired because of difficulties to anesthetize [8,9] and repeated adhesion failure of restorative materials [5,8].